The FFM Will Begin Employer Notifications of Employee Subsidy Determinations in Spring 2016 - What to Expect and How to Respond
(Posted on 05/04/16)
The advance premium tax credits (lovingly referred to as subsidies) are just that - advanced tax credits. That means that consumers who bought subsidized coverage through the exchanges just went through the process of reconciling the credit as they filed their 2015 taxes. Their actual MAGI is compared to their estimate, and the tax credit gets adjusted accordingly. This year, H&R Block reportedthat "a majority of its clients (60 percent) who enrolled in a state or federal marketplace and received the Advance Premium Tax Credit (APTC) are paying back a portion of that credit when they file. The average amount paid back is higher - $579 this year compared to $530 last tax season."

While the income levels can be reconciled through the 1040, there are additional processes that had to be built to confirm if the applicant had an affordable offer of minimum value coverage from an employer, which would disqualify them from subsidy eligibility. There are a few new methods for collecting that information. One is the new ACA reporting requirements and another is an employer appeals process.

Starting this spring, the FFM will be sending out marketplace appeals to employers if one of their employees receives a subsidy on the exchange and the employee provides the employers contact information. The purpose of this notification is to allow an employer to respond and provide information if the employers offer of coverage meets the ACA requirements in terms of affordability and the minimum value threshold. This appeal process will allow the employer to provide information on the quality of their plan offering that will affect the employees subsidy eligibility.

This is also good time to reinforce the behavior of employer's distributing the Notice to Employees of Coverage Options upon hire to make sure they are clear if their employer sponsored plan meets the ACA requirements, and thus precludes them from subsidy eligibility.

It is better for all involved if an employee does not receive a subsidy they are not entitled to, and can then avoid the painful repayment process next Spring.

Below are some FAQs and further details from CMS as well as a copy of the form the employer will use to respond to the notification.