If you have a Health Insurance Marketplace Plan or are going to be shopping for one during open enrollment for 2023, you should review the proposed changes that are on the horizon.
Every year there are changes to the Affordable Care Act (ACA). These changes aim to improve policyholder experience and ensure that rules and regulations are easy to follow for both insurance companies and employers.
For next year, 2023, the Biden Administration has announced proposed changes hoping to allow policyholders more access to the medical care they need by designing the plans to be more robust and medically relevant. This will ensure that ACA enrollment is simple and efficient, allowing enrollment to be streamlined. Discriminatory benefit designs will be eliminated as part of the Administration’s efforts to strengthen insurance plans.
ACA Enrollment Streamlining and Refined Requirements
One of the Biden Administration’s most important goals with the upcoming 2023 ACA changes is a more streamlined approach to the Marketplace plans. There will hopefully be a standardized plan available in each tier option, making it easier to understand for the policyholder when making comparisons. Additionally, some brokers will have the option to compare plans side-by-side.
A critical change coming in 2023 is the implementation of a rating system. Policyholders that have had Marketplace plans in the past will be able to rate and review their plan and experience. The rating system allows potential policyholders to view other consumer experiences, allowing them to more easily decide which plan is best for them.
If a plan has not been rated yet, it will display as a new plan. Otherwise, each plan will be rated on a 5-star system, with one star being the worst. Allowing this comparative shopping option for policyholders is a huge step in ensuring their satisfaction.
The Centers for Medicare and Medicaid Services (CMS) have changed the requirements for 2023. As part of this, diabetes patients will be evaluated for kidney health; colorectal cancer screening will be refined to include those aged 45-to-49. A measure for initiation and engagement in alcohol and drug abuse and dependence treatment will be temporarily removed. Optional data reporting will be included, and stratified race and ethnicity data will be required to advance health equity.
A phased-in approach would collect racial and ethnic data on five specific measures, including colorectal cancer screening, high blood pressure, diabetes, and prenatal care. By 2024, plans must submit data directly collected from enrollees on race and ethnicity. Until then, plans could use both directly collected and imputed data.
Another goal by CMS is to discuss the possibility of updating the Qualified Health Plan (QHP) enrollee survey questionnaire in the longer term. For example, adding additional topics like obtaining mental health treatment and prescription access and making it a bit shorter.
Health Care Cost Adjustments
As with everything else currently, the Health Insurance Marketplace insurance premiums will increase in 2023. While you may see an increase as low as 5 percent or as high as 15 percent or more, the average increase will be around 10 percent.
Health Care Costs
The cost of health care continues to rise, pushing insurance companies to increase their premiums which are then passed onto the consumer. Hospitals, doctors, mental health care providers, and prescription drug companies have increased the cost of their care. At least 13 states so far have filed for rate increases, according to the Kaiser Family Foundation.
Some insurance companies are also attributing their price increases to the fallout of the COIVD-19 pandemic and the need to recoup the money they spent during its height. They also expect health care providers to continue to raise costs, so their price increases anticipate that as well. While COVID-19 did not cost insurers as much as they initially thought, it is still a small factor in the premium projections for 2023.
It is important to note that this is the first time in several years that the Health Insurance Marketplace plans have substantially increased. And even though the increase does seem to be averaging around 10 percent, some will see a smaller increase.
Accessible and Comprehensive Health Plans
In 2023, ACA insurance plans must be clinically based and not discriminate based on age, anticipated life expectancy, disability, medical dependency, quality of life, or other health conditions.
An expanded list of health care providers and facilities is included in the final rule, which adopts time and distance standards. In addition to emergency medicine, clinical behavioral health outpatient services, residential behavioral health facilities, and urgent care, other health care providers will be added. The standards for time, distance, and wait time will be determined at the county level based on the size of the population. We will have more details about these standards in the future.
Further, the changes address the problem of insurance plans not having a sufficient number of health care providers in their network. The issue with having a limited number of in-network health care providers is it can ultimately lead to either lack of care or higher out-of-pocket costs for the consumer. Additionally, mental health services continue to be hard to cover due to network availability. By increasing the availability of in-network health care providers, policyholders are more likely to enroll in a plan and not risk being uninsured.
Changes On The Horizon
All of the proposed changes for the ACA in 2023 are still pending. The official implementation of these changes will be announced before open enrollment begins on November 1.
ACA Subsidies 2023
We know the subsidies have been extended for the 2023 plan year, which will help millions of Americans afford a Health Insurance Marketplace plan, thanks to the Inflation Reduction Act. So, even though premiums will increase this year, those who qualified for a subsidy last year will still, in addition to others who apply.
The Biden Administration has always wanted to strengthen the Affordable Care Act by ensuring consumers have access to affordable, quality health care. The proposed changes for 2023 are a start to this, and we are hopeful that more beneficial changes will come in 2024.