Understanding the Notice of Benefit and Payment Parameters (NBPP)

The Notice of Benefit and Payment Parameters (NBPP) is an annual publication by the Centers for Medicare & Medicaid Services (CMS) that outlines the rules and regulations for the Affordable Care Act (ACA) health insurance marketplaces. The NBPP provides important information for both individuals and families looking for health coverage as well as insurance companies offering plans on the marketplaces.

What’s the Purpose of the NBPP?

The NBPP serves several purposes, including:

Setting standards for the health benefits that must be covered by ACA-compliant health plans.
Establishing payment rules for insurance companies participating in the marketplaces.
Outlining the eligibility requirements for individuals and families to receive premium subsidies and cost-sharing reductions.

Who Should Pay Attention to the NBPP?

Anyone who is interested in obtaining health insurance coverage through the ACA marketplaces should familiarize themselves with the NBPP. This includes individuals, families, and small businesses. Additionally, insurance companies that offer plans on the marketplaces need to comply with the regulations outlined in the NBPP.

What are the Key Components of the NBPP?

The NBPP covers a wide range of topics, including:

Essential health benefits: The NBPP defines the minimum set of health benefits that must be covered by ACA-compliant health plans. These benefits include things like doctor visits, hospital stays, and prescription drugs.
Actuarial value: The NBPP establishes the actuarial value (AV) for each health plan tier. AV is a measure of the comprehensiveness of a health plan’s coverage.
Premium subsidies: The NBPP outlines the eligibility requirements and income limits for individuals and families to receive premium subsidies to help pay for health insurance.
Cost-sharing reductions: The NBPP also sets forth the eligibility requirements and income limits for individuals and families to receive cost-sharing reductions to help lower their out-of-pocket costs for health care services.

When is the NBPP Published?

The NBPP is typically published in the fall of each year and takes effect on January 1st of the following year. This allows insurance companies time to adjust their plans and rates accordingly.

Where Can I Find the NBPP?

The NBPP can be found on the CMS website at https://www.cms.gov/Regulations-and-Guidance/Guidance/Subsidy-and-Enrollment/index.html.

If you have any questions about the NBPP or need assistance in finding health insurance coverage, contact a licensed insurance agent or visit HealthCare.gov.