ACA Health Plan Subsidies to Become Easier to Get for 2017

Getting subsidies for Affordable Care Act health plans is about to become easier.

Additional verification of eligibility will only be required if the difference between stated income and Internal Revenue Service or Social Security data is at least 25 percent, or $6,000, under guidance from the Department of Health and Human Services.

Currently, additional verification is required if the discrepancy is only 10 percent or greater.

The change, which is for the 2017 plan year, “will reduce the number of consumers who have to follow-up and submit documentation to verify their household income while maintaining important program integrity controls,” the Centers for Medicare & Medicaid Services said in the guidance.

The new data-matching standards “will allow more consumers to get their household income immediately verified by the Marketplace when they submit an application,” the CMS said.

Subsidies for about 73,000 households with unresolved income discrepancies were adjusted between January and March in the 38 ACA marketplaces run by the federal government, and coverage was terminated for about 17,000 consumers with unresolved citizenship or immigration status discrepancies, the CMS said in a recent report. The 13 state-run marketplaces can implement the new thresholds or they can submit proposals to go beyond the guidance.

Douglas Holtz-Eakin, a critic of the ACA who was director of the Congressional Budget Office from 2003 to 2005, said the change could exacerbate existing problems in verifying the subsidies for eligible people, those with incomes of between 100 percent and 400 percent of the federal poverty level. “It’s lowering the bar to make the ACA look better,” he said. Holtz-Eakin is president of the American Action Forum.

On March 31, about 11.1 million consumers had coverage through all of the ACA marketplaces, of which 8.4 million were enrolled through the federal marketplaces. About 85 percent of consumers enrolled in all the marketplaces – some 9.4 million – received premium tax credits averaging $291 a month to make premiums more affordable.

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