2020 is an unprecedented year for healthcare in many ways, but in the grand scheme of things, regulation and new rules must go on as usual. Despite some late changes and some extensions, changes to Affordable Care Act (ACA) benefits plans have been announced. These changes include everyday necessities such as prescription drug coverage, enrollment periods, and dependent coverage.

If you’re involved in benefits administration, here are some of the recent changes to the ACA and healthcare plans which might affect you and your teams.

Delays in Changes for 2021

Some changes for the 2021 plan year have been pushed to 2022. With COVID-19 creating ongoing uncertainty in terms of costs and scope for insurers, benefits providers are being given additional time to deal with policy changes. Insurers have been given one extra week to turn in their 2021 Qualified Health Plans to CMS for approval. They’ll also receive an extension for rate filing, giving insurers a longer time to determine how COVID-19 costs will affect 2021 rates.

Temporary Changes Related to COVID-19

Some temporary changes to policy for exchange plan operators have also been announced by the CMS. One which could have immediate (or even retroactive) significance to enrolled plan members are adjustments to the Basic Health Program.

Basic Health Program Changes

The Basic Health Program (BHP) offers states the ability to create and offer an alternative to marketplace coverage for certain consumers who have incomes between 133 and 200% of the federal poverty levels. To date, only New York and Minnesota offer BHPs, although any state can submit a BHP “Blueprint” outlining how their prospective BHP would operate and meet guidelines.

CMS will now allow states to request certification of “temporary revisions that make significant changes” to their BHP Blueprint with respect to COVID-19 coverage. These changes can be retroactive to the start of the declared Public Health Emergency, which began January 31, 2020. Expected changes might include temporary waives on limits to some benefits, premiums, or cost-sharing.

Special Enrollment Periods & Dependent Coverage

Employees who qualify for Special Enrollment Periods will have some new timelines and restrictions to be aware of. One change: enrollees will no longer be able to switch from one tier to another (such as bronze to gold) during certain SEPs.

Another change comes for dependent coverage. If an enrollee in an exchange plan gains a dependent, they can be added to the enrollee’s current plan. If the plan doesn’t allow for dependents, the enrollee can change to another plan or enroll the dependent in another plan.

Prescription Drug Costs

Through several new rule changes, prescription drug costs are being addressed. One involves rebates and price concessions granted to insurers operating exchange plans. Beginning in 2022, the value of those rebates and concessions will be taken into account by the ACA, which could result in rebates to consumers.

Additionally, coupons granted to consumers by drug manufacturers have been a long source of contention for insurers. Some have worked to stop applying coupon values towards a plan member’s out-of-pocket limit. Under new rules, insurers won’t be mandated to apply coupon values, but individual states will have the right to prohibit insurers’ copay accumulator programs, a method some insurers have used to stop coupon amounts from applying to a deductible or out-of-pocket maximum.

ACA Compliance for Business Owners with Furloughed Staff

As the ACA itself changes, business owners will also have to keep an eye on their changing staffing situation. Furloughs, lay-offs, and reductions in hours, which may have been put into place to deal with COVID-19, can have repercussions on an employer’s ACA compliance. For example, if your company has furloughed employees, how does this affect hours tracking for the purpose of keeping their full or part-time status?

Another consideration is how a pause in operation or a furlough of workers can affect your full—time employee count for the year.  This can then affect your status as an Applicable Large Employer (ALE), the measure which makes your business subject to the ACA Employer Mandate.

As your business changes during the COVID-19 era, your ACA compliance factors are going to shift as well – whether it’s at the individual employee level, or at a much higher company-wide level.

If you’re having trouble keeping up with ACA changes, using a benefits administration platform like WBD’s can take the guesswork out of ACA reporting and eligibility management. With the ability to handle each member’s current and historical status, WBD’s ACA reporting means your business will have accurate hours measurement and tracking, keeping your company on track for ACA compliance despite these quickly-changing times.

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