On November 15, 2023, the Centers for Medicare & Medicaid Services released its proposed 2025 Notice of Benefit and Payment Parameters, the annual regulation which governs core provisions of the Affordable Care Act. This expert perspective focuses on aspects of the proposed rule likely to be of interest to state officials, including requirements for State-Based Marketplaces to align with the standards of the Federally Facilitated Marketplace, proposals for states to update essential health benefits, and initiatives to ease the eligibility and enrollment process for consumers.
Advance Premium Tax Credits and Cost-Sharing Reductions: A Primer for Assistors
Manatt Health Solutions
Advance Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs) remain critical to the ability of marketplaces to offer affordable coverage. It is especially important that marketplace staff, eligibility workers, navigators, certified application counselors, and other assistors are well-informed regarding the role of APTCs and CSRs in the continuum of coverage created by the Affordable Care Act. While there are numerous regulations explaining how APTCs and CSRs work, much of this information is very technical. This brief, prepared by Manatt Health Solutions, is designed to make it easier to understand APTCs and CSRs at a deeper level. Information provided in this brief includes eligibility criteria, options for using APTCs and a discussion on how the APTC is calculated, and a detailed review of the income measure used to evaluate eligibility.