The Scoop: health insurance news – December 2, 2020

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Open registration ends in 13 days in most states

In most of the United States, open enrollment for individual / family health plans is expected to close in just 13 days – December 15. If you haven’t yet determined your health coverage for next year, now is the time to do so. !

An executive order signed by President Biden authorized a special COVID-related registration period on HealthCare.gov. The SEP will take place from February 15 to May 15.

In 10 states and Washington, DC, the end of open registrations has been extended, with deadlines that vary by state and continue through January in some cases.

There are four other states (Connecticut, Idaho, Maryland, and Vermont) that operate their own registration platforms and therefore have the option of extending open registration if they wish, although there are still plans to do so. end on December 15 in each of these states. In the rest of the country, the federal government manages the exchange and controls the open registration schedule, which is currently scheduled to end on December 15.

Oregon Biparty Congressional Delegation Calls on HHS to Expand Open Registration

Across Oregon A bipartisan delegation from Congress sent a letter to HHS this week, asking the federal government to extend the registration period open on HealthCare.gov. Oregon, like most of the rest of the country, relies on the HealthCare.gov registration platform, which means the state is unable to extend the registration deadline on its own.

Oregon lawmakers have pointed out that this year’s COVID pandemic and devastating wildfires in Oregon are making it harder for people to sign up for health coverage for 2021 in a timely manner. They are asking the HHS to give additional flexibility by giving people until the end of December – instead of December 15 – to sign up for a health plan for 2021.

Washington Healthplanfinder Accepts Public Comments on Standardized 2022 Plan Designs

Washington state rolled out standardized plans for the home market for the first time this fall. Over the past month, some consumers in the state have signed up for these plans for 2021 coverage, but the Washington exchange has already done much of the work to complete the standardized plan designs for 2022. They have delivered public draft plan designs and accept public comments on proposed plan designs until December 29. Comments can be emailed to [email protected]

Delaware fines insurers nearly $ 600,000 for violation of mental health parity

Delaware Newly re-elected Insurance Commissioner Trinidad Navarro has imposed nearly $ 600,000 in fines for violation of mental health parity by state health insurers. The Delaware Department of Insurance conducted a review of the state’s four major health insurers, verifying compliance with state and federal mental health parity requirements. (In general, the plan requirements and benefits provided for mental health care cannot be more stringent than the requirements and benefits that apply to other medical care.)

After finding “thousands” of violations, Delaware regulators worked with insurers to address the issues and create more equitable access to mental health coverage and care in the state.

Proposed changes to health insurance rules include waiver for states to eliminate trade

Last week CMS released the proposal Notice of benefits and payment parameters for 2022 (summary available here). Many aspects of ACA have been left to HHS / CMS to implement and require continuous adjustment, so CMS publishes these rulemaking guidelines annually. There is a 30-day public comment period, and it appears the Trump administration is hoping to finalize the proposed rules before the Biden administration takes over on January 20, 2021.

The service and payment parameters offered cover a wide range of issues, as is always the case. But the following are the things that are most likely to directly affect you and your health insurance coverage:

  • Allow States to suppress their exchanges: This is generally considered the most dramatic change CMS has proposed for 2022, and it is very similar to the waiver approval it granted to Georgia last month. If finalized, this rule change would allow states to eliminate their central stock exchange (HealthCare.gov or a state-run stock exchange) and move to a direct listing system through brokers, agents and insurers. Many people already enroll in exchange plans through the enhanced direct enrollment channel, using a third party website instead of the exchange website. But there are a lot of concerns that consumers are falling through the cracks in states that choose to abandon their trading platforms altogether – potentially having to visit multiple websites in order to get full information, not being in. able to find out their eligibility for programs like Medicaid and CHIP. , or the sale of lower quality coverage, such as short-term health insurance.
  • Maximum disbursement amount at $ 9,100: Under the ACA, non-grandfathered or grandmother health plans (or totally excluded from ACA rules) must cap out-of-pocket expenses for their enrollees. But this cap changes every year, according to a formula that has evolved over time. This year, the maximum amount payable for a single person was $ 8,150. Next year it will be $ 8,550. And for 2022, CMS has proposed a maximum disbursement limit of $ 9,100. (The family cap is always double the individual amount.) Many plans will continue to have lower spending limits, although catastrophic plans have the maximum direct exposure allowed, like most Bronze plans.
  • SEP more flexible for people who lose their eligibility for bonuses: Under the current rules, a person who receives a bonus subsidy (bonus tax credit) is entitled to a special enrollment period if they become ineligible for this bonus subsidy in the middle of the year (due to change in income or change in household size), but they are limited to choosing a different plan at the same level of metal as the plan they already have. CMS offers a special, more flexible enrollment period that would also allow switching to a plan at a lower metal level in order to give people the flexibility to lower their monthly premiums as much as possible. Here are all the details.
  • New SEP when the employer terminates contributions to COBRA premiums: In some cases, employers are subsidizing the cost of COBRA benefits for a period of time – this has been particularly common this year amid the widespread layoffs that have resulted from the COVID pandemic. At the end of this grant, the full cost of COBRA coverage may be unaffordable, but there is technically no special enrollment period for this situation, as it is not one of the official trigger events. CMS notes that people signing up through HealthCare.gov have obtained a Loss of Coverage SEP in this situation, but the proposed rule change would add this as an official qualifying event for individual market coverage, making it applicable to the entire market. nationwide, both on the stock market and over the counter.
  • New Affordability Threshold for Disaster Plan Eligibility: People 30 and older can only subscribe to a catastrophic plan if they have a hardship / affordability exemption from the exchange, indicating that the cheapest metal tier plan available to them would cost more of a certain percentage of their income. In 2020, this threshold is 8.24%. For 2022, CMS proposed an increase to 8.47 percent.
  • MLR Discounts: Earlier this year, to deal with the COVID pandemic, CMS issued guidelines allowing insurance companies to issue medical loss ratio (MLR) discounts earlier than usual. CMS is proposing a rule change that would essentially make this year’s relaxed rules permanent, allowing insurers the option to prepay MLR discounts rather than wait until fall to issue them.

At Health Affairs, Katie Keith has three in-depth articles on the proposed benefit and payment parameters: one on the rules related to health insurance swaps, a second on the MLR rules and a third on the rules related to the adjustment of health insurance. risks.


Louise Norris is an individual health insurance broker who has written on Medicare and health reform since 2006. She has written dozens of opinions and educational articles on the Affordable Care Act for healthinsurance. org. His updates on the state health exchange are regularly cited by media outlets covering health reform and other health insurance experts.


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