Out of Pocket Maximums Could be Increasing Soon

Recently, the Department of Health and Human Services (HHS) published its proposed Notice of Benefit and Payment Parameters for 2020. This proposed rule describes benefit and payment parameters under the Affordable Care Act (ACA) that would be applicable for the 2020 benefit year. Proposed standards included in the rule relate to:

  • Annual limitations on cost-sharing
  • The individual mandate’s affordability exemption
  • Direct enrollment in the Exchanges
  • Special enrollment periods in the Exchanges

HHS is also seeking comments on other issues, like “silver loading,” automatic re-enrollment through the Exchanges, and any measures that would potentially reduce eligibility errors and government misspending.

Proposed Changes

The out-of-pocket maximum (OOPM) and the ACA’s affordability exemption threshold would both increase with the new rule.

  • OOPM: $8,200 for self-only coverage and $16,400 for family coverage in 2020
  • Affordability threshold: 8.39 percent of household income

The proposed rule would also expand opportunities for individuals to directly enroll in Exchange coverage by enrolling through the websites of certain third parties rather than through HealthCare.gov.