Changes In Health Insurance Rules For 2022: A Roundup

Every year, the HHS or the Department of Health and Human Services and the Department of Treasury come up with a finalized version of different rules and regulations concerning the implementation of the ACA or the Affordable Care Act and the health insurance marketplaces. The rules and regulations for the Affordable Care Act and the health insurance marketplaces are updated with the help of the NBPP or the Notice of Benefit and Payment Parameters. Generally, rule changes apply for the year concerned and the future years too. There have been some significant changes for the year 2022. However, a few changes in the 2022 version of the NBPP would apply before 2022. Here is a roundup.

Changes in ACA Marketplaces For 2022

The finalized version of the NBPP in September 2021 reversed a few changes introduced in the early half of 2021. Along with that, it also has some new rules. However, a few aspects of the initial version of the NBPP areas it is. The Joe Biden administration had issued other rules in April 2021, which they finalized later on.

The Notice of Benefit and Payment Parameters also addresses various actuarial issues. The regulations play a crucial role in how the insurers design their products and set prices for them. Now, here are the details.

The Maximum Out-of-Pocket Limit is $8700

As per the health coverage for 2022, the maximum out-of-pocket limit for a single individual has been set at $8700. For a family, the limit is around $17,400. Although the limits apply to a majority of the health plans, they do not apply to fixed indemnity plans and short-term health plans.

The same goes for Medicare Part A and Medicare Part B. The initial cap amount for 2022 was around $9100 (single individual) and $18,200 (family). The methodology used to calculate the maximum-out-pocket limit changed in 2020, resulting in a higher out-of-pocket limit. The public had negative opinions about the proposal for a rule change. That compelled the HHS and the Treasury Department to revert the methodology that was in place before 2020.

As a result, the maximum out-of-pocket cap for 2022 is $400 lower than the normal benchmark. In 2022, there will be several health plans that would have limits below $8700 for an individual. The list of these health plans will comprise individual or family health plans and employer-sponsored health plans.

People who are eligible for CSR or cost-sharing reductions will enjoy lower maximum out-of-pocket limits. An applicant can be eligible for CSR benefits if their income doesn’t exceed 250% of the poverty level and they choose a silver plan in the health exchange.

Extension of Open Enrollment Window

There is an extension in the open enrollment window for individual and family health plans in states that use HealthCare.gov through January 15, 2022. However, to avail coverage effective from January 1, 2022, enrollments must be completed by December 15, 2021. Applications forwarded between December 16, 2021, and January 15, 2022, will be effective from February 1.

In the case of coverage for 2018, 2018, 2020, and 2021, the open enrollment window for states using HealthCare.gov was from November 1 to December 15. In the case of coverage for 2022 and the subsequent years, the enrollment window is from November 1 to January 15. For 2022 coverage, 33 states are using HealthCare.gov as their marketplace. DC and 17 other states have exchange platforms.

Enrollment Window All the Year Round for Low-Income Applicants

There is a provision in the NBPP 2022 that gives an enrollment opportunity to low-income applicants all year round. For an individual signing up for 2022 coverage, the income should be around $19,320. The household income should not be more than $39,750.

People having earnings up to 150% of the poverty level can enroll anytime in 2022. However, this applies only if they are not availing of Medicaid, an employer-sponsored plan, or Medicare Part-A. However, this facility might not be available or accessible a year from now, i.e., from 2022.

Changing the health insurance rules for 2022 was a bit complicated procedure for the authorities. There have been plenty of changes that have been favorable for the healthcare industry consumers. Also, steps changes that would have negative impacts on the consumers have been retracted. While the changes seem to favor the common people and provide better healthcare cover, it is still too early to take a call. However, we will have to wait and see whether the changes positively impact the entire industry and the people.