Potential legislative impacts give priority to education and support
Fast facts: Three Congressional impacts to Plan Year 2023
- Impending expiration of the America Rescue Plan Act (ARPA) and subsidies, enacted to give Americans temporary COVID-19 pandemic relief, could impact millions of consumers. Congress is considering an extension of the expanded subsidies as a permanent decision. However, if Congress does not extend the subsidies, premiums for the subsidized could rise by 53%.
- Shopping experience will be simplified on Healthcare.gov due to President Biden’s Executive Order 14036. Issuers will be required to offer standardized plan options at every network type and tier level. Plans will be displayed differently than they have in past years, which will allow consumers to compare costs, plan attributes, and quality ratings.
- New Network Adequacy Requirements will be implemented. The intent of the rule is to help ensure that patients will have access to the right provider in an accessible location by requiring Qualified Health Plans to provide care within required parameters, including distance.
- Value of coverage for consumers is expected to increase. The Centers for Medicare & Medicaid Services (CMS) will update the allowable range in coverage levels, which will likely require some plans to increase coverage by making plans more comprehensive with lower costs. Consumers will find it easier to compare plans and distinguish between offerings.
- Increase in Essential Community Provider (ECP) threshold. CMS will increase the threshold of available ECPs in each plan service area to participate in the plans’ provider network. Consumers who are low-income or medically underserved will have increased access to a variety of providers.