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The 2020 Draft Health Market Rules Are Here Now

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The Trump administration has released a 331-page draft document that could shape how the U.S. major medical insurance market will work in 2020.

(RelatedTrump’s CMS Posts Draft 2019 Health Insurance Rules)

The Centers for Medicare and Medicaid Services (CMS) has sketched out the shape of insurance things to come in a proposed set of Patient Protection and Affordable Care Act (PPACA) benefits and payment parameters for 2020.

CMS — an arm of the U.S. Department of Health and Human Services (HHS) — has also released other documents related to 2020 coverage, including a draft letter to 2020 plan issuers.

The documents could affect all people with commercial health coverage, but some provisions apply only to and its users. Refresher

Drafters of the Affordable Care Act, the statutory package that includes PPACA, created the ACA public exchange system in an effort to give people a way to shop for coverage on an apples-to-apples basis on the web, and to use federal premium tax credit subsidies to pay for the coverage.

Some states run their own ACA exchange programs.

HHS set up to provide ACA public exchange services in states that were unwilling or unable to provide all ACA exchange services themselves.

Web Brokers

CMS officials say they want to make it easier for web brokers to enroll consumers directly in plans, without sending the consumers to

But they have also indicated that they want to set some limits on how brokers operate. managers want to set a new requirement “that prohibits web-broker websites from displaying recommendations for [qualified health plans (QHPs)] based on compensation the web-broker, agent, or broker receives from QHP issuers,” officials say in the draft regulation preamble.

Special Enrollment Periods (SEPs)

Managers of the ACA public exchange system created the open enrollment period system, or limits on when people can buy coverage without meeting special qualifications, to scare healthy people into paying for coverage all year-round. The idea is to discourage healthy people from waiting until they get sick to pay for coverage.

HHS now wants to add a SEP aimed at people who are unable to qualify for premium subsidies because their income is too high and then buy coverage off-exchange. The proposed SEP would let those people apply to use exchange plan coverage, and ACA premium tax credit subsidies, if their income dropped enough to qualify for premium tax credit help.

2020 Open Enrollment Dates

Managers of intend to set the following deadlines.

June 19: 2020 plan applications due.

July 24: 2020 plan rates due.

Aug. 1: Proposed 2020 rate changes show up on web.

Aug. 21: 2020 plan applications locked in.

Nov. 1: Open enrollment begins. Fees

Some states rely on for all ACA exchange services.

Others, such as Nevada, have been using enrollment and account administration systems but manage their own marketing programs. managers want to cut the user fee plan issuers pay to 3% of premiums, from 3.5%, for issuers in the states in which handles all exchange services, and to 2.5%, from 3%, for issuers in “partnership” states.

Cost-Sharing and Affordability Limits

Here’s what could happen to some parameters that affect whether your clients have access to coverage considered “affordable,” and what out-of-pocket costs for an exchange plan user might look like.

Employer plan affordability cut-off: Self-only coverage will be considered affordable if it costs up to 8.39% of projected household income, up from 8.3% this year.

Maximum annual cost-sharing amount: The limit will increase to $8,200 for self-only coverage, from $7,900 this year, and to $16,400 for family coverage, up from $15,800.


A copy of the draft parameters is available here.

A draft copy of the letter to would-be plan issuers is available here.

The preamble to the draft regulations lists many contact people. The contact person for broker direct enrollment issues, for example, is Daniel Brow.

Comments on the draft will be due Feb. 19.

— Read ACA Definitions: Enrollment Period Basicson ThinkAdvisor.

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