Regulators want to accommodate existing programs that help sick consumers pay for federal exchange coverage without letting new aid programs drive up claims.
Officials at the Center for Consumer Information & Insurance Oversight talk about private premium assistance programs in a new collection of two answers to frequently asked questions.
CCIIO supervises all Patient Protection and Affordable Care Act exchanges and administers the federal exchanges.
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In November, CCIIO discouraged private charities and other private third-party payers from paying the premiums for consumers who buy private qualified health plan exchange coverage.
PPACA itself provides subsidies – in the form of premium assistance tax credits. But, if private organizations help people pay the premiums, that could skew the insurance risk pool, CMS officials said in November.
HHS officials have worried PPACA rules might already make the exchanges very attractive to sick people and not attractive enough to young, healthy people to hold risk levels down.
In the new guidance, CCIIO officials acknowledge that existing programs, such as the federal Ryan White HIV/AIDS program and Indian organization aid programs, already have permission to help some consumers pay for coverage.
A federal agency, the Health Resources Services Administration, has given grantees advice about how to use the grants to pay for QHP coverage for people with HIV or AIDS.
Indian tribes, tribal organizations, urban Indian organizations, and state and federal government programs and federal program grantees can pay QHP premiums for sick people, officials say in the new guidance.
Other private organizations can pay QHP premiums, but only if they base support decisions on the applicants' finances and not on the enrollees' health, officials say.
If a private group helps people with financial problems pay for coverage, the organization ought to pay for a consume's premiums for an entire policy year, not just part of it, officials say.
Similarly, if a private group helps a consumer with QHP deductibles or other cost-sharing amounts, the group should provide that help for the whole policy year, officials say.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
