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.
Consumer Assistance Resource Guide: MAGI Household Income Eligibility Rules
Manatt Health Solutions
Early evidence from across the nation suggests that consumer assisters are playing a vital role in helping people enroll in the new coverage options made possible by the Affordable Care Act. The following resource guide on MAGI Household Income Eligibility Rules is part of a Consumer Assistance Resource Guide series developed to help consumer assisters answer some of the most common eligibility and enrollment questions.
To be eligible for an Insurance Affordability Program (IAP) — Medicaid, CHIP or Advance Premium Tax Credits and Cost Sharing Reductions — an applicant’s income must be below a certain eligibility level. Modified Adjusted Gross Income (MAGI) rules—primarily based on federal tax rules—are used to calculate income eligibility when an individual is applying for an IAP. This guide, prepared by Manatt Health Solutions, explains the types of income included and excluded when determining eligibility.