Income, insurance status rules relaxed for health exchanges

By , Posted on 08 July 2013

The Obama administration is rolling back requirements for state and federal health insurance exchanges to verify the income and insurance status of people applying for coverage.

income, insurance status rules eased for exchangesHealth insurance exchanges, or so-called marketplaces, are being created to allow uninsured individuals and small businesses to purchase affordable coverage and are expected to open Oct. 1. 

To date 34 states have refused to create their own insurance exchanges, which means the federal government is now forced to operate them on the states' behalf.

Under health reform laws, the government will subsidize premiums for families earning up to 400 percent of the federal poverty limit for those purchasing plans on the online exchanges. Using 2013 poverty guidelines, that means a family of four earning up to $94,200 annually would be eligible for subsidies.

Prior to the final rule issued by the Department of Health and Human Services, exchanges were expected to verify applicants' income status and conduct random checks to determine their access to employer-sponsored coverage.

Under the new HHS rules, federally operated exchanges still will verify such information beginning in 2014, but 16 states and the District of Columbia operating their own exchanges can wait until 2015 to do so. "The rules also allow only random -- rather than comprehensive -- checks on income eligibility in 2014,"  according to Reuters.

For applicants not included in the sample, "the Exchange may accept the attestation of projected annual household income without further verification," the rule states.

News of the verification process starting later than planned comes on the heels of another health reform provision delay -- one that requires employers with more than 50 full-time workers to offer health insurance. That is also being delayed until 2015.

Related articles:

Key health reform provision delayed until 2015

Health insurance marketplaces: How do they operate and who benefits?

Cadillac tax explained: High-cost health insurance subject to big hit

Smokers face big penalties under health reform

Health insurance now tied to taxes

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Des Toups

Des Toups

Managing editor

Des Toups is a writer, editor and expert on insurance, cars and personal finance. He has written extensively about all three for national publications such as MSN and major newspapers such as the Seattle Times. He has been quoted about insurance issues in The New York Times, USA Today and Kiplinger's.


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