What Are the Major Changes to OEP This Year?
According to a report from Kaiser Family Foundation( KFF), a non-profit organization that studies national health concerns, there are 58.6 million Medicare and Medicare Advantage beneficiaries in the United States. In addition, according to a recent press release from the U.S. Department of Health & Human Services (HHS), since the 2023 Marketplace OEP began on November 1st, nearly 3.4 million people across the country have chosen a health plan through the Affordable Care Act (ACA) Marketplace.
Millions of eligible Americans are already choosing which coverage alternatives will make the most sense for them in 2023 as the Open Enrollment Period for 2023 has launched.
You should know the following changes to help your clients get the best value when choosing coverage during OEP.
1. Changes to Plan Choices and Premiums Due to the Inflation Reduction Act
The Inflation Reduction Act will help people with Medicare save money by making it easier for them to get treatments that aren’t too expensive and by making Medicare stronger. Here’s what you need to know about the law:
- As a result of the Inflation Reduction Act, starting January 1st, 2023, plans can’t charge you more than $35 for a one-month supply of each Medicare Part D-covered insulin you take, and they can’t make you pay a deductible for insulin.
- Medicare will be able to negotiate with drug companies about the price of some expensive brand-name Medicare Part B and Part D drugs that don’t have any competition for the first time.
- The Advisory Committee on Immunization Practices has recommended that patients with Medicare Part D prescription coverage receive all immunizations, including the shingles vaccine, at no additional cost beginning in 2023.
Review all the Inflation Reduction Act changes when comparing 2023 plan options.
2. Changes Due to ARPA Implementation
A KFF report says that the American Rescue Plan Act (ARPA) expanded and improved premium subsidies for health insurance, Medicaid, the Children’s Health Insurance Program (CHIP), and other types of coverage available through the ACA marketplace. These subsidies started in 2021 and will be in place until 2022. The Inflation Reduction Act (IRA) ensures that the ARPA’s subsidies will continue for three more years until 2025. Here are some changes due to ARPA:
- The standard premiums on the ACA Marketplace are going up by an average of 4% in all 50 states and D.C.
- New standards will assess family coverage affordability based on the worker’s part of the premium in 2023. If that amount exceeds 9.12% of household income in 2023, family members can obtain health insurance through the Marketplace and qualify for income-based premium tax credits.
- Insurance providers can no longer refuse to renew coverage for people who fall behind on premium payments. Members can buy Marketplace health insurance and may qualify for tax credits.
- For 2023, HealthCare.gov will only need pre-enrollment verification during Special Enrollment Periods (SEPs) if they’ve lost their current coverage. During their SEP, people can self-certify their eligibility and enroll in coverage for additional eligible events like marriage, divorce, permanent move, etc.
3. Changes to ACA Enrollment Dates
On November 1st, 2022, states across the country began accepting applications for health insurance coverage in 2023. (There are a few notable exceptions, like Idaho, which starts on October 15th, and New York, which starts on November 16th). Current policyholders in California could start the renewal process on October 1st, and Open Enrollment started on November 1st.
Most states’ Open Enrollment Periods for coverage in 2023 will end on January 15th, 2023. The deadline for enrolling in a plan with a January 1st effective date is typically December 15th; enrollments completed in the second part of December or the first half of January have an effective date of February 1st.
But more exceptions stand out:
- In the states of New Jersey, Maryland, California, and Nevada, coverage can start on January 1st as long as the application is sent in by December 31st.
- In Massachusetts, Rhode Island, and New Mexico, the cut-off date for a January 1st start date is December 23rd.
When the Biden administration took over, it extended Open Enrollment until January 15th, 2022, an extra month. This change will happen for the plan year of 2022 and will continue indefinitely or until the law is changed. The HealthCare.gov service affects the 33 states that have adopted it. The other 18 states and the District of Columbia can decide if they want to follow that schedule or set one of their own.
4. Changes in Medicare Advantage Plans
The Kaiser Foundation published its Medicare Advantage 2023 Spotlight and detailed these changes:
- In 2023, the average Medicare recipient will have 43 Medicare Advantage plans to choose from, which is more than in previous years.
- In 2023, most big insurance companies will offer Medicare Advantage plans in more counties than in 2022.
- In 2023, more Medicare Advantage plans for individuals will include coverage for prescription drugs (MA-PDs) that don’t cost extra (other than the Part B premium).
- Medicare Advantage plans will see a boost in supplementary benefits, including such as transportation to and from medical visits, copayment assistance for prescription drugs, and credits for over-the-counter medicines.
Maximize Efficiency for OEP 2023
The process of buying a plan on Healthcare.gov or a state exchange will be similar to past years. You can help your clients get ready to choose the best coverage by explaining their coverage options, including the plan changes listed above. Use Claro Agent Resource Center to stay organized and maximize efficiency during the OEP for 2023.
