On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.
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.