Maintaining affordability for all families is important for insurance to have the intended effect of improving access to care and protecting people from the financial stress of high medical costs. Individuals should therefore be screened for eligibility for premium subsidies as they enter the system and as life changes happen. Even if an exchange is not responsible for administering the subsidies that make coverage affordable, it must facilitate that process so families can seamlessly enroll in the right coverage with the correct subsidy level.
There should be minimal documentation requirements for individuals, while ensuring accuracy of the information. The federal Medicaid program allows for extensive documentation requirements; some states require individuals to go through a process akin to a mortgage application and demonstrate their level of assets, including the value of any burial plots they own.
This in-depth process is burdensome for both individuals and the states in question. A better approach is the one used for means-testing in Medicare Part B, where the previous year’s income data is accessed to determine subsidies. If the individual believes there is an error, then they have the opportunity to offer documentation to increase the subsidy.
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