6 policy changes coming to ACA marketplace plans in 2023

CMS plans to improve coverage and enrollment for ACA marketplace plans in 2023. Read up on the new standards and see how they might boost your business with clients.

The Centers for Medicare & Medicaid Services finalized requirements and standards for insurers, issuers, agents, brokers, and web-brokers of Affordable Care Act marketplace plans, aiming to improve quality of coverage and experience of enrolling for consumers.1

These standards will affect plans and rates in the 2023 plan year through six major policies.1

1. Advancing standardized plan options, which aims to standardize plan attributes such as deductibles, maximum out-of-pocket costs, and cost-sharing.1 As a result, the available coverage before deductibles would increase, and consumers will have the ability to more easily compare differing plans, helping them choose coverage that meets their needs.1

2. Implementing new network adequacy requirements, securing access to providers regarding both distance and availability, which will work to ensure consumers have reasonable access to the care they need.1

3. Increasing value of coverage for consumers by initiating updates to the benefits offered in metal coverage levels to get enrollees the most out of their coverage, ensuring more coverage at a reduced cost, and allowing them yet more ease in comparing plan coverage.1

4. Increasing access for consumers and removing barriers to coverage through updating and refining CMS’s nondiscrimination policy, formalizing that any limits to benefits must be based on clinical reasoning to be nondiscriminatory.1

5. Expanding access to essential community providers, requiring 35% of community providers in a plan’s service area to participate in its network, which will improve provider access for lower income and medically underserved communities.1

6. Further streamlining HealthCare.gov operations by establishing a set user fee for 2023’s federal and state marketplaces based on the 2022 user fee, ensuring funding will be available for essential functions like outreach, determining eligibility, and processing fees.1

These policies, developed to meet President Biden’s goal of strengthening ACA-offered plans, will make it easier for consumers to compare plans, access the care they need, and improve the quality of coverage offered to recipients.1

At JAR Insurance Services, we understand that to provide the best guidance to clients, agents need to have comprehensive information on the latest developments in the health insurance industry. We connect our agents with the most up-to-date and career-making resources needed to stay ahead of the competition, solidify their reputations as trusted health insurance authorities, and establish and strengthen their independent success. To work with partners who have your success at the top of their priority list, contact our agent support staff to see what you can do today to become a JAR agent.

1. Morse S. Final rule requires insurers to standardize plan options in the ACA marketplace. Healthcare Finance. April 28, 2022.