CMS has released a final rule setting standards for ACA health insurance marketplaces and insurers selling coverage through the health law’s exchanges in 2020.
Six things to know:
1. Fees. The user fee rate for plans sold on the federally facilitated exchanges decreases from 3.5 percent to 3 percent of premiums, according to CMS. The user fee rate for plans sold on state-based exchanges that used the federal platform decreases from 3 percent to 2.5 percent of premiums.
2. Navigator program. CMS will make changes regarding the duties and training requirements for navigators operating in federally facilitated exchanges. Twenty training topics will be integrated into four broad categories. The agency said it will also make certain types of assistance, including post-enrollment tasks, optional for these navigators.
3. Premium adjustment percentage. The premium adjustment percentage was finalized at 1.2895211380, according to CMS. This is a 28.9 percent increase in private individual and group market health insurance premiums compared to the period from 2013 to 2019.
4. Cost-sharing. For the 2020 benefit year, the maximum annual limitation on cost-sharing is $8,150 for self-only coverage and $16,300 for other coverage. That’s up from $7,900 for self-only coverage and $15,800 for other coverage in 2019.
5. Risk adjustment. Federal government officials revealed they approved Alabama’s request to reduce risk-adjustment transfers for the small group market by 50 percent for the 2020 benefit year.
6. Annual open-enrollment period. For benefit year 2020, the open-enrollment period for the individual marketplaces will begin Nov. 1, 2019.