Biden's HealthCare.gov Gives Individual Coverage HRAs a Cool Welcome

Traditionally, ACA supporters have been skeptical of employer-run cash-for-coverage programs, but the state-based ACA public exchanges in some places have embraced individual coverage HRA users.

Individual Coverage HRA Rules

Biden administration officials note in the introduction to the final new final rule that one concern about exchange plans, or "qualified health plans" (QHPs), is about what happens to workers who are eligible for individual HRAs, and who have family members who are eligible for ordinary ACA public exchange plan premium tax credit subsidies.

"One commenter stated that guardrails should limit opportunities for consumers to accidentally enroll in or be steered toward a non-subsidized QHP or non-QHP; and therefore, at a minimum, substantially different coverage types should be listed on separate website pages (as proposed) to ensure consumers compare apples-to-apples," officials write in the new final rule preamble. "Other commenters expressed similar sentiments."

Officials say they have decided to approve the provision allowing combined exchange plan and off-exchange plan listings, for individual coverage HRA users, as written, but to watch web brokers closely to see what they do to prevent consumer confusion.

"We agree that guardrails are necessary to help consumers understand their options and minimize the chance they inadvertently choose to enroll in a plan or product that they did not intend to enroll in or that does not meet their needs," officials say.

"As a result of the comments received expressing concerns about consumer confusion due to this exception, we encourage any direct enrollment entity considering updates to its website design to leverage this exception to contact us before implementing any updates (by emailing [email protected]). We are interested in working collaboratively with direct enrollment entities to ensure their planned website designs meet applicable regulatory requirements and intend to carefully monitor implementation under this exception," officials said.

Other Provisions

The final rule also sets some key ACA program figures for 2022.

Here's what's happening to some of those parameters:

• The required contribution percentage, used in calculations determining whether employer-provided coverage is affordable: 8.09% (down from 8.27%).
• The maximum annual cost-sharing, for self-only coverage: $8,700 (up from $8,550)
• The maximum annual cost-sharing, for family coverage: $17,400 (up from $17,100)
• HealthCare.gov user fee: 2.75% of total monthly premiums (down from 3%)
• HealthCare.gov user fee in states where local agencies do some of the work: 2.25% (down from 2.5%)

(Image: Centers for Medicare and Medicaid Services)