HHS Releases Exchange Regulations To Help Individuals Apply For Coverage

Along with the 13 exchange grants, HHS also released three regulations designed to streamline the process of applying for coverage. They are: 1) guidelines and standards for small employers participating in the Small Business Health Options Program or SHOP exchange, 2) eligibility rules for premium tax credits, 3) coordinating and simplifying the exchange with Medicaid and Children’s Health Insurance Program eligibility.

“It’s really three rules that connect to one another,” HHS Secretary Kathleen Sebelius said on a call with reporters. “If you look at this from a consumer lens, we don’t anticipate that individuals, families, small business will have to try to figure out which door to go through. This anticipates a common portal. So somebody enters the marketplace and the system will direct them to the right program or plan. They will not have to, as they do right now, try to sort through confusing options, multiple options.”

The system, in other words, is meant to work in the following manner: an individual would enter the exchange and receive an advanced refundable tax credit that the IRS would directly send to the insurance carrier a monthly payment. Once the individual files their tax returns, they will have to credit the government back if their income fluctuated throughout the year.