Proposed 2023 OOP Limits and ALE Penalties
Dec 31, 2021
Federal regulators have publication of for several Affordable Care Act (ACA) requirements, summarized in this and .
Employers will be particularly interested in the premium adjustment percentage being proposed to index to 1.4408219719(about 4.6% higher than 2022). This is used to index maximum out-of-pocket cost-sharing for non-grandfathered health plans and to calculate §4980H penalties for applicable large employers (ALEs).
| Annual Out-of-Pocket Maximum for Non-Grandfathered Health Plans always rounded down to nearest $50, and family always twice the per-person limit |
2021 | 2022 | 2023 |
| Per Person | $8,500 | $8,700 | $9,100 |
| Per Family | $17,100 | $17,400 | $18,200 |
| ALE Penalties always rounded down to nearest $10 |
2021 | 2022 | 2023 |
| §4980H(a) Penalty | $2,700/yr ($225.00/mo) |
$2,750/yr ($229.17/mo) |
$2,880/yr ($240.00/mo) |
| §4980H(b) Penalty | $4,060/yr ($338.33/mo) |
$4,120/yr ($343.33/mo) |
$4,320/yr ($360.00/mo) |
There are a couple more points of interest to employers which may affect 2023 plan designs and claims projections. These two proposals are described in the announcement as follows.
- “The 2023 Payment Notice proposed rule also would explicitly prohibit health insurance issuers from discriminating on the basis of sexual orientation and gender identity.”
- “Additionally, this proposal refines the Essential Health Benefits nondiscrimination policy by requiring issuers to rely on clinical evidence as a basis of the health plan design.”
- “For example, plans could not be designed to burden people managing chronic conditions with inordinately high prescription costs, absent a clinical rationale.”
IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information.
This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.
