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The Scoop: health insurance news – December 2, 2020

A round-up of state and national headlines regarding individual health insurance and health reform

In most of the United States, open enrollment for individual/family health plans is scheduled to end on December 15. | Image: Rawpixel / stock.adobe.com

Open enrollment ends in 13 days in most states

In most of the United States, open enrollment for individual/family health plans is scheduled to end in just 13 days – on December 15. If you haven’t yet figured out your health coverage for next year, now’s the time to get that done!

White House

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

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

There are four other states (Connecticut, Idaho, Maryland, and Vermont) that run their own enrollment platforms and thus have the option to extend open enrollment if they choose to do so, although it’s still scheduled to end on December 15 in each of those states. In the rest of the country, the federal government runs the exchange and has control over the timing of open enrollment, currently slated to end December 15.

Oregon’s bipartisan congressional delegation asks HHS to extend open enrollment

Oregon’s entire bipartisan congressional delegation sent a letter to HHS this week, asking the federal government to extend the open enrollment period on HealthCare.gov. Oregon, like most of the rest of the country, relies on the HealthCare.gov enrollment platform, which means the state is unable to extend the enrollment deadline on its own.

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

Washington Healthplanfinder accepting public comments on standardized plan designs for 2022

Washington State rolled out standardized plans in the individual market for the first time this fall. For the last month, some consumers in the state have been enrolling in these plans for 2021 coverage, but Washington’s exchange has already done much of the work to complete the standardized plan designs for 2022. They have publicized the draft plan designs, and are accepting public comments on the proposed plan designs through December 29. Comments can be emailed to standardplans@wahbexchange.org.

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

Delaware’s recently re-elected insurance commissioner, Trinidad Navarro, has imposed nearly $600,000 in fines for mental healthy parity violations by health insurers in the state. The Delaware Department of Insurance conducted a review of all four of the state’s major health insurers, checking for compliance with state and federal mental health parity requirements. (In general, the plan requirements and benefits provided for mental healthcare cannot be any more strict than the requirements and benefits that apply to other medical care.)

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

Proposed health insurance rule changes include waiver allowing states to eliminate exchanges

Last week, CMS published the proposed Notice of Benefit and Payment Parameters for 2022 (summary available here). Many aspects of the ACA were left up to HHS/CMS to implement and require ongoing adjustments, so CMS issues this rulemaking guidance each year. There’s a 30-day public comment period, and it appears that the Trump administration is hoping to finalize the proposed rules before the Biden administration takes over on January 20, 2021.

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

  • Allow states to eliminate their exchanges: This is generally considered the most dramatic change that CMS has proposed for 2022, and it’s very similar to the waiver approval that it granted to Georgia last month. If finalized, this rule change would allow states to eliminate their central exchange (HealthCare.gov or a state-run exchange) and switch to a system of direct enrollment via brokers, agents, and insurers. Many people already enroll in on-exchange plans via the enhanced direct enrollment pathway, utilizing a third party’s website instead of the exchange website. But there are widespread concerns that consumers will fall through the cracks in states that opt to abandon their exchange platforms altogether – potentially having to visit multiple websites in order to get comprehensive information, not being able to learn about their eligibility for programs like Medicaid and CHIP, or being sold lesser quality coverage, such as short-term health insurance.
  • Maximum out-of-pocket increasing to $9,100: Under the ACA, health plans that aren’t grandfathered or grandmothered (or excepted from ACA rules altogether) must cap in-network out-of-pocket costs for their enrollees. But this cap changes each year, under a formula that has evolved over time. This year, the maximum out-of-pocket for a single person was $8,150. Next year, it will be $8,550. And for 2022, CMS has proposed a maximum out-of-pocket limit of $9,100. (The family cap is always double the individual amount.) Many plans will continue to have lower out-of-pocket caps, although catastrophic plans have the maximum allowable out-of-pocket exposure, as do most bronze plans.
  • More flexible SEP for people who lose eligibility for premium subsidies: Under current rules, a person who is receiving a premium subsidy (premium tax credit) qualifies for a special enrollment period if they become ineligible for that premium subsidy mid-year (either due to an income change or a change in household size), but they’re limited to picking a different plan at the same metal level as the plan they already have. CMS is proposing a more flexible special enrollment period that would also allow the option of switching to a plan at a lower metal level in order to give people the opportunity to reduce their monthly premiums as much as possible. Here are all the details.
  • New SEP when employer terminates contributions to COBRA premiums: In some cases, employers subsidize the cost of COBRA benefits for a certain period of time – this has been particularly common this year amid the widespread layoffs that stemmed from the COVID pandemic. When that subsidy ends, the full cost of the COBRA coverage can be unaffordable, but there’s not technically a special enrollment period for this situation, as it’s not among the official triggering events. CMS notes that people enrolling through HealthCare.gov have been granted 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 nationwide, both on-exchange and off-exchange.
  • New affordability threshold for catastrophic plan eligibility: People who are 30 and older can only buy a catastrophic plan if they have a hardship/affordability exemption from the exchange, indicating that the lowest-cost metal-level plan available to them would cost more than a certain percentage of their income. In 2020, that threshold is 8.24 percent. For 2022, CMS has proposed an increase to 8.47 percent.
  • MLR rebates: Earlier this year, to address the COVID pandemic, CMS issued guidance that allowed insurance companies to issue medical loss ratio (MLR) rebates 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 rebates rather than waiting until the fall to issue them.

At Health Affairs, Katie Keith has three detailed articles about the proposed benefit and payment parameters: One addressing rules related to the health insurance exchanges, a second addressing the MLR rules, and a third addressing the rules related to risk adjustment.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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