Court Says Marketplace Insurers Are Entitled to Payments for Reducing Cost-Sharing, but Must Offset Premium Tax Credit Increases

Commonwealth Fund August 18, 2020
Timothy S. Jost

Toplines

Two new legal decisions deal with the way insurers are compensated for reducing cost-sharing for low-income people in marketplace plans

Court say insurers are entitled to reimbursement for 2017 cost-sharing payments but may not receive the full payment for following years

On August 14, the Federal Circuit Court of Appeals released two decisions in cases brought by insurers claiming damages because the Trump administration stopped making so-called cost-sharing reduction (CSR) payments in the fall of 2017. These payments were created by the Affordable Care Act (ACA) to compensate insurers for reducing cost-sharing for low-income individuals in silver-level marketplace plans. In one case, the court decided that the insurers were entitled to reimbursement for the payments and should receive them...

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