Thousands to Be Questioned on Eligibility for Health Insurance Subsidies

The Obama administration is contacting hundreds of thousands of people with subsidized health insurance to resolve questions about their eligibility, as consumer advocates express concern that many will be required to repay some or all of the subsidies. Of the eight million people who signed up for private health plans through insurance exchanges under the new health care law, two million reported personal information that differed from data in government records, according to federal officials and Serco, the company hired to resolve such inconsistencies.

  • The government is asking consumers for additional documents to verify their income, citizenship, immigration status and Social Security numbers, as well as any health coverage that they may have from employers. People who do not provide the information risk losing their subsidized coverage and may have to repay subsidies next April.

Federal subsidies for the purchase of private insurance are a cornerstone of the Affordable Care Act. More than eight out of 10 people who selected health plans through the exchanges from October through mid-April were eligible for subsidies, including income tax credits. So far this year the federal government has paid out $4.7 billion in subsidies, and the amount is expected to total $900 billion over 10 years.

  • Since June 1, the government has notified hundreds of thousands of people that “the information in your application doesn’t match what we found in other records.” Accordingly, the notice says, “you need to follow up as soon as possible and provide more documents to make sure the marketplace has the correct information.”

“If you don’t send the needed documents,” it says, “you risk losing your marketplace coverage or help you may be receiving to pay for such coverage.”

The government has a long list of documents that consumers can use to establish their eligibility. These include copies of birth certificates, Social Security cards, high school diplomas, driver’s licenses, pay stubs and voter registration cards.

  • “The law requires us to double- and triple-check this data,” said Julie Bataille, a spokeswoman at the Centers for Medicare and Medicaid Services, so “we’re reaching out to consumers — via mail, email and phone calls — to encourage them to provide supporting documentation.”

For months, Republicans have asserted that the administration was lax in verifying the income and eligibility of people who applied for insurance subsidies. The government enrolled people “before the systems were in place to accurately confirm eligibility,” said Representative Diane Black, Republican of Tennessee.

In some cases, the government told consumers that they had been found eligible for subsidized insurance and could enroll right away. But to keep the coverage, it said, they had to “send the marketplace more information” to verify their eligibility.

Representative Erik Paulsen, Republican of Minnesota, said “many Americans are going to find out that they owe money to the Internal Revenue Service because their premium tax credits were paid incorrectly.”

*Modified from a article



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