The Obama administration last week said it will offer relief to consumers unable to purchase health insurance through state-run exchanges that have been hampered by technical difficulties.
In a three-page memo issued Friday by the Centers for Medicare and Medicaid Services, the agency said the federal government will allow subsidies for individuals who were unable to buy insurance through an online exchange and signed up for a health plan outside the marketplace. These individuals will now be allowed to sign up for coverage in the exchange and receive federal subsidies on a retroactive basis, starting on the date they first enrolled in a health plan outside the exchange.
To read more about state-exchange enrollment issues see: http://eba.benefitnews.com/news/fed-tech-issues-hurting-state-run-exchanges-2737671-1.html?mstr_chnnl=ebn_health_care_reform
Individuals with no coverage in or outside of the exchanges will, once enrolled, be considered to have been covered retroactively to the date, established by the marketplace, on which coverage would have been effective absent technical difficulties, CMS says.
In both circumstances, the health plan provider will be required to adjudicate or re-adjudicate, as applicable, the enrollees claims incurred during the retroactive period, and refund or credit to the individual any excess cost sharing or premiums paid, according to the CMS guidance.
The new policy, although welcomed by most, is the latest in a string of changes related to the Affordable Care Act that continues to complicate enrollment for individuals and employers.
A copy of the CMS memo can be found at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/retroactive-advance-payments-ptc-csrs-02-27-14.pdf
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