In 2013 and 2014 the word “exchange” was being used everywhere in the health insurance industry. Now, just a couple of years later, that term isn’t being used as frequently as it was just a couple years prior. Why? For one, the federal government decided the phrase “health insurance marketplace” or “marketplace” was what they would start calling their exchange. The media and general public also seem to associate the word “Obamacare” as being synonymous with the government-run exchanges. Additionally, private exchanges are not experiencing the growth rates that many had projected.

It should be pretty clear by now that two of the biggest provisions of the Affordable Care Act (ACA) are the Individual and Employer Mandates. The Individual Mandate requires all Americans to have a health insurance plan or pay a penalty, unless an exemption applies. Factors that may influence the amount of the Individual Mandate penalty include household size and income. The Employer Mandate requires employers with 50 or more employees to offer health insurance coverage to at least 95% of its full-time employees or risk penalties.

As required under the ACA, the federal government must conduct audits of Marketplace coverage to ensure that only people who are truly eligible are receiving a subsidized plan.

 

Effective Spring 2016, CMS launched an "Employer Initiatives" Program to aid in the auditing process. As part of this program, CMS may contact an employer to request whether or not one or more employees were enrolled in minimum essential coverage, or whether or not they were offered a health plan which was affordable and had minimum value.