On Thursday, April 13, the Department of Health and Human Services finalized a long-awaited regulation intended to stabilize the Affordable Care Act (ACA) individual health insurance marketplace. The final rule tracks closely to the proposed rule by shortening the open enrollment period, tightening eligibility for special enrollment periods, modifying the actuarial values (AVs) used to determine levels of coverage, deferring to states to certify network adequacy, and reducing the threshold requirement for essential community provider (ECP) network participation.
Significant changes to existing regulations include:
It is important to note that while insurers have viewed the final regulation as an important step toward stabilizing the individual marketplace, there remain challenges to the marketplace outside the scope of this regulation. In particular, insurers have made clear that the continuation of cost-sharing reduction subsidies for individuals between 100 and 250 percent of the federal poverty level is critical to ensuring both affordable coverage and their continued participation in the marketplace.