CMS Finalizes Second 2022 Payment Notice with Cost-Sharing Limits

The second 2022 Notice of Benefit and Payment Parameters final rule (“2022 payment notice”) finalized changes that made cost-sharing limits $400 lower than what CMS had proposed in 2020.

“Families deserve to have access to health care coverage that doesn’t break the bank. That’s why today we’re acting to lower consumers’ maximum out-of-pocket costs by $400 and why President Biden has a plan to reduce families’ health care costs for the long run,” said HHS Secretary Xavier Becerra.

“Health care access is personal to me as it is for families across the country. The Department of Health and Human Services is committed to building on the ACA to make sure our health care system is more accessible for every American.”

HHS decided against finalizing the premium adjustment percentage index (PAPI) and cost-sharing parameters included in the proposed rule. According to the final rule, these will be calculated with the National Health Expenditure Accounts (NHEA) projections of average per-enrollee employer-sponsored insurance premium.

The final premium adjustment percentage index for 2022 is 1.3760126457. The final required contribution percentage will be 8.09 percent. The final maximum annual limitation on cost-sharing for 2022 will be $8,700 for self coverage and $17,400 for other-than-self-only coverage.

Annual cost-sharing limitations for those whose incomes fall between 100 to 200 percent of the federal poverty level will be $2,900 for self coverage and $5,800 for covering others. For those with incomes between 200 and 250 percent of the federal poverty level, self coverage cost-sharing will be capped at $6,950 and for covering others the limit will be $13,900.

Based on these changes, the annual limitation on cost-sharing will be $400 lower than what was proposed in 2020.

“The ACA and the American Rescue Plan offer a lifeline to coverage for millions who might otherwise be uninsured,” said Jeff Wu, CMS acting principal deputy administrator and the deputy director for policy in the CMS Center for Consumer Information & Insurance Oversight.

“Those groundbreaking legislative actions are lowering health insurance premiums for millions of Americans, and the regulatory steps we’re taking today build upon those actions. They will ensure that next year, Americans will continue to find affordable, quality coverage through the marketplaces. Consumers and insurers alike will benefit from improvements in the 2022 payment notice.”

The second 2022 payment notice also finalized adjustments to the qualifications for special enrollment periods on the Affordable Care Act marketplace, the continuation of price adjustment for hepatitis C drugs, risk adjustment reporting requirements, and the annual reporting of state-required benefits deadline of July 1, 2022, among other changes.

Bolstering and expanding the Affordable Care Act has been the bedrock of the Biden administration’s healthcare strategy. The administration spearheaded the American Rescue Plan Act which boosted premium tax credits and extended a special enrollment period for the Affordable Care Act marketplaces.