Stakeholder Perspectives on Round Three of CMS’s 2022 Notice of Benefit and Payment Parameters. Part 2: Insurers

The Centers for Medicare and Medicaid Services (CMS) in conjunction with the Treasury Department released an updated version of its proposed Notice of Benefit & Payment Parameters (NBPP) for 2022. The NBPP outlines rules that govern Affordable Care Act marketplaces and insurance reforms for each plan year. This is the third installment of the 2022 NBPP, parts of which were finalized on January 19, 2021. The new rule reverses many of the provisions included in the January rule as well as new proposals intended to expand access to coverage.

CHIR experts reviewed stakeholder comments for the January rule. We are now reviewing stakeholder reactions to the new rule on the following issues:

  • Marketplace User Fees
  • Direct Enrollment Exchanges
  • 1332 Waivers
  • Extending the Open Enrollment Period
  • Adding a new special enrollment period (SEP) for individuals eligible for APTCs under 150 percent of the federal poverty line (FPL)
  • Standardized Plans

In the second of this blog series, we summarize the key takeaways from comments submitted by the private health insurance industry, including: America’s Health Insurance Plans (AHIP), the Association for Community Affiliated Plans (ACAP), the Alliance of Community Health Plans (ACHP), Centene, CVS/Aetna, Molina, and Anthem.

Increasing Marketplace User Fees

The January rule lowered the fees insurers are required to pay to support marketplace operations. This proposal would reverse that policy and increase the fees, arguing that they are critical to necessary investments in the Navigator program, outreach, and marketing. Only three of the seven insurers above commented on this proposal. AHIP supported the proposal but did recommend CMS switch to a per member per month user fee to better match fees to enrollment. Centene also expressed support for the user fee change but encouraged CMS to finalize user fees before premium rates are filed in the future. ACAP was the only stakeholder that opposed the change in user fees, arguing it was too late in the benefit year and rate-setting process to make such changes.

 Repeal of Exchange Direct Enrollment Option

The January NBPP would have allowed states to work with private entities and brokers to operate their own enrollment websites and the new rule reverses this provision. Overall, insurers supported repealing these provisions, citing concerns about the reliability and accuracy of direct enrollment exchanges.

Reinstating Former 1332 Waiver Guardrails

The January NBPP codified a revised interpretation of section 1332 of the ACA that significantly relaxed the statutory guardrails. This proposal would return to a stricter interpretation of the guardrails, adopted in 2015 guidance to states. All insurers and insurer groups were supportive of this proposal. Centene encouraged the administration to consider enabling combined 1115/1332 waivers to enhance coordination across the Medicaid programs and the Marketplaces.

Extending the Open Enrollment Period

The proposed rule lengthens the open enrollment period for 2022 to run from November 1, 2021 to January 15, 2022. All insurers with the exception of ACAP opposed extending the open enrollment period. A few noted that consumers who enroll after January 1 will miss out on a full year of coverage. Indeed, AHIP said that extending the deadline halfway through January incentivizes consumers to begin the year uninsured. Molina echoed this point saying that this will guarantee loss of coverage for some in January because many consumers wait until the last day of a deadline to pursue enrollment. CVS suggested that if the OEP must be extended, it should start before November 1 instead of extending after December 15 to preserve uniform January 1 coverage effective dates.

Others identified “consumer confusion” and lack of consistency as reasons they should maintain the current open enrollment period. Responding to the administration’s argument that extending the open enrollment period after January 1 enables those that are auto-enrolled into plans they cannot afford to make a change before the end of open enrollment, insurers suggested creating a targeted SEP for the affected individuals. ACAP supported the OEP extension, arguing that doing so would enable consumers who are auto re-enrolled to switch plans to “the most appropriate coverage,” and also to give more time for Navigators and other assisters to help consumers. Other insurers called for CMS to increase investments in outreach and enrollment assistance as an alternative to a longer enrollment period.

Adding a Special Enrollment Period for Low Income Individuals

The proposal creates a new monthly SEP for individuals with income less than 150 percent of the federal poverty level. This SEP is unique in that it does not require a specified timeline for eligibility based on a life event, but rather an opportunity for consumers to enroll at any time during the year depending on their income. For-profit insurers were unanimously opposed to this new SEP, citing concerns about adverse selection. ACAP and ACHP, representing non-profit insurers, were both supportive of the new SEP, although ACAP did urge CMS to monitor how people use the SEP and reassess if there is evidence of adverse selection.

Insurers argued that consumers would enroll in plans at the time of care and drop coverage when they no longer need it. After a tumultuous start to the ACA marketplaces, insurers are now enjoying a relatively stable market and many warned that this SEP could undermine that stability. AHIP predicted higher premiums as a result. AHIP and Anthem suggested that the SEP for loss of minimum essential coverage was an adequate alternative to reduce coverage gaps for this population. There were also recommendations for CMS to take a more active role coordinating with state Medicaid agencies to help smooth transitions.

Standardized Plans

The administration also indicated that it intends to require plans with standardized benefit design beginning in plan year 2023. Insurers argued that plan would reduce innovation, consumer choice, and competition. In their comments, Centene noted that standardized plans often have lower enrollment and are more expensive. Many insurers were concerned that the labeling of standardized plans may confuse consumers and prevent them from finding a plan that best fits their needs. Insurers did have a number of recommendations in the event that standardized plans are implemented. They argued that insurers should be given the option, and not be required to offer standardized plans. They also urged that standardized plans should not be preferentially displayed on

A Note on Our Methodology

This blog is intended to provide a summary of comments submitted by insurers. This is not intended to be a comprehensive report of all comments on every element in the Notice of Benefit and Payment Parameters proposed rule, nor does it capture every component of the reviewed comments. For more stakeholder comments, visit

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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.