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Health Insurance Marketplace Enrollment Made Easier for 2023

New rules issued by the U.S. Department of Health and Human Services (HHS) should make it easier for consumers to find health insurance on the Marketplace for 2023.

Creating New Standardized Plans

While insurance companies who offer plans on the Marketplace are required to offer standardized plans by network type (HMO, PPO, POS, and EPO) and metal level (Bronze, Silver, Gold, and Platinum), starting in 2023, they will also have to be based on standardized plans created by the Center for Medicare and Medicaid Services (CMS).

The new standardized plans will allow you to have a better idea of what the plan will include at the time you enroll and how much it will cost you. This change should make it easier to compare premiums, provider networks, and coverage, for different plans.

HealthCare.gov will include examples on the website so that you can easily see the types of plans available and choose the one that will work best for you.

Making it Easier to Prove You Qualify for a Special Enrollment Period

When you have a certain life event, like losing your health insurance at work, or moving to a new state, you are eligible for a Special Enrollment Period (SEP) to buy a health insurance plan through the Marketplace.

HHS is making it easier to sign up for a plan during a SEP.

Starting in 2023, the only time you will need to prove you qualify for a SEP, will be when you enroll because you lost coverage (e.g., like losing your coverage at work), but not for other life events like marriage, a new baby, or a move.

This change should make it easier to enroll by taking out a step that often creates a barrier to those who want to get coverage, but are unable to submit documents.

Helping You Find Providers Near You

To make sure that you have access to health care providers in your area, CMS will now review plans to make sure that the plan has enough local providers included in the plan.

CMS will look at both how long it takes to get to the provider and how far away providers are located in relation to those who can access the plans. They will also take into consideration access to telehealth when deciding how well a plan provides access to local health care providers.

No one should have to wait months to see the doctor, so starting next year, CMS will review appointment wait times, to ensure that providers are able to get patients appointments within a reasonable timeframe.

Protecting Patients with Complex Medical Conditions

Marketplace plans are required to cover Essential Health Benefits (EHB). EHBs are things like preventative care, laboratory services, prescription drugs, and hospitalizations. To improve access to care for everyone, the plans must now cover EHBs based on clinical evidence.

This will keep health insurance companies from discriminating against older patients or patients with complex health conditions. HHS will also make it clear that plans may not discriminate based on sexual orientation or gender identity.

For more information, see our Quick Guide to Health Insurance Marketplaces.

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