The Centers for Medicare & Medicaid Services proposed a rule requiring consumers to verify their eligibility before receiving federal premium subsidies through the Affordable Care Act's marketplaces. Under the proposal, people seeking advance payments of the premium tax credit or income-based cost-sharing reductions would have to pass verification before receiving the aid, a shift from current enrollment practices.
Currently enrolled consumers would be required to return to the exchange and confirm their eligibility annually to remain eligible for financial assistance. If they do not re-verify, they would be automatically re-enrolled without subsidies, CMS said. The requirements would take effect for 2028 health plans.
A pre-enrollment verification window would begin on August 1, 2027, allowing consumers to verify information ahead of the next coverage year. The exchange could use this period to request documents to confirm information on applications, according to the agency.
"Implementing the Working Families Tax Cuts legislation will protect taxpayer dollars and restore trust in the Exchanges by verifying eligibility before that money leaves the building," said CMS Administrator Dr. Mehmet Oz.