Lexology March 17, 2025
On March 10, 2025, the Centers for Medicare and Medicaid Services (CMS) proposed a rule that in many respects reverts to pre-Biden administration rules and definitions for health care marketplaces across the country. The proposed rule would:
- End the availability of the monthly special enrollment period (SEP) for individuals with household incomes below 150% of the federal poverty level (FPL).
- Require all marketplaces to reinstitute pre-enrollment verifications of eligibility for SEPs and require further verifications of income when there is no tax data available for verification.
- Require marketplaces to continue to re-enroll an individual into the same plan but reduce advance payment of the premium tax credit by $5 when a consumer does not proactively verify their ongoing eligibility...
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