- On February 12, 2024
The Biden Administration has released two new sets of frequently asked questions (FAQs) documents addressing policy issues of the Affordable Care Act (ACA). The first set clarifies the ACA’s preventive care requirements and updates policy regarding first-dollar coverage of contraceptives. The second set explains how the ACA’s premium tax credits interact with the affordability of employer-sponsored coverage for employees and their families.
Contraceptive Coverage FAQs
The new FAQs reiterate the ACA requirement for most group health plans and health insurance policies to cover certain preventive care services without cost-sharing, including providing comprehensive contraceptive care to adolescent and adult women. Plans must cover at least one form of contraception in each category of the FDA’s Birth Control Guide, with exceptions only for male sterilization surgery.
The updated guidance clarifies that plans can impose some medical management or cost-sharing on individual forms of contraception within a category if they offer at least one therapeutically equivalent option in that category with no out-of-pocket costs. However, if a plan chooses this route, it must offer an exception process to ensure medically necessary access to any specific method or product.
Premium Tax Credit FAQs
The updated guidance clarifies when family members are eligible for refundable tax credits to offset individual exchange-market coverage costs, even if they have access to employer-sponsored plans through a relative. While large employers must offer “minimum value” and “affordable” coverage to employees (and at least “minimum essential coverage” to dependent children), the affordability test considers only the cost of individual coverage, not family coverage.
Guidance issued in 2022 allowed family members offered “unaffordable” family coverage to access exchange-based subsidies without penalizing the employer. These latest FAQs clarify that this option only applies if all employer-sponsored family coverage options are unaffordable. They also provide updated information regarding reporting, claiming, reconciling premium tax credits on tax returns, and the impact of unemployment compensation on eligibility.