Filed Under:Health Insurance, Individual Health

What if you disagree with an exchange?

CMS also has proposed creating a new class of PPACA
CMS also has proposed creating a new class of PPACA "certified application counselors." (AP Photo/Jacquelyn Martin)

The Centers for Medicare & Medicaid Services (CMS) has released draft regulations that could govern disputes involving the new health insurance exchanges.

The draft regulations, "Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals, etc." (CMS-2334-P), are set to appear in the Federal Register Jan. 22.

If the law takes effect on schedule and works as drafters expect, individuals who are completely uninsured may be able to sign up for Medicaid coverage or CHIP plan coverage through an exchange. Low-income and moderate-income uninsured individuals may be able to get free coverage, discounts on coverage and out-of-pocket costs, and tax credits they can use to help pay for coverage.

Individuals with access to group health plans may still be able to enroll in government health programs, or get subsidies they can use to buy coverage through an exchange, if they can show that the employee's share of the premiums for bare-bones, "Bronze level" coverage exceeds 9.5 percent of their family income.

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Nichole Morford

Nichole Morford
Managing Editor

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