Benefits to Agencies – not quantified. The Marketplace matching programs improve the accuracy of data used for making program eligibility determinations, and ensure that individua ls are correctly determined and are not inappropriately enrolled in multiple programs. Improved data quality helps ensure that eligibility determinations and other decisions affecting APTC are accurate, which helps avoid future improper payments. This avoidance of future improper payments fits the third cost benefit analysis key element but hasn’t been quantified. Using data made available through the Marketplace matching programs in combination with an individua l applicant’s attestation of his or her personal information is more reliable than relying solely on applicant attestations. The use of data matching mitigates the risk of fra ud and abuse by 1 This estimate is significantly less than those included in prior CBAs because CMS has refined the application process and also has a better understanding of the time associated with applying for/enrolling in a QHP. The estimate is based on an ½ hour-average to complete an application for QHP coverageplus an additional 1 hour for the consumer to provide supporting documentation to the Marketplace should a datamatching issue occur. 2 Enrollees in QHPs have the opportunity each year to be automatically reenrolled in a QHP or to return to the Exchange to choose a new plan – however, Exchanges encourage enrollees to update their information and reevaluatetheir health coverageneeds for the coming year. Furthermore, enrollees are required to report certain life changes as they occur, since they may impact coverage and/or participation in insurance affordability programs. CMS has elected to usethe entire universe of 2021 QHP enrollees (12 million) in this CBA in order to present the most conservative casefor consumer opportunitycosts. applicants or third parties by requiring that personal information provided on an eligibility application match known data on the individua ls. Benefits to Enrollees of obtaining health coverage – quantified, but outside the scope of the 4 key elements For plan year 2021, 12,004,365 consumers enrolled in a QHP across all Exchanges. Of these, 88% received APTC, with an average value of $509 per month (annualized to $6,108 per year). In total, therefore, approximately $64.5 billion in APTC was provided to enrollees in plan year 2021.3 Approximately 51% of the QHP enrollees in plan year 2021 received financial assistance through CSRs when enrolling ...
Benefits to Agencies – not quantified. The Marketplace matching programs improve the accuracy of data used for making program eligibility determinations, and ensure that individuals are correctly determined and are not inappropriately enrolled in multiple programs. Improved data quality helps ensure thateligibility determinations and other decisions affecting advanced premium tax credits (APTC) areaccurate, which helps avoid future improper payments. This avoidance of future improper payments fits the third cost benefit analysis key element . Using data made available through the Marketplace matching programs in combination with an solely on applicant attestations. The use of data matching mitigates the risk of fraud and abuse by applicants or third parties by requiring that personal information provided on an eligibility application match known data on the individuals. Benefits to Enrollees of obtaining health coverage quantified, but outside the scope of the 4 key elements For plan year 2019, 10,579,744 consumers enrolled in a QHP across all exchanges. Of these, 87% received an advanced payment of the premium tax credit (APTC), with an average value of $514 per month (annualized to $6,168 per year). In total, therefore, approximately $56.8 billion in APTC was provided to enrollees in plan year 2019.1 Approximately 52% of the QHP enrollees in plan year 2019 received financial assistance through cost-sharing reductions when enrolling in a silver-level plan. The financial estimate of this benefit is not quantified here, as it is dependent on individual utilization of medical services. Additionally, a significant number of consumers receive health coverage through Medicaid, CHIP, or a BHP, and received eligibility determinations for that coverage based on data made available through these agreements. Because of the wide variety in state approaches to making and reporting eligibility determinations, the number of enrollees in these programs is not quantified here. The financial benefit of having health coverage, whether through a QHP, Medicaid, CHIP, or BHP varies by individual and individual health needs, and is therefore not estimated here. While these benefits to consumers are made possible in part by the Marketplace matching programs, the benefits are ultimately paid with federal funds (or, in the case of Medicaid and CHIP enrollees, with a combination of federal and state funds). Neither that funding nor these benefits to consumers can be considered a direct cost or benefit of conducting the ...
Benefits to Agencies – not quantified. The Marketplace matching programs improve the accuracy of data used for making program eligibility 38 2 Estimate is based on an ½ hour-average to complete an application for QHP coverage plus an additional 1 hour for the consumer to provide supporting documentation to the Marketplace should a data matching issue occur. 3 Enrollees in QHPs have the opportunity each year to be automatically reenrolled in a QHP or to return to the Exchange to choose a new plan – however, Marketplaces encourage enrollees to update their information and reevaluate their health coverage needs for the coming year. Furthermore, enrollees are required to report certain life changes as they occur, since they may impact coverage and/or participation in insurance affordability programs. CMS has elected to use the entire universe of 2022 QHP enrollees (14.5 million) in this CBA in order to present the most conservative case for consumer opportunity costs. determinations, and ensure that individuals are correctly determined and are not inappropriately enrolled in multiple programs. Improved data quality helps ensure that eligibility determinations and other decisions affecting APTC are accurate, which helps avoid future improper payments. This avoidance of future improper payments fits the third cost benefit analysis key element but hasn’t been quantified. Using data made available through the Marketplace matching programs in combination with an individual applicant’s attestation of his or her personal information is more reliable than relying solely on applicant attestations. The use of data matching mitigates the risk of fraud and abuse by applicants or third parties by requiring that personal information provided on an eligibility application match known data on the individuals.
