Insurance Exchanges

Starting January 1, 2014, new federal subsidies will be available for lower- to middle-income people to purchase private, nongroup coverage through new health insurance exchanges. A key issue for the exchanges is whether enough younger and healthier people will sign up for coverage to avoid significant adverse selection in which only older and sicker uninsured adults enroll, thus driving up premiums. This brief examines which uninsured adults ages 18 to 64 are most likely to purchase insurance through the exchanges.

This set of Frequently Asked Questions (FAQ) provides guidance on how health insurance Marketplaces will verify incomes of applicants that qualify for premium tax credits or cost-sharing reductions. CMS has determined that they will have sufficient resources to request and process additional income documentation such that the sample size is 100 percent. However, state-based Marketplaces are allowed to determine their own sample size percentage for this group, as long as it is statistically significant.

These templates were released as part of the Paper Work Reduction Act notice, and represent the metrics that the Department of Health and Human services propose state-based marketplaces collect in order to monitor and evaluate their operations.

This educational slide deck, prepared by Manatt Health Solutions, provides detailed information on Advance Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs). It is designed as a tool to educate navigators, certified application counselors, and other assistors, as well as Marketplace staff, eligibility workers,  and others that need to understand and be able to explain how APTCs and CSRs work in practice. This presentation gives the audience a more visual display to aid in the comprehension of the technical information related to APTCs and CSRs. The document begins with a glossary of key terms and the general role of APTCs and CSRs, and then takes a deeper dive into the technical components.