New Rules for Health Coverage for 2022

Buying Health Insurance?

Buying health insurance for 2022? Learn the new rules, regulations, and ways to get coverage. Many Californians will receive additional financial help to pay for monthly premiums and make health insurance coverage more affordable than ever for you and your family. For low-income Californians, expanded special enrollment means the opportunity to enroll in health insurance will last all year long. Learn more about what else has changed and what may impact your health insurance and medical care in 2022. 

Expanded Health Insurance Subsidies Continue

Californians will continue to receive more help paying for health insurance. In 2021, the American Rescue Plan went into effect, helping millions of Californians and people all around the country lower the cost of health insurance premiums by expanding financial help for health insurance. These expanded subsidies continue through 2022, saving many California households hundreds to thousands of dollars on their premiums. 

Some consumers will even qualify for a $0 monthly premium thanks to this expanded financial help. The only way for Californians to receive this financial help is to enroll through Covered California. Call us today at (800) 650-0922 to learn more. 

Increase in Tax Penalties for No Health Insurance

In California, people must have coverage or pay a tax penalty (unless they qualify for an exemption). These tax penalties for not being insured generally increase each year adjusted for inflation. For 2022, Californians without coverage for the entire year will likely pay a minimum penalty of $800 per adult and $400 per dependent child under the age of 18. A family of four who goes the whole year with no coverage will owe a minimum of $2,400 come tax time. 

No More Surprise Medical Bills

No one likes being surprised by an unexpected bill. The No Surprises Act helps protect consumers with health insurance against surprise medical bills. As of January 1, 2022, this new law provides new protections under certain circumstances. These include care that you get in an emergency or from a provider who’s out of network but provides care in an in-network facility, and some other unusual but costly services like air ambulances from out-of-network providers.

The purpose of this new law is to protect you from expensive out-of-pocket costs and to ensure that during an emergency, you’re able to get care in the quickest and most streamlined way without worrying about who’s in your network or whether you have prior authorization from your health insurance.

Out-of-Pocket Maximums Changed for 2022

The out-of-pocket maximum is the upper limit of how much you have to pay for covered services in one year. It applies to copayments, deductibles, and coinsurance for in-network care and services. Once you meet this amount, your health plan will pay 100 percent of the costs for covered benefits. For 2022, the out-of-pocket limit is $8,700 for an individual and $17,400 for a family — up from $8,550 and $17,100, respectively, in 2021.

This out-of-pocket maximum doesn’t include every expense you might pay for out of pocket, however. Your health insurance premiums themselves, some other things like out-of-network care, and costs for services that aren’t covered by your plan, don’t count toward your limit.

New Monthly Statements Show How Much You Spent on Care 

A new California law will make tracking those out-of-pocket health care costs easier than ever, starting in 2022. The law, Senate Bill 368, requires most health insurance companies to send monthly statements showing how much you’ve paid toward your deductible and how close you are to reaching your out-of-pocket maximum. This should help make it easier to anticipate and budget for upcoming medical expenses.

Low-Income Families Can Enroll Any Time of Year

In most cases, you have to wait until a period of time each year called “open enrollment” to buy health insurance. There are exceptions for when you have a major life change like moving or having a baby. For most of those exceptions, you have 60 days from the date of the event to enroll. This time period is called “special enrollment.” 

Starting in 2022, people with an annual household income at or below 150 percent of the federal poverty level, or up to $19,320 for a single person and $39,750 for a four-person family, who are not eligible for Medi-Cal can enroll in coverage through Covered California any time of year. This new form of special enrollment doesn’t have a deadline. 

New Mental Health Coverage Provisions 

A California law, signed October 8, 2021, now requires that when you see a mental health or substance abuse health professional, you must be offered a return appointment within 10 business days. This new law also applies to your health care provider referring you to a mental health or substance abuse specialist — that referral appointment must be scheduled within 10 business days. The new law goes into effect in July 2022, giving organizations time to find additional therapists and mental health clinicians to meet the need.

A Pandemic Relief Exception Expired 

The amount of financial help (subsidies) you receive to pay for health insurance is largely based on your annual household income, so when you enroll in coverage, it’s important to estimate your income for the upcoming year as accurately as possible. If you don’t, you’ll have to pay back the excess financial help you received at the end of that tax year. Due to a pandemic relief law, people who miscalculated their income didn’t have to pay back any excess subsidy money for the 2020 tax year, but for tax year 2021 and beyond that exception is no longer in effect. Make sure when applying for subsidies, you use the best estimate of your 2022 income. If your income changes during the year, report it right away.

Public Charge Rule Reversed

As part of the Trump administration’s additions to the public charge rule, the amount of government assistance a person received for health insurance could negatively impact their application for certain immigration statuses. This discouraged many people who immigrated to the United States from applying for or keeping their coverage due to worry that it could negatively impact their immigration status.

In 2021, the Biden administration reversed elements of the Trump administration’s public charge rule, preventing immigration officials from taking into account government-aided insurance — including Medicaid, CHIP, or any coverage purchased through Covered California — when someone submits an immigration application. 

In general, applying for health insurance coverage through Covered California and receiving financial assistance for a Covered California health plan or receiving low- or no-cost coverage through Medi-Cal, will not make an individual a “public charge." It will not affect the consumer’s immigration status, their chances of becoming a lawful permanent resident or their chances of becoming a naturalized citizen. The exceptions are if the individual receives long-term care in a nursing home or other facility paid for by the government through the Medi-Cal program or does not tell the truth on their application for health coverage.

Children’s Hearing Aids Benefits Cover More Families

Due to a new California benefit, hearing aid coverage for children is now extended for families with incomes of up to 600 percent of the federal poverty level. That translates to an upper limit of $131,760 for a family of three.

The new hearing aid benefit covers hearing aid(s), hearing aid replacements, supplies, and accessories; and audiology and other post-evaluation services related to hearing aids. The coverage applies to children between birth and age 17 who are otherwise not eligible for Medi-Cal and whose families meet the income guideline. It’s available for children with no health insurance or who have health insurance but no coverage for hearing aids and related services. To get a hearing aid for your child, you’ll need a referral or valid hearing aid prescription from a physician.

Don’t Wait to Enroll 

It’s a good idea to stay on top of new health insurance rules — and to stay covered. Covered California’s open enrollment period typically happens between November and January. If you don’t sign up during open enrollment, you may still be able to apply for health insurance and financial help through Covered California under special enrollment. If you have questions or need assistance, free expert help is available.