§18082 Advance Determination and Payment of Premium Tax Credits and Cost-sharing Reductions

Summary

The Secretary, working with the Treasury Secretary, must set up a program that lets an Exchange ask for a fast check of a person’s income so they can get premium tax credits and cost-sharing help when they sign up for a health plan through the Exchange. The Secretary must tell the Exchange and the Treasury about each decision. If an employee gets a credit because their employer did not offer proper coverage or the coverage was unaffordable or did not meet minimum value, the Secretary must tell Treasury the employer’s name and employer ID. Treasury will pay the credits and reductions in advance to the insurance companies to lower the person’s monthly premiums. The income check is usually done during open enrollment and is based on the most recent tax year for which information is available. The Secretary must also allow changes when income, family size, filing status, unemployment, or other big facts change. Someone who has a 20 percent or larger drop in income or who files for unemployment can use later or estimated income to get a new decision. Treasury pays the credits to issuers monthly (or another schedule). Insurers must lower the bill by the payment, tell the Exchange and Secretary, show the reduction on bills, report nonpayment, and give a 3-month grace period before ending coverage. No federal payments go to people not lawfully present. States may make extra payments for people if they want.