CMS Releases Guidance on Redetermination Process for 2016

CMS issued guidance on the 2016 annual redetermination process for the Federally-facilitated Marketplace, with significant updates from 2015. While the guidance retains a provision allowing enrollees who take no action prior to the enrollment deadline to maintain coverage, the processes for determining eligibility for 2016 have changed. Most notably, enrollees who take no action will receive a new eligibility determination updated for 2016 based on either updated tax return information from the IRS or information from the most recent eligibility application. Additionally, enrollees who failed to reconcile their advance payments of the premium tax credit (APTC) from the 2014 coverage year will be re-enrolled in coverage without APTC or cost-sharing reductions.