Amended by section 1001 of HCERA. Reduces cost sharing for individuals between 100 percent and 400 percent of the Federal Poverty Level (FPL) who enroll in a silver-level Qualified Health Plan (QHP) in the individual market. First, reduces out-of-pocket (OOP) limits under ACA section 1302(c)(1) – set at Health Savings Account dollar amounts – by: two-thirds for those 100-200 percent FPL; one-half for those 200-300 percent FPL; and one-third for those 300-400 percent FPL.
Provides for coordination – including an HHS adjustment to OOP limits if necessary – with actuarial value limits so that the plan’s share of the total allowed costs of benefits does not exceed 94 percent (100-150 percent FPL), 87 percent (150-200 percent FPL), 73 percent (200-250 percent FPL) and 70 percent (250-400 percent FPL).
Provides additional cost-sharing reductions for low-income beneficiaries, increasing the plan’s share of the total allowed costs of benefits to 94 percent (100-150 percent FPL) and to 87 percent (150-200 percent FPL). Separately, eliminates cost-sharing for Indians enrolled in a QHP who are under 300 percent FPL.
Sets parameters for administering the subsidies between QHPs and HHS, including HHS making periodic and timely payments to the issuer equal to the value of the reductions.