Subsidy

Posted November 1st, 2017 in Producers, Employers, Individuals
As you may have heard, the Trump administration discontinued funding for the cost-sharing reduction subsidies (CSR subsidies). Critics of this move believe it will create instability in the Exchange and individual marketplaces. Political efforts to restore the CSR subsidies are underway, but it appears Republican leadership has some demands as part of those restoration efforts.
Posted May 23rd, 2017 in Producers, Employers, Individuals
One of the major issues at hand is whether the Trump administration will continue funding the cost-sharing reduction subsidies (CSRs), which are available to people who purchase coverage on the Health Insurance Marketplace. If the CSR subsidy funding is eliminated, there will be a great deal of volatility added to the individual health insurance market, and here’s why. 
 
Posted April 5th, 2017 in Producers, Employers, Individuals
You’ve all heard by now that Congress was unsuccessful in passing the American Health Care Act (AHCA), a bill that was intended to repeal and replace significant parts of the Affordable Care Act (ACA). Surely, within time, there will be another bill introduced to change the ACA, but that could take time. It may be weeks, months, or maybe even not until next year, although President Donald Trump does have a “wild card” he can use.
Posted November 10th, 2016 in Producers, Employers

People who have access to affordable coverage from their employer are ineligible to receive subsidies through the Health Insurance Marketplace, also known as the Exchange. For 2017, coverage is considered affordable if the employee’s share of premium for self-only coverage is 9.69% or less of their household modified adjusted gross income.

Posted May 23rd, 2016 in Producers, Employers
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. 
 
Posted October 8th, 2015 in Employers, Producers, Individuals

The open enrollment period (OEP) in the individual market will begin on November 1, 2015 and end on January 31, 2016.

During this time period, just about anyone can enroll or make plan changes to coverage in the individual market.

Here are some helpful reminders as the OEP approaches:

Who is eligible for a subsidy?

There are a number of factors that affect eligibility or can disqualify an individual for a subsidy, such as:

Posted July 2nd, 2015 in Producers, Employers, Individuals
On June 25, 2015, the Supreme Court of the United States (SCOTUS) ruled 6-3 in favor of the federal government and their ability to provide subsidies in Exchanges. The plaintiffs had contested the federal government’s interpretation of the healthcare law citing language in the Affordable Care Act (ACA) which specifically says subsidies can only be provided by an Exchange “established by the state.”  
 
Posted June 5th, 2015 in Producers, Employers, Individuals
The Supreme Court is expected to rule on the King vs. Burwell case at the end of this month. This is the court case that is challenging whether or not the federal government can provide subsidies to Exchange enrollees in the 37 states in which it operates. Media coverage of the case implies that the judges are evenly split and a ruling could go either way.
Posted March 27th, 2015 in Producers, Employers, Individuals

On March 4, 2015 the U.S. Supreme Court heard oral arguments in regards to the King vs. Burwell case, which is the most significant challenge to the Affordable Care Act (ACA) since the constitutionality of the Individual Mandate was challenged back in 2012. The plaintiffs in the King vs. Burwell case argue that subsidies can only be provided by states that establish an Exchange on their own. They further argue that the federal government, which is utilized in 37 states, cannot provide subsidies to Exchange applicants.  

Posted December 12th, 2014 in Producers, Individuals
Earlier this year the IRS released three revenue procedures (2014-46, 2014-37, 2014-41) which provide guidance to individuals on their obligation to maintain minimum essential coverage and includes information on subsidies available through the Health Insurance Marketplace (Exchange).  
 

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