August 22, 2019

Recent Reports Show Decline in Enrollment for Unsubsidized Population

CMS released two reports on August 12, 2019, showing a significant drop in exchange enrollees who did not qualify for advance payments of the premium tax credit (APTCs), therefore requiring those persons to pay for the entire premium themselves.  The reports show a decline of 40% between 2016 and 2018 for those without any APTC.  Health insurers offering plans on the exchanges often count on the unsubsidized individuals to pay the premiums that those who qualify for subsidies, regardless of the amount, often don’t pay.  This non-payment often results in recoupment from providers for services already performed for the unsubsidized population, making it difficult for plans to contract with providers in order to meet network adequacy requirements.