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Life Health > Health Insurance on hunt for double dippers

Your article was successfully shared with the contacts you provided. exchange system managers are trying to identify exchange plan premium tax credit users who also have Medicaid coverage, or also have coverage through the Children’s Health Insurance Program (CHIP).

A consumer who has Medicaid or CHIP coverage that qualifies as minimum essential coverage (MEC) is not supposed to use the Patient Protection and Affordable Care Act (PPACA) premium tax credits to pay for exchange coverage, officials at the Centers for Medicare & Medicaid Services (CMS) say in a memo aimed at state health agency officials.

The data matching program could affect agents and brokers who have some exchange plan with very low income levels, or producers who volunteer to help navigators and or public health programs iron out low-income consumers’ health insurance problems. itself does not yet have the tools it needs to cut off the consumers’ access to the premium tax credits, CMS officials say.

The consumers themselves will have to talk to a state exchange or health insurer to end use of the exchange plan coverage and the exchange plan premium tax credit. Consumers can cancel their exchange coverage through or by calling the call center.

Consumers who are in Medicaid but prefer exchange plan coverage, and have some cash, can enroll in an exchange plan during the open enrollment period, or during a special enrollment period (SEP), if a SEP is available. Medicaid users who buy exchange plans that will have to pay for the coverage without use of the premium tax credit, officials say.

In some cases, officials say, consumers may have both exchange plan coverage and public health plan coverage, because they apply for both programs at the same time, or apply for one type of coverage while having another type of coverage, and fail to terminate redundant coverage.

CMS will send the redundant coverage notices, or “periodic data matching” (PDM) notices, to the individual identified as the household contact for the exchange application, officials say.

Consumers who ignore the notices may end up having to pay some or all of the excess premium tax credit payments they have received, officials say.

See also: Last-minute filers narrow PPACA tax credit reporting gap


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