New Marketplace Rules for 2024

From Center on Budget and Policy Priorities

Earlier this week, the Administration issued its annual update to private market rules, which includes several improvements that will make it easier for eligible people to enroll in and keep marketplace coverage for the upcoming 2024 plan year.  See a summary here and highlights below.

• People who attest to the loss of minimum essential coverage (MEC) and select a marketplace plan before the first of the month that they will lose coverage will have a coverage effective date of the first day of the month that they lose coverage.  For example, if a person attests to losing MEC on July 15 and selects a marketplace plan by June 30, their coverage will begin on July 1.  This change will be effective in states that use HealthCare.gov and will be optional for state-based marketplaces (SBMs).
• The Special Enrollment Period (SEP) following the loss of Medicaid or CHIP coverage will be 90 days.  This change goes into effect on January 1, 2024 for states that use HealthCare.gov.  This is in addition to the temporary unwinding SEP already in effect in FFM states.  SBMs have the option to implement this change beginning when the rule is effective (60 days after is is published in the Federal Resister).
• Marketplace enrollees will receive an automatic 60-day extension, in addition to the existing 90-day period currently required, to resolve data matching inconsistencies related to income. 
• The final rule includes two new essential community provider (ECP) categories: Substance Use Disorder Treatment Centers and Mental Health Facilities.

CMS also published the maximum out-of-pocket (MOOP) limits for marketplace plans for plan year 2024.

• For individuals earning between 100-200% of the federal poverty level (FPL), the MOOP limit for self-only coverage will be $3,150 (or $6,300 for non-self-only coverage).
• For individuals earning between 201%-250% FPL, the MOOP limit for self-only coverage will be $7,550 (or $15,100 for non-self-only coverage)
• For individuals earning above 250% FPL, the MOOP limit for self-only coverage will be $9,100 (or $18,200 for non-self-only coverage).