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[Solved] ACA Subsidy with OOP calculation

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 Greg
(@earliretca)
Active Member Customer
Joined: 2 years ago
Posts: 3
Topic starter  

It seems that PRC is not capping the ACA subsidy at the chosen ACA Insurance Premium amount when there are out-of-pocket expenses.

For example, say during Period 3, the Insurance Premium is $23681 and the SLCSP is $32046, so in this case the user has chosen a lower-cost Bronze plan instead of the baseline Silver plan. When there are no Period 3 healthcare OOP expenses, PRC computes an ACA Subsidy Amount of $26717, which seems plausible, and the Net Healthcare Expenses is $0, also plausible.

If instead the OOP expenses are, say, $7000, PRC computes an ACA Subsidy Amount of $26261, which seems plausible. However, PRC computes a Net Healthcare Expense of $4420, which does not seem to be correct. This amount equals the Insurance Premium ($23681) + OOP ($7000) - ACA Subsidy Amount ($26261). However, it is my understanding that the subsidy is capped at the Insurance Premium if the premium is less than the full subsidy. So, in the above case, the subsidy should be $23681, giving a Net Healthcare Expense of $7000.

I'm still learning the subtleties of ACA. Is my understanding incorrect, or should the subsidy be capped in PRC?

[I'm using vPRC2024.1.4. I set overall inflation and healthcare inflation to zero to see the above effects more clearly.]



   
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(@smatthews51)
Member Admin
Joined: 5 years ago
Posts: 1140
 

@earliretca This is a subtlety that I wasn't aware of but after considerable digging I have confirmed that you are correct. I'll get a fix into PRC2024 within the next few days. Thanks for bringing this to my attention!

Stuart



   
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 Greg
(@earliretca)
Active Member Customer
Joined: 2 years ago
Posts: 3
Topic starter  

Thanks Stuart. This issue is resolved for me in PRC2024.1.5.4.



   
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