On April 27, 2023, CMS published the 2024 Notice of Final Benefit and Payment Parameters and an accompanying fact sheet. The final rule is primarily directed at health insurers and the ACA marketplace but includes information that may indirectly impact group health plans.
Generally, the annual parameters update the ACA requirements and uniform standards for marketplace coverage. Among other items, the 2024 changes are designed to improve network adequacy (e.g., by requiring provider networks for marketplace coverage), encourage enrollment in plans with reduced cost-sharing for lower-income individuals and simplify the enrollment process.
Beginning in 2024, the final rule will allow federally facilitated exchanges to apply a special enrollment rule for individuals losing Medicaid or Children’s Health Insurance Program (CHIP) coverage due to eligibility redeterminations. Under the special rule, these individuals can choose an exchange plan 60 days before or 90 days after their loss of coverage. (Under current rules, the coverage loss must be reported within 60 days.) State-based exchanges can allow additional enrollment time and can implement the rule in 2023. To avoid potential gaps in coverage, exchanges may offer earlier coverage effective dates for those who attest in advance to a future loss of minimum essential coverage.
These marketplace special enrollment flexibilities may assist individuals who lose Medicaid or CHIP coverage in the coming months as the COVID-19 continuous enrollment policy ends and states return to normal eligibility requirements. Those losing coverage who are eligible for employer-sponsored group health coverage may also seek to exercise their HIPAA special enrollment right to enroll in the group health plan. Employers should be aware of the potential increase in employees losing Medicaid or CHIP coverage who may be seeking to enroll in the employer-sponsored group health plan or marketplace coverage.
Additionally, for federally facilitated exchange coverage, the final rule formalizes the policy of allowing children to stay on their parent’s coverage until the end of the year when they turn 26. (The ACA technically only requires such coverage until age 26, but the rule now prohibits mid-year terminations of the child’s coverage.) However, this policy is optional for state-based exchange coverage.
As a result of a policy change in 2023, the benefit and payment parameters no longer announce the permitted ACA plan annual cost-sharing limits. As a reminder, the 2024 limits, as specified in a prior CMS memo , are $9,450 for self-only coverage and $18,900 for family coverage. (The 2023 limits are $9,100 and $18,200.) These limits are distinct from the IRS out-of-pocket maximums applicable to HSA-compatible high deductible health plans.
Employers should be aware of the release of the final rule, which is effective June 18, 2023.
Final Rule » Fact Sheet »
PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.
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