CMS Finalizes Lower-Than-Proposed Cost-Sharing for Marketplace Plans; Enrollment Closes Aug. 15
By Joey Berlin


The Centers for Medicare & Medicaid Services (CMS) has settled on a lower maximum for consumers’ out-of-pocket costs for federal health insurance marketplace plans in 2022 than what the agency proposed in November.

For the 2022 plan year, CMS also took steps to increase competition in the marketplaces and “improv[e] the consumer experience” for Americans who rely on those plans, CMS said in a news release. That includes rules that will help them “more easily distinguish between plan options and increase opportunities to qualify for future special enrollment periods (SEPs), when consumers are eligible to enroll in marketplace plans outside annual open enrollment,” the release said. 

CMS previously extended this year’s SEP through Aug. 15 because of the COVID-19 pandemic. 

Nearly 1.3 million Texas residents selected a marketplace plan in the 2021 open enrollment period between Nov. 1 and Dec. 15, 2020, according to CMS figures. This year, the Texas Medical Association recommended a combination of state and federal approaches to reduce the state’s more than 5 million residents who lack health coverage, including a state-administered reinsurance program to help reduce marketplace premiums. 

CMS released the final version of its 2022 payment notice in two parts: one in January, one in April. The headliner in the most recent notice was lowering the final maximum out-of-pocket cost to $400 less than what CMS proposed in November 2020. CMS says the new policies also expand options for obtaining coverage. 

“It also breaks down barriers – like high costs – that too often have put health care out of reach, particularly in underserved communities,” CMS said in its April release. The new special enrollment policies “will expand the opportunities consumers have to sign up for health coverage outside the annual open enrollment period.” 
For more information on the CMS payment notice for 2022, consult CMS’ fact sheet on part two of the rule. 

Last Updated On

June 17, 2021

Originally Published On

June 17, 2021

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Joey Berlin

Associate Editor

(512) 370-1393

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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