Benefit and Payment Parameters for 2023

On April 28, 2022, the Department of Health and Human Services (HHS) filed its final Notice of Benefit and Payment Parameters for 2023.

This final rule describes benefit and payment parameters under the Affordable Care Act (ACA) that apply for the 2023 benefit year.

Finalized standards in the rule include:

• The individual mandate’s affordability exemption—The finalized 2023 required contribution percentage is 8.17%.

• Standardized plan options in the Exchanges—Insurers in the federally facilitated Exchanges (FFEs) and state-based Exchanges using the federal platform (SBE-FPs) must offer certain standardized plan options beginning with the 2023 plan year.

HHS also separately announced the updated annual limitations on cost-sharing for 2023 on Dec. 28, 2021. The finalized 2023 maximum annual limit on cost-sharing is $9,100 for self-only coverage and $18,200 for other-than-self-only coverage.

HHS did not adopt standards for qualified health plans, states, and Exchanges that prohibit discrimination based on sexual orientation and gender identity in benefit design and insurer marketing practices. Instead, HHS deferred finalizing these provisions to future rulemaking on ACA Section 1557. A fact sheet on the rule is also available.

To discuss how this rule may apply to you or your employees' health insurance options, contact our team at RCB & Associates, LLC | 616-233-9050