Up to 115,000 people stand to lose Obamacare health insurance coverage by Sept. 30, and another 336,000 people are at risk of losing federal subsidies to pay for that coverage, officials revealed Monday.
The 115,000 people failed to show valid proof of citizenship or legal residency for the insurance plans they bought through HealthCare.gov, a top federal official revealed Monday.
But the Obama administration also said those people with questionable eligibility will be able to keep their coverage if they continue paying their premiums, provide documentation showing their legal status in the U.S., and sign up again in their health plans during a special enrollment period.
If they don't, "at the end of September, they'll be terminated," said Andy Slavitt, principal deputy administrator of the Centers for Medicare and Medicaid Services. Many of those people also will face demands from the Internal Revenue Service that they repay federal subsidies they received this year to help them pay for their health insurance plans.
The administration also said it was warning another 336,000 people they need to provide proof of income by Sept. 30, or risk losing those federal subsidies that reduce—often greatly—what they personally pay in monthly insurance premiums.
Without documentation, as of Nov. 1, the subsidies will be changed to reflect the income data that the federal government has about the households in question, Slavitt said. CMS was sending reminder letters to those people Monday.
Those people comprise 279,000 households whose enrollment information, when they applied for Obamacare via HealthCare.gov, contained claims about income that did not match other data the federal government has about them. HealthCare.gov is the insurance marketplace that sells insurance in the 36 states not running their own health exchange.
Under the Affordable Care Act, only U.S. citizens or legal residents are eligible for enrollment in insurance plans sold through the health-care exchanges.
The amount of money people receive in subsidies, or premium assistance, depends on their income levels; as a rule, people who earn less get more in subsidies.
More than 8 million people enrolled in Obamacare plans by mid-April, the end of open enrollment for 2014. The vast majority, around 86 percent, received some kind of subsidy, because their household income was between about one to four times the federal poverty level, or about $46,000 to $92,400, for a family of four.
About 5.4 million of the nationwide enrollment came via HealthCare.gov.
As of May 30, there were data-matching issues for 966,000 individuals who claimed they were legal residents of the U.S. There were also data-matching problems related to another 1.2 million households whose members were enrolled through HealthCare.gov.
Since then, 851,000 individuals have submitted documentation that they are citizens or legal residents, according to the Centers for Medicare and Medicaid Services. Slavitt said those cases are either "resolved or in the process of being resolved."
Another 897,000 households have submitted proof of income qualifying them for subsidies. As of Sunday, about 467,000 households with income data-matching issues have been closed, and another 430,000 or so are in the process of being resolved, CMS said.
The remainder not only face the prospect of losing their subsidies after Nov. 1, but also may be forced to repay the difference between what they were eligible for in terms of subsidies, and what they actually received.
Slavitt said that problems with matching data submitted by enrollees applying for insurance will happen again in future Obamacare enrollment cycles, including the second one, which runs from Nov. 15 to Feb. 15.
"This year isn't a one-time event," Slavitt said. "Circumstances in peoples' lives will always change."