Tax Credit or Cost Sharing Reductions- 2016? Check this!

On Exchange healthplan?- did you get Premium Tax Credit and cost sharing reduction payments in 2016?

CMS is re-determining subsidy eligibility for all on-exchange members again this year.

The Marketplace will use the newest income data available to re-determine advance payments of the premium tax credit (APTC) and cost-sharing reductions (CSR). This applies to enrollees who do not return to the Marketplace to update their application information and select a plan by December 15, 2016.

Also in October, CMS will send a Marketplace Open Enrollment Notice (MOEN) to all on-Exchange members.

This notice will contain certain basic information, including: a description of the annual redetermination and renewal process; the requirement to report changes affecting eligibility and the ways for reporting such changes; and the last day members can choose a plan for coverage starting January 1. For enrollees who authorized the Marketplace to request updated tax return information for use in the annual redetermination process and who are receiving APTC or income-based CSRs, this notice will have information on the process the FFM will use to establish APTC and CSR eligibility for 2017 for enrollees who do not actively reenroll.

Again this year, consumers who received subsidies in 2016 but did not file a 2015 federal tax return with Form 8962 to reconcile their APTC will be placed into a federal tax return (FTR) group. This could result in a loss of APTC and CSR eligibility. These consumers will receive a special version of the MOEN from CMS in October indicating that they are at risk for losing APTC in 2017. During Open Enrollment, this group will need to actively renew and include their latest income information or their APTC will be set to $0 for 2017.

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