CMS Offers Special Enrollment Period to Correct Income Counting Error

CMS is offering a special enrollment period (SEP) for those enrollees whose household incomes were incorrectly inflated during the last open enrollment period because the system erroneously counted dependents’ social security incomes, reports While the error in the eligibility determination system was fixed on April 17, 2015, it may have resulted in enrollees being incorrectly determined ineligible for Marketplace subsidies or eligible for lower subsidies than they should have been. In states that have not expanded Medicaid, correcting this error might lead enrollees to lose subsidies, if the corrected income falls below 100% of the federal poverty level and above the state’s Medicaid eligibility levels. CMS will reach out to affected consumers to ask them to update their applications and to notify them that they may be able to make changes retroactive to their original coverage date, as early as January 1, 2015.

CMS Encourages Insurance Commissioners to Keep Premiums Affordable

CMS’ CEO for Health Insurance Marketplaces, Kevin Counihan, sent a letter to state insurance commissioners encouraging them to ensure that coverage remains accessible and affordable as they determine final premium rates for 2016. As a result of conversations with issuers and state officials to ascertain drivers of premium increases, Couinhan noted that commissioners should consider: claims data indicating recent enrollees are healthier than enrollees who shopped during the first open enrollment period; the moderate trends in overall medical costs in 2015; CMS’ 100% coinsurance rate for 2014 reinsurance; and, that risk corridor collections are anticipated to be sufficient for all 2014 payments. CMS is advising states to hold public hearings to ensure rates receive appropriate public scrutiny.

IRS Report Finds One-Third of Tax Credit Recipients Have Not Reconciled

An Internal Revenue Service (IRS) report on the 2014 tax filing season revealed that, as of May 2015, roughly two-thirds of the 4.8 million filers who should have filed the form to reconcile their premium tax credits or to potentially receive a credit at tax filing time have done so. The remainder should do so as quickly as possible to retain their potential eligibility for premium tax credits in the upcoming open enrollment system. Of the 3.2 million taxpayers who have reconciled, approximately 40% were refunded an average of $600 and 50% repaid an average of $800. While a total of 12 million taxpayers claimed an exemption from the shared responsibility payment, approximately 7.5 million taxpayers paid the tax. The average amount owed was $200, and the majority of taxpayers (85%) who paid the individual shared responsibility payment still received a net refund.