CMS to Lower Health Care Costs in 2022 Marketplace Plans

The Centers for Medicare & Medicaid Services (CMS) adopted new provisions to lower maximum out-of-pocket costs to consumers by $400, while increasing competition and improving the consumer experience for millions of Americans who will rely on the Federal Health Insurance Marketplaces in plan year 2022. 

The final rule includes several provisions to help consumers more easily distinguish between plan options and increase opportunities to qualify for future special enrollment periods (SEPs), when consumers are eligible to enroll in marketplace plans outside annual open enrollment. These SEP policies will offer greater flexibility for those who need coverage—particularly those communities hardest hit by COVID-19. 

"Families deserve to have access to health care coverage that doesn't break the bank. That's why today we're acting to lower consumers' maximum out-of-pocket costs by $400 and why President Biden has a plan to reduce families' health care costs for the long run," said HHS Secretary Xavier Becerra. "Health care access is personal to me as it is for families across the country."

The annual payment notice makes regulatory changes in the individual and small group health insurance markets, and outlines parameters and requirements issuers need to design plans and set rates for the upcoming plan year. The notice also includes regulatory standards to help states, the marketplaces, and insurance issuers in the individual and small-group markets better serve consumer needs.

This year, CMS is finalizing the payment notice in multiple phases. The first 2022 payment notice final rule was released in January 2021, as outlined in a fact sheet available at: https://www.cms.gov/newsroom/fact-sheets/notice-benefit-and-payment-parameters-2022-final-rule-fact-sheet. The second 2022 payment notice final rule, released today, continues CMS's trend toward stabilizing the insurance market, promoting program integrity, and reducing regulatory burden.

For consumers, the second phase of the 2022 payment notice expands options for accessing coverage. It also breaks down barriers—like high costs—that too often have put health care out of reach, particularly in underserved communities. The rule finalizes a maximum annual limitation on cost-sharing that is $400 below what CMS proposed in November 2020.

A number of other provisions will make it easier for consumers to comparison shop for plans, as well as improve support for the Federal Health Insurance Marketplaces, health insurance issuers, and other stakeholders who facilitate access to coverage. For further information on provisions in the second 2022 payment notice final rule, consult the fact sheet available at: https://www.cms.gov/newsroom/fact-sheets/notice-benefit-and-payment-parameters-2022-final-rule-part-two-fact-sheet