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CMS Issues Clarification Regarding Third Party Payment of Premiums

cms logoOn November 4, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a frequently asked question (FAQ) [PDF 112 KB] related to third-party payments of premiums for qualified health plans (QHPs) in the Health Insurance Marketplace. Since then, questions have arisen whether this FAQ applies to payments of premiums and cost sharing made on behalf of QHP enrollees by certain types of third-party payors.

As a result, earlier this month CMS posted additional FAQs [PDF 172KB] to clarify that the November 4, 2013, FAQ on third party premium assistance does not apply to the Ryan White HIV/AIDS Program. The new CMS FAQ states that third party premium and cost-sharing payments made by state and federal programs and grantees, including the Ryan White HIV/AIDS Program, on behalf of QHP enrollees are allowable and encouraged.

The statement also clarifies that a Marketplace may permit Indian tribes, tribal organizations, and urban Indian organizations to pay QHP premiums on behalf of members who are qualified individuals.

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