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Enrollment and Eligibility (ENR) FAQ

Guidance for FAQ regarding Premium Payment and Premium Payment Transactions

Program Area: Enrollment and Eligibility (ENR)

Question: An Issuer has a fully subsidized member with a $100 premium and the full $100 is covered by an Advanced Payment Premium Tax Credit (APTC). If Federal subsidies cannot be used for abortion payments, will the Federally-facilitated Marketplace (FFM) pay an Issuer $99 for the APTC and require an Issuer to collect $1 from the member, making the member's total premium equal $100?

Answer: If an Issuer has a fully subsidized member with a $100 premium and the full $100 is covered by an Advanced Payment Premium Tax Credit (APTC), the Issuer cannot apply any portion of that Federal subsidy for an abortion payment. If permissible by an Issuer's State, the Issuer may opt to establish a separate allocation account for the collection of additional premium payments from a member who requires coverage for abortion services. However, an Issuer must comply with a State law that prohibits abortion coverage in Qualified Health Plans.

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: July 08, 2014

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.