Third-Party Payment Programs May Provide Another Way to Help Consumers Keep Affordable Health Coverage

By Zachary Baron

As millions of newly insured consumers gain peace of mind from newfound health insurance coverage, we know that the work to help consumers #GetCovered and #StayCovered is just beginning.

We also know that the more affordable coverage is, the more likely consumers are to enroll. Eighty-five percent of individuals that selected marketplace plans during the first open enrollment period (OE1) were determined eligible to receive financial assistance to help pay their premiums. And it’s crucial to raise awareness of the availability of financial help because uninsured consumers who did not start to explore their new marketplace options during OE1 cited “I can’t afford insurance” as the number one reason why they did not try to enroll.

Our new issue brief, Third-Party Payment: An Innovative Financial Help Model, discusses efforts being made in Wisconsin and Oregon to make coverage even more affordable for marketplace enrollees through the implementation of third-party payment programs, and provides a detailed history of federal guidance on third-party payments to-date.

Third-party payments are when private organizations supplement the financial help enrollees are otherwise receiving from the marketplace. Third-party payments from private and nonprofit foundations can only be made based on an enrollee’s financial status (health status cannot be considered), and must cover the full plan year. Third-party payment programs are not the only way to make coverage more affordable, but enrollment stakeholders may want to explore whether such a program would be beneficial in their region or community.


Download the full report to read more about this innovative financial help model for marketplace enrollees and key questions for enrollment stakeholders to take into consideration.

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