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Why Some ACA Customers May Lose Their Subsidy

By Kyle Marshall | December 8, 2014 | Healthy Lifestyle, Insurance Education

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We’re now a year into the health insurance exchange under the Affordable Care Act. With that milestone comes a change from the federal government that will affect about 5,500 Blue Cross and Blue Shield of North Carolina customers.

It could mean that you’ll see a reduction — or even elimination — of the federal subsidy that you received to help offset the cost of health insurance.

The Centers for Medicare and Medicaid Services (CMS) wants to be sure that everyone who received a subsidy to purchase health coverage for this year in fact qualified for it. CMS checks what applicants report as income against IRS records from tax filings.

Needed: Proof of Income

In early November, CMS notified health insurance companies that some policyholders’ subsidies are being eliminated or reduced. The change is occurring in cases where policyholders have not been able to document their income. In some instances, policyholders hadn’t responded to requests from CMS to provide proof of income.

If the government has determined that your ACA subsidy will either be reduced or eliminated, you should expect to receive a notice from CMS this month.

What BCBSNC Is Doing

If you’re affected, the December premium bill you receive from BCBSNC will reflect the change in subsidy. And if you make payments by automatic draft, we’ll turn off auto-draft for December — to help you avoid an unplanned higher cost — and send a new bill that accounts for the reduction or loss of subsidy.

In some cases you might get your subsidy restored by updating your 2014 income in your ACA profile at, or by entering current employment and income information when applying for 2015 coverage.

The number of affected BCBSNC customers represents about 2 percent of our total ACA customer base for 2014. Nationally, about 120,000 households can expect subsidy reductions this month, according to CMS.

BCBSNC customers with questions about the subsidy adjustments should contact the federal marketplace at 800-318-2596. For questions about BCBSNC billing, please call Customer Service at 888-206-4697.

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