The health insurance market in the USA is constantly evolving. Stay informed with this quick guide to the recent changes in 2022 and 2023 that impact your coverage and choices.
1. The number and percentage of Americans lacking health insurance is falling to historic lows
According to a report by the Commonwealth Fund, the number of uninsured Americans dropped from 43.4 million in 2018 to 35.7 million in 2020, a decrease of 17.7 percent. The percentage of uninsured Americans also fell from 14.8 percent in 2018 to 12.2 percent in 2020, the lowest level since the implementation of the Affordable Care Act (ACA) in 2014. The report attributes this decline to policy changes aimed at helping people get and stay covered during the COVID-19 pandemic, such as the expansion of Medicaid eligibility in several states, the extension of the special enrollment period for HealthCare.gov, and the increase of premium subsidies under the American Rescue Plan Act (ARPA).1
Learn More Here: The State of U.S. Health Insurance in 2022 – Commonwealth Fund
2. The Biden administration announced new measures to make coverage more accessible and affordable for millions of Americans in 2023
On April 28, 2022, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced new measures that will allow consumers to more easily find the right form of quality, affordable health care coverage on HealthCare.gov that best meets their needs. These measures include establishing standardized plan options for issuers offering Qualified Health Plans (QHPs) on HealthCare.gov, simplifying the consumer shopping experience by standardizing maximum out-of-pocket limitations, deductibles, and cost-sharing features, enhancing consumer assistance and outreach activities by increasing funding for navigators and other assisters, and improving data collection and reporting on health disparities and social determinants of health.2
Learn More Here: HHS Announces New Policy to Make Coverage More Accessible and Affordable for Millions of Americans in 2023 | HHS.gov
3. The maximum out-of-pocket cap for ACA-compliant plans increased slightly for 2022 and 2023
The maximum out-of-pocket cap is the most that a person has to pay for covered services in a year under an ACA-compliant plan. This cap includes deductibles, copayments, and coinsurance, but not premiums or services that are not covered by the plan. For 2022, the maximum out-of-pocket cap is $8,700 for an individual and $17,400 for a family. For 2023, the cap is $9,000 for an individual and $18,000 for a family. These amounts are slightly higher than the previous years, reflecting an annual adjustment based on the premium adjustment percentage.3
Learn More Here: Health Insurance Rule Changes That Took Effect in 2022 and 2023
4. The open enrollment window for HealthCare.gov was extended for both 2022 and 2023
The open enrollment window is the period when people can sign up for a new health insurance plan or change their existing plan on HealthCare.gov. For 2022, the open enrollment window was extended from November 1, 2021 to January 15, 2022, giving consumers an extra month to enroll or switch plans. For 2023, the open enrollment window will be even longer, running from November 1, 2022 to January 31, 2023. This extension is intended to give consumers more time and flexibility to compare plans and find the best option for their needs.3
Learn More Here: Health Insurance Rule Changes That Took Effect in 2022 and 2023
5. A year-round enrollment window was created for low-income applicants who qualify for premium-free plans
Under the ARPA, which was enacted in March 2021, more people became eligible for premium subsidies on HealthCare.gov, including those with incomes above 400 percent of the federal poverty level (FPL) and those who received unemployment compensation in 2021. As a result, many people with incomes below or slightly above 150 percent of the FPL can now qualify for premium-free plans on HealthCare.gov. To make it easier for these low-income applicants to enroll or switch plans at any time during the year, a year-round enrollment window was created for them starting from July 1, 2021. This means that they do not have to wait for the open enrollment window or a qualifying life event to sign up for a premium-free plan.3
6. A special enrollment period was created for people who received unemployment compensation in 2021
Under the ARPA, people who received or were approved to receive unemployment compensation for any week in 2021 are eligible for premium-free silver plans on HealthCare.gov, regardless of their actual income. To help these people enroll or switch plans, a special enrollment period was created for them from July 1, 2021 to December 31, 2021. This means that they can sign up for a premium-free silver plan at any time during this period, even if they already have another plan on HealthCare.gov.1
Learn More Here: Health Insurance Rule Changes That Took Effect in 2022 and 2023
7. The navigator duties and funding were expanded to improve consumer assistance and outreach
Navigators are organizations that receive federal grants to provide unbiased information and assistance to consumers who want to enroll in health insurance plans on HealthCare.gov. The final 2022 NBPP expanded the duties of navigators to include helping consumers with post-enrollment issues, such as filing appeals, applying for exemptions, and understanding their rights and responsibilities. The final 2022 NBPP also increased the funding for navigators from $10 million to $80 million for the 2022 plan year, and the final 2023 NBPP further increased it to $100 million for the 2023 plan year. These increases are expected to enhance the availability and quality of consumer assistance and outreach activities.12
Learn More Here: Health Insurance Rule Changes That Took Effect in 2022 and 2023, HHS Announces New Policy to Make Coverage More Accessible and Affordable for Millions of Americans in 2023 | HHS.gov
8. The separate billing requirements for abortion coverage were repealed to reduce administrative burden and confusion
Under the Trump administration, issuers that offered QHPs that covered non-Hyde abortion services (i.e., abortions that are not eligible for federal funding) were required to send separate bills and collect separate payments for the portion of the premium attributable to such services. This requirement was intended to ensure compliance with the statutory prohibition on federal funds being used for abortion services, but it also imposed significant administrative burden and confusion on issuers and consumers. The final 2022 NBPP repealed this requirement and restored the previous policy that allowed issuers to send a single bill and collect a single payment for QHPs that covered non-Hyde abortion services.1
Learn More Here: Health Insurance Rule Changes That Took Effect in 2022 and 2023
9. The option for states to eliminate the exchange was repealed to preserve consumer choice and protection
Under the Trump administration, states were given the option to eliminate the exchange in their state and instead rely on private entities, such as web brokers or insurers, to enroll consumers in QHPs. This option was supposed to increase flexibility and innovation for states, but it also raised concerns about consumer choice, protection, and access to financial assistance. The final 2022 NBPP repealed this option and reinstated the requirement that states must have an exchange that meets the federal standards and performs the core functions of an exchange.1
Learn More Here: Health Insurance Rule Changes That Took Effect in 2022 and 2023
10. The section 1332 waiver guardrails were made robust again to ensure coverage affordability and comprehensiveness
Section 1332 of the ACA allows states to apply for waivers from certain ACA requirements if they can demonstrate that their alternative approach would provide coverage that is at least as affordable, comprehensive, and accessible as the ACA coverage, and would not increase the federal deficit. These criteria are known as the guardrails of section 1332 waivers. Under the Trump administration, these guardrails were relaxed to allow states more leeway in designing their waivers, but this also increased the risk of undermining the ACA goals and consumer protections. The final 2022 NBPP restored the original interpretation of the guardrails that was established by the Obama administration, ensuring that section 1332 waivers would not reduce coverage quality or affordability for any group of consumers.1
