Have you ever had an unexpected medical bill with excessive out-of-pocket costs from an out-of-network provider? Beginning in 2022, this will be an issue of the past.
The No Surprises Act will take effect on January 1, 2022. This act protects consumers from surprise medical bills, whether they receive coverage through their employer (including a federal, state, or local government), through the Health Insurance Marketplace, or directly through an individual health plan. According to federal estimates, it will apply to 10 million unexpected bills per year, and this act is expected to reduce premiums by 0.5% to 1%, in most markets in most years.
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What Does the No Surprises Act Mean for Me?
For individuals, this consumer protection act means the following:
- No surprise billing for emergency services. Even if emergency services are provided out-of-network, these services must be covered at an in-network rate without requiring prior authorization.
- No out-of-network cost-sharing and balance billing for emergency and certain non-emergency services. The cost of the service for the individual cannot be higher than if the services are provided by an in-network provider should this situation arise. Also, any deductible or coinsurance must be based on the in-network rate.
- No out-of-network charges and balance billing for ancillary care by out-of-network providers at an in-network facility.
- No additional out-of-network charges and balance billing without advance notice. Providers must provide advance notice (written in plain language) explaining that patient consent is required to get care on an out-of-network basis before the individual can be billed.
While States are primarily responsible for enforcing the No Surprises Act, they can enlist help from the federal government. Consumers can appeal health plan denials, reach out to the enforcement entity, contact their state consumer assistance program or use the national consumer complaints system that will be established should a problem arise.
*Please note: The rules don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE because these programs have other protections against high medical bills.
Contact the Team at LIG Solutions for Your FREE Plan Comparison
While comparing health coverage plan options can seem overwhelming, take comfort in the fact that you don’t have to do this alone.
LIG Solutions offers transparent, free consultations regarding your health insurance options. We’ll discuss what you’re looking for in a plan as well as available options that would suit your specific situation. As brokers, we have access to all private insurance and Marketplace health coverage plans, so you can feel confident that all options will be considered and any questions you have will be answered. We’re here and ready to help you find the best plan for your needs and budget.
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