Affordable Care Act Requirements for 2022-2023

Health insurance is one of the most critical decisions an employer or employee can make — but 56% of employees spend less than 30 minutes evaluating benefits. And 93% of workers simply choose to keep their plan — even when better options might be available in the marketplace.

Annual changes to the federal health insurance marketplace, coupled with Affordable Care Act (ACA) requirements, are meant to help both employees and employers get more fair coverage. And employers play a critical role in assisting employees in finding better and more affordable options.

But before you can jump in, it helps to know the new changes. Here is what we know about Open Enrollment for the 2022-2023 period.

When is Affordable Care Act Open Enrollment for 2022-2023?

Open Enrollment for 2023 begins on November 1, 2022, and ends on January 15, 2023. Some states have exceptions, based on their 2021-2022 period, including:

• California — November 1-January 31
• Idaho — November 1-December 22
• Kentucky — November 1-January 31
• Maryland — November 1-February 28
• Massachusets — November 1-January 23
• New Jersey — November 1-January 31
• New York — November 16-March 31
• Rhode Island — November 1-January 31
• Washington DC — November 1-January 31

It is always important to review your state’s regulations and ensure there is not a special enrollment period before creating your compliance deadline calendar.

Affordable Care Act coverage requirements for employers

Does your healthcare coverage comply with ACA requirements? Here are key items to check:

• Check your grandfathered group health plan to ensure it hasn’t lost its status. Health plans that undergo significant changes can lose their grandfathered status. And since plans that are considered “grandfathered in” were applicable starting on March 23, 2010, it’s likely that some change has occurred. If so, you will need to confirm that the recent plan design meets ACA requirements.
• Confirm waiting periods aren’t longer than 90 days. The waiting period in regard to health insurance is how many days it takes for coverage to apply to the employee or their dependents.
• Essential health benefits should not have a dollar limit.
• No pre-existing condition limitation should be enforced.
• You should not have another employer payment plan, with a few HRA exceptions.
• Notify new employees about the insurance marketplace. All new hires should receive a written notice about the Health Insurance Marketplace within 14 days of starting the job.
• Applicable large employers (ALE) should review their status and plans to ensure their full-time employees, at a minimum, are receiving affordable healthcare options. One way to calculate affordability is to calculate a plan’s minimum value. Generally, a healthcare plan can be said to have a minimum value if it covers 60% of healthcare expenses and offers sufficient inpatient and outpatient support. This minimum value calculator can help you determine whether your plan meets this threshold.
• Report the cost of healthcare coverage for each employee on their W-2.
• Add additional Medicare tax of 0.9% on wages or compensation for high earners.
• Distribute Medical Loss Ratio (MLR) rebates, if applicable.
• File Patient-Centered Outcomes Research Institute (PCORI) fees, if applicable.
• Confirm complaint with non-discrimination requirements, if applicable.

Changes to the ACA Health Insurance Marketplace for 2023

In April 2022, the Department of Health and Human Services (HHS) released its Notice of Benefit and Payment Parameters for 2023 Final Rule to the Centers for Medicare & Medicaid Services (CMS). What that means, in reality, is that the HHS and CMS are finalizing the marketplace environment for 2023.

Some of the changes employers can expect to see in regard to the healthcare coverage marketplace include:

More standardized plan offerings

If a health insurance organization offers a non-standardized gold health maintenance organization (HMO) qualified plan in a certain service area, they must also provide access to a standardized plan in the same region.

Compliance reviews

Beginning in 2023, CMS will review all qualified health plans (QHP) for compliance with network adequacy standards in order to improve accessibility. In 2024, these plans will also be evaluated for wait times.

Narrowed de minimis ranges

All plans are subject to some value adjustments since health coverage is largely based on estimates of health benefit costs. Since these ranges are narrowing, participants can potentially expect increased premium tax credits.

Refined Essential Health (EHB) Nondiscrimination Policy Guidelines

Clinical evidence should govern health coverage limitations. Therefore, the HHS has updated the requirements to prevent health benefits from being limited due to a participant’s age, expected length of life, current disability, potential future disability, medical dependency, quality of life, or health conditions.

Changes to the Special Enrollment Period (SEP) Verification

Starting in the 2023 Open Enrollment period, the only SEP verification that will remain will be for the SEP for loss of minimum essential coverage. This type of SEP is the majority for all healthcare coverage enrollments in the marketplace on the federal level.

State marketplaces will report to the federal level

State-based marketplaces will now be asked to report directly to the HHS to prevent excess advanced payments for tax credits. This issue occurs when an employee enrolls in a plan but does not get coverage for the full month.

More transparent plan filtering

The CMS has also asked its brokers to create a clear filtering system for plans. For example, a consumer should be able to filter health insurance plans by cost, alphabetically by plan name, and other intuitive markers.

No more preferred advertising

Online brokers can no longer give qualified health plan advertisements and preferred website placements in exchange for compensation.

So, what does all this mean for you and your business?

It’s important to give your employees plenty of time and reminders before the deadline.

Essentially, the setup for choosing marketplace plans may change this year. New ways to search through plans and changes to premium tax credits can all affect how quickly an employee selects their desired healthcare plan. Therefore, giving your employees plenty of time and reminders before the deadline is important.

How employers can stay on top of compliance

We know HR managers and business owners have a lot on their plate. That’s why we’ve crafted a number of guides, checklists, and templates to help you keep compliance on track.

Here are just a few of our top free guides:

• ACA Compliance Guide
• Remote Work Compliance Tips
• Benefits Benchmarks Report