What’s changing about Affordable Care Act benefits in 2023?
If you follow the news, you know that federal governing constantly changes. What was done one way today could be done much differently tomorrow. That can also apply to Affordable Care Act (ACA) health plans, which the government sells on its federal marketplace.
So if you’re thinking about renewing your plan or buying an ACA plan for the first time, it’s good to know what’ll be different about plans in 2023. Some of the new rules may impact how you buy ACA plans and how you use your insurance in the new year.
Here are 5 important changes coming to ACA plans in 2023.
Need help choosing the right health plan? Call a licensed insurance agent at (800) 827-9990, or compare plans online today.
ACA plan change #1: Standardized plan options will help make shopping easier.
Not all changes have to make things more difficult for you, right? When you’re shopping for a health plan, you’ll want to consider several factors, including:
- Your cost-sharing amounts, whether that be coinsurance (a percentage of the total cost) or copayments (the amount you pay for each visit)
- Your plan’s monthly bill (premium)
- Your plan’s provider networks
- Your plan’s quality ratings
Unfortunately, apples-to-apples comparisons can be tough when you have dozens of plans to choose from. “In 2022, it’s not unusual for individuals to see 100 or more choices on healthcare.gov. In some large counties, you have 200-plus choices,” says David Anderson. He’s a research associate with the Duke Margolis Center for Health Policy at Duke University.
As of 2022, nine state-based marketplaces help make comparison shopping easier by including standardized plans that offer the same basic features at each metal level. (The metal categories of ACA plans reflect the percentage of your average in-network medical costs that will be covered: For bronze, it’s 60%; for silver, it’s 70%; for gold, it’s 80%; and for platinum, it’s 90%.)
So every standardized bronze plan in a given market has the same deductible and the same coinsurance and copay amounts, for example. This lets you focus more easily on things such as your monthly bill and whether the plan has your doctors when comparing plans.
For the 2023 plan year, however, all insurance companies that sell plans on the federal marketplace will have to offer standardized plans. This means they’ll have to offer standardized plans for each service area, plan type (such as HMOs), and metal level (bronze, silver, gold and platinum) where they also offer non-standardized plans. And those standardized plans will be highlighted on the website to make shopping easier.
If you have standardized plans available, you may not need to comparison shop as much for your plans as you did in the past.
ACA plan change #2: Your plan will have to guarantee you reasonable access to providers.
Since the ACA was signed into law in 2010, insurance companies offering health plans have had to offer “adequate” provider networks. That means if you buy a plan, your health care network would have to be large enough to provide you with reasonable access to in-network health providers. Sounds sensible, right?
But the rules changed during the Trump administration, with federal oversight of the network adequacy standards shifting to the states, accreditation by private organizations or the issuer’s attestation. In short, what “adequate” meant was redefined.
Ultimately, the federal courts overturned the Trump administration’s switch. So federal oversight is returning for 2023, which may mean better enforcement of the adequacy network requirement. For example, if you’re in a large metro county in 2023, you must have access to an in-network primary care doctor within 10 minutes and 5 miles of your home. If you’re in a rural county, however, that standard is 40 minutes and 30 miles.
The rules will get even clearer in 2024, when appointment wait times take effect. Starting then, you must be able to get an appointment with a primary care doctor within 15 business days and an appointment with a specialist within 30 days.
Another great way to get access to the providers you want? Getting the health plan that works for you. Call a licensed insurance agent at (800) 827-9990, or visit find a plan online.
ACA plan change #3: If you live in a hard-to-reach area, you may have more health care options.
Just as you can expect reasonable access to health care providers, in 2023 a new rule will address what are known as essential community providers (ECPs). These are providers that focus on low-income and medically underserved individuals. Think: inner-city community health centers, Ryan White HIV/AIDS Program providers, and Indian Health Service facilities.
Historically, qualified health plans had to contract with at least 20% of the ECPs in their service areas. As of 2023, that number increases to 35%. However, the new rule may have a limited effect, since 80% of plans on the federal marketplace met the higher standard as of 2021. “Most of the time, it won’t be all that hard for an insurer to have the majority of the ECPs in their region in network,” says Anderson. “It’s mainly an attempt to police the worst behavior.”
ACA plan change #4: Your health plan may have to be a little more generous.
The ACA metal categories — bronze, silver, gold and platinum — have everything to do with the percentage of what you’ll pay. For example, bronze plans generally cost the least on a monthly basis, but you’ll have to pay more when you need care. The opposite is true of platinum plans. Since these percentages are hard targets to hit precisely, insurance companies have some leeway. In other words, a plan could qualify for silver status if it covers between 66% and 72% of average costs.
Starting in 2023, insurance companies will have a little less wiggle room. Plans at each metal level must fall within plus or minus 2 percentage points of the target. Plans that fall short of that mark will have to offer you better benefits.
It’s good to remember that your monthly insurance bill can still go up. And Anderson isn’t sure whether an additional 2% will matter one way or the other, especially when insurance bills can reach hundreds of dollars. But it’s something, right?
ACA plan change #5: You won’t be denied coverage for old bills that are past due.
Previously, an insurance company could decline coverage if you owed them monthly bills that were past due. You would’ve had to pay them along with your first bill for the new plan year.
That will no longer be the case, although past-due bills can still be referred to a collection agency. The idea is that denying you coverage goes against what the ACA stands for in the first place: guaranteed health benefits. That’ll give you added protection that you didn’t have before.
With ACA open enrollment in effect , now’s the best time to start thinking about what your health plan will look like next year. To get a jump on things, call a licensed insurance agent at (800) 827-9990, or start shopping for a plan online today.