Valued Voice

Enrollment in the health insurance exchange marketplace in Wisconsin grew for the first time in the past five years, reaching 212,209 for benefit year 2022. The national total also increased in 2022, up 5.2% to reach 14.5 million people. 
 
First implemented for the 2014 benefit year, the health insurance exchange marketplace has been the primary place for people without government coverage or group health insurance options through their employer to sign up for coverage in the individual market. Enrollment increased for the first few years after implementation but then started declining. Rising premiums and insurers exiting the market led the state to implement the Wisconsin Healthcare Stability Program, first effective in 2019. While premiums appeared to have stabilized, enrollment continued to decline in 2020 and 2021. But new subsidies enacted as part of the American Rescue Plan Act in 2021, as well as investments in outreach, likely contributed to the near 11% increase for 2022. 
 
The subsidies are significant—most people with income below 150% of the federal poverty level (about $20,400 for a single person and $41,600 for a family of four) have coverage options available with no monthly premium, as well as subsidized cost-sharing amounts. New subsidies are also available to people with higher income levels as well. 
 
While the 2022 benefit year has just begun, the federal Centers for Medicare & Medicaid Services (CMS) is already looking forward to the 2023 benefit year. Annually, CMS releases guidelines to issuers offering qualified health plans in the federal health insurance exchange marketplace. For 2023, the proposed rule covers several operational areas, including network adequacy. In particular, CMS seeks to adopt specific quantitative time, distance and appointment wait-time standards, as well as increase the percentage of essential community providers from 20% to 35%. CMS also would require that, in order to count toward meeting the network adequacy standards, providers must be contracted within the network tier that results in the lowest cost-sharing obligation. Finally, CMS proposes to collect information from health insurance issuers regarding whether providers offer telehealth services to help inform future development of telehealth standards.