The Department of Health and Human Services released its final Notice of Benefit and Payment Parameters for 2019. This final rule describes benefit and payment parameters under the Affordable Care Act (ACA) that apply for the 2019 benefit year.
Annual Cost Sharing Limitation
The ACA’s out-of-pocket maximum (cost sharing) limit will increase to $7,900 (self-only coverage) and $15,800 (family coverage) for 2019. This maximum is updated annually based on the percent increase in average premiums per person for health insurance coverage.
| Out-of-Pocket Maximum | ||
| 2018 | 2019 | |
| Single | $7,350 | $7,900 |
| Family | $14,700 | $15,800 |
Individual Mandate’s Affordability Exemption
Under the ACA, individuals who lack access to affordable minimum essential coverage (MEC) are exempt from the individual mandate penalty. Coverage is considered affordable for an employee if the required contribution for the lowest-cost, self-only coverage does not exceed 8 percent of household income.
The tax reform bill, called the Tax Cuts and Jobs Act, reduced the ACA’s individual mandate penalty to zero, effective beginning in 2019. As a result, beginning in 2019, individuals will no longer be penalized for failing to obtain acceptable health insurance coverage. However, the final rule notes that individuals may still need to seek this exemption for 2019 and future years (for example, in order to be eligible for catastrophic coverage). As a result, the final rule increases the required contribution percentage in 2019.
For 2019, an individual qualifies for this affordability exemption if he or she must pay more than 8.3 percent of his or her household income for MEC.
New EHB-benchmark Plan options
Health plans in the individual and small group markets are required to offer a core package of items and services called essential health benefits. This includes things like hospitalizations, maternity, mental health, etc.) The plans should be equal in scope to benefits offered by a typical employer health plan.
Beginning with the 2020 plan year, states can now select a new EHB-benchmark plan on an annual basis that provides substantially more options (although it cannot be more generous than the most generous comparison plan).
Download the bulletin for more details.