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Group & Health Core Exam Old Group & Health Design & Pricing Forum

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  #1  
Old 09-15-2018, 01:19 PM
PersevY PersevY is offline
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Join Date: Aug 2018
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Default ACA cost sharing subsidy

In the solution to problem 1(c) Spring 2016, it says "All cost sharing is zero for Native Americans below 300% FPL for all metal plans", does this mean that the cost sharing for all individuals who are qualified for cost sharing subsidies is 0? won't this conflict with the concept of this subsidy and also the member max OOP limit?
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Old 09-15-2018, 05:13 PM
MATEseminars.dc MATEseminars.dc is offline
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College: Northern Arizona University
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Default ACA cost sharing for Native Americans

The syllabus is very limited on the details for this topic, and you can find it on page 8 of the study note "Implications of Individual Subsidies in the Affordable Care Act". What you stated is really all that there is in the source material on the topic.

From outside sources I have found that this zero cost share is a little misleading. It seems that there is only zero cost share for services acquired at a “IHS (Indian Health Service), Indian tribe, tribal*organization, urban Indian organization or through the Contract Health Service program.”

Source: https://www.healthinsurance.org/faqs...ions-for-them/

So if the qualified member received all services at a qualified provider they would not have any costs at the point of service. In turn the MOOP would not come into play either. Obviously this is different than what the monthly premium would be for the plan. That would be a totally different calculation.

I hope that helps.

-Dustin
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Old 09-16-2018, 12:55 AM
PersevY PersevY is offline
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Default

Thanks for clarifying on this!
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