2020's Proposed Notice of Benefit & Payment Parameters

A Stethoscope

Early this year, the Department of Health and Human Services (HHS) published its proposed Notice of Benefit and Payment Parameters for 2020. This proposed rule describes benefit and payment parameters under the Affordable Care Act (ACA) that would be applicable for the 2020 benefit year.

What’s included in the proposed rule for 2020?

Proposed standards included in the rule relate to:

  • Annual cost sharing limitations.

  • The individual mandate’s affordability exemption.

  • Direct enrollment in the Exchanges.

  • Special enrollment periods in the Exchanges.

Cost-Sharing Limitations

The ACA requires the out-of-pocket maximum to be updated annually based on the percent increase in average premiums per person for health insurance coverage. Under the proposed rule, the out-of-pocket maximum would increase for 2020 to $8,200 for self-only coverage and $16,400 for family coverage.

Affordability Exemption

Despite the repeal of the individual mandate taking effect in 2019, the proposed rule notes that individuals may still need to seek this exemption for 2019 and future years. Under the proposed rule, the required contribution percentage would increase in 2020 by 0.09 percent. The proposed rule provides that, for 2020, an individual would be exempt from the individual mandate penalty if he or she must pay more then 8.39 percent of his or her household income for minimum essential coverage.

Changes to Exchange Enrollment

The 2020 proposed rule would enhance direct enrollment through the Exchanges. Specifically, the proposed rule would expand opportunities for individuals to directly enroll in Exchanges coverage by enrolling through the websites of certain third parties — called direct enrollment entities — rather than through HealthCare.gov. The proposed rule would implement several changes intended to streamline the regulatory requirements applicable to these direct enrollment entities.

Additionally, the proposed rule would establish a new special enrollment period for off-Exchange enrollees who experience a decrease in household income and are determined to be eligible for the premium tax credit through the Exchange. This would allow enrollees to enroll in more affordable Exchange plans when their household income decreased mid-year.

For more information on the proposed rule, contact us today!