Regulators are trying to accommodate existing programs that help sick consumers pay for federal exchange plan coverage without letting new aid programs drive up claims.
Officials at the Center for Consumer Information & Insurance Oversight, an arm of the U.S. Department of Health and Human Services, talk about private premium assistance programs in a new collection of two answers to frequently asked questions.
CCIIO, part of the HHS Centers for Medicare & Medicaid Services, supervises all Patient Protection and Affordable Care Act exchanges, and it administers the HHS-run exchanges.
In November, CCIIO discouraged private charities and other private “third-party payers” from paying the premiums for consumers who buy private “qualified health plan” exchange coverage.
PPACA itself provides subsidies — premium assistance tax credits — to help moderate-income consumers pay the QHP premiums.
But, if private organizations help people pay the premiums,” that could skew the insurance risk pool, CMS officials said in November.
HHS officials have worried that PPACA rules may already make the exchanges very attractive to sick people and not attractive enough to young, healthy people to hold claim risk to manageable levels.
In the new guidance, CCIIO officials acknowledge that existing programs, such as the federal Ryan White HIV/AIDS program and Indian organization aid programs, already have official federal permission to help some consumers pay for coverage.
Indian tribes and tribal organizations have official PPACA permission to pay QHP premiums.
A federal agency, the Health Resources Services Administration, has given grantees advice about how to use the grants to pay for QHP coverage for people with HIV or AIDS.
Indian tribes, tribal organizations, urban Indian organizations, and state and federal government programs and federal program grantees can pay QHP premiums for sick people, officials say in the new guidance.
Other private organizations can pay QHP premiums, but only if they base support decisions on the applicants’ finances and not on the enrollees’ health, officials say.
If a private organization helps people with financial problems pay for QHP coverage, the organization ought to pay for a consumer’s premiums for an entire policy year, not just part of a year, officials say.
Similarly, if a private group helps a consumer with QHP deductibles or other cost-sharing amounts, the group should provide that help for the whole policy year, officials say.