The managers of the Affordable Care Act public health insurance program have published a manual for a multi-billion-dollar ACA subsidy program that ended this fall: the cost-sharing reduction subsidy program.
Health insurers are supposed to use the procedures described in the manual to tell the program managers how much cost-sharing reduction subsidy money they received and how much they might have to pay back to the federal government.
The program managers have tried to come up with rules that will prevent insurers from getting any kind of extra or double benefits.
Some states and nonprofit organizations, for example, have set up their own subsidy programs. In a discussion of state subsidies, officials say the state or nonprofit subsidy amount should be included when reporting the amount the enrollee paid.
But the amount “should be excluded from the value of cost-sharing reductions provided by the issuer,” officials write.
How health insurers react to the subsidy program rules could affect how likely the insurers are to sell individual major medical coverage in 2019.