Biden's HealthCare.gov gives individual coverage HRAs a cool welcome

Web brokers might be able to combine exchange and off-exchange major medical options for ICHRA users.

The Trump administration created the individual coverage HRA program to help employers of all sizes give workers cash the workers can use to buy their own health coverage. (Photo: Shutterstock)

Managers of HealthCare.gov have bent, a little, to accommodate web brokers that help workers with individual coverage health reimbursement arrangements (HRAs) sign up for health insurance.

Officials at the Centers for Medicare and Medicare Services and the parent of CMS, the U.S. Department of Health and Human Services, gave individual coverage HRA programs a limp handshake in a new final rule.

Related: ICHRA has potential to reshape the way employers pay for benefits

The final rule describes a batch of parameters that will apply to Affordable Care Act rules and programs, including HealthCare.gov and state-based ACA public health insurance exchange programs, in 2022. The parameters regulations also will shape the open enrollment period for 2022 exchange plan coverage, which is set to begin Nov. 1.

Trump’s web broker listing rules

The new final rule is based on draft regulations that CMS and HHS put out in December 2020, while Donald Trump was still president. The Biden administration has blocked or altered many of the changes proposed in the draft regulations.

Originally, for example, officials suggested that they might let web brokers display full information for some exchange plans and only basic information for other exchange plans, instead of requiring web brokers to display full information for all exchange plans.

Instead, in the new final rule, officials have required web brokers to post most available information for all exchange plans.

In most cases, web brokers must post information about ACA exchange plans in one section of the website, information about off-exchange major medical plans in a second section, and information about other types of products, or “excepted benefits,’ such as dental insurance and short-term health insurance, in a third section.

The Trump administration also proposed helping the new individual coverage HRA program, or ICHRA program, by letting web brokers show individual coverage HRA users a list of all individual and family major medical plans, including off-exchange plans, available in the shopper’s area.

The Trump administration created the individual coverage HRA program to help employers of all sizes give workers cash the workers can use to buy their own health coverage.

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 directenrollment@cms.hhs.gov). 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:

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