Final Notice of Benefit and Payment Parameters for 2020

Jun 13, 2019

Recently, the Department of Health and Human Services (HHS) released its final Notice of Benefit and Payment Parameters for 2020. This proposed rule describes benefit and payment parameters under the Affordable Care Act (ACA) that would be applicable for the 2020 benefit year. Standards included in the rule relate to:

  • Annual limitations on cost sharing
  • The individual mandate’s affordability exemption
  • Direct enrollment in the Exchanges
  • Special enrollment periods (SEP) in the Exchanges

HHS also sought comments on issues to address in the future, such as the practice of “silver loading,” the automatic re-enrollment process through the Exchanges and any additional measures that would reduce eligibility errors and potential government misspending. HHS noted that it intends to take the comments received in response to the proposed rule into consideration in future rulemaking.

Notable Changes for 2020

The out-of-pocket maximum (OOPM) will increase, and the ACA’s affordability exemption threshold will decrease for 2020.

  • OOPM: $8,150 for self-only coverage and $16,300 for family coverage
  • Affordability threshold: 8.24% of household income

The final rule also enhances direct enrollment through the Exchanges and establishes a new SEP for the Exchanges.



Posted In: Benefits & HR

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