Today, the Department of Health and Human Services (, through the Centers for Medicare & Medicaid Services (CMS), announced new measures that will allow consumers to lớn more easily find the right size of quality, affordable health care coverage on that best meets their needs. These measures set the landscape for the upcoming HealthCare.Gov mở cửa Enrollment Period, which will begin on November 1, 2022, & are part of the Biden-Harris Administration’s ongoing effort lớn strengthen & build on the Affordable Care Act (ACA).

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“The Affordable Care Act has successfully expanded coverage and provided hundreds of health plans for consumers to choose from,” said Health và Human Services Secretary Xavier Becerra. “By including new standardized plan options on, we are making it even easier for consumers to lớn compare unique and value across health care plans. The Biden-Harris Administration will continue to lớn ensure coverage is more accessible khổng lồ every American by building a more competitive, transparent, và affordable health care market.”

“The recent xuất hiện Enrollment Period demonstrated the demand for high-quality, affordable health coverage. These steps increase the value of health care coverage on HealthCare.Gov and further strengthen the health insurance Marketplace,” said CMS Administrator Chiquita Brooks-LaSure. “This policy will make it easier for people to lớn choose the best plan that meets their needs by standardizing plan options, lượt thích maximum out-of-pocket limitations, deductibles, & cost-sharing features.”

The 2023 Notice of Benefits & Payment Parameters Final Rule (final 2023 Payment Notice) makes regulatory changes in the individual and small group health insurance markets and establishes parameters & requirements issuers need to design plans & set rates for the 2023 plan year. The rule also includes regulatory standards lớn help states, the Marketplaces, and health insurance companies in the individual & small group markets better serve consumers. Major policies include the following:

Advancing Standardized Plan Options In accordance with President Biden’s Executive Order 14036 on Promoting Competition in the American Economy, the rule helps simplify the consumer shopping experience by establishing standardized plan options for issuers offering Qualified Health Plans (QHPs) on With standardized maximum out-of-pocket limitations, deductibles, and cost-sharing features, consumers will be able lớn more directly compare other important plan attributes, such as premiums, provider networks, prescription drug coverage, and chất lượng ratings when choosing a plan.

These standardized plan options expand the availability of coverage for services before consumers meet their deductibles, which will make it easier lớn access important services. They also include simpler cost-sharing structures that will allow consumers khổng lồ more easily understand their coverage. Issuers offering QHPs on will be required to lớn offer standardized plan options at every network type, at every metal cấp độ (Bronze, Silver, Gold, & Platinum), & throughout every service area where non-standardized options are offered starting in 2023. These plans will be differentially displayed on khổng lồ help consumers make more informed choices about their coverage.

Implementing New Network Adequacy RequirementsThe rule helps ensure that patients have access to lớn the right provider, at the right time, in an accessible location. The rule requires QHPs on the Federally-facilitated Marketplace (FFM) to ensure that certain classes of providers are available within required time & distance parameters. For example, a QHP on the FFM will be required to lớn ensure that its provider network includes a primary care provider within ten minutes và five miles for enrollees in a large metro county. The rule also sets a standard, starting in the 2024 plan year, requiring QHPs on lớn ensure that providers meet minimum appointment wait time standards. For example, QHPs will be required to lớn ensure that routine primary care appointments are available within 15 business days of an enrollee’s request. Additionally, will đánh giá additional specialties for time (i.e., the time it takes the enrollee khổng lồ get an appointment) and distance (i.e., the distance between the provider & enrollee) – including emergency medicine, outpatient clinical behavioral health, pediatric primary care, & urgent care. OB/GYN parameters will also be aligned with the parameters for primary care.

Increasing Value of Coverage for Consumers Under the rule, CMS is updating the allowable range in metal coverage levels for non-grandfathered individual và small group market plans. This change will likely require some plans to increase the generosity of their coverage, making it more comprehensive, và lower costs for many consumers. In addition, these changes will make it easier for consumers to lớn compare plans at the various coverage metal levels (Bronze, Silver, Gold, and Platinum) và distinguish between the plan offerings.

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Increasing Access for Consumers & Removing Barriers lớn CoverageThe final rule aims khổng lồ protect consumers from discriminatory practices related lớn the coverage of the essential health benefits (EHB) by refining the CMS nondiscrimination policy. Specifically, a benefit kiến thiết that limits coverage for an EHB on a basis protected from discrimination under this rule (such as age và health condition) must be clinically-based lớn be considered nondiscriminatory. The rule also updates unique Improvement Strategy Standards lớn require issuers lớn address health và health care disparities.

Expanding Access lớn Essential Community Providers Under the final rule, for Plan Year (PY) 2023 & beyond, CMS is increasing the Essential Community Provider (ECP) threshold from 20% khổng lồ 35% of available ECPs in each plan’s service area to participate in the plan’s provider network. The higher ECP threshold will increase access lớn a variety of providers for consumers who are low-income or medically underserved. CMS anticipates that most issuers will easilymeet the 35% threshold – for PY2021, 80% of the QHPs on the FFM already met this standard.

Further Streamlining OperationsThe rule sets the FFM và State-based Marketplaces on the Federal Platform (SBM-FPs) user fees for 2023 at the same màn chơi as 2022. Maintaining FFM and SBM-FPs user fees at the 2022 màn chơi will ensure adequate funding for essential Marketplace functions such as consumer outreach and education, eligibility determinations, và enrollment process activites. CMS finalizes two of the three proposed mã sản phẩm specification changes khổng lồ the risk adjustment models, improving risk prediction for the lowest & highest risk enrollees.

To view the final rule in its entirety, please visit:

To view the final rule Fact Sheet, visit:

To learn more about how standardized plans can support consumer decision-making & improve competition, please see the Assistant Secretary for Planning và Evaluation (ASPE) Issue Brief: