Low-income Americans will still be able to use health savings accounts after Jan. 1, 2014.
Officials at the Center for Consumer Information and Insurance Oversight talk about how they will make that possible in a new batch of answers to questions about provisions of the Patient Protection and Affordable Care Act that are set to take effect at the beginning of next year.
One question in the batch refers to a conflict between HSA plan design rules -- which are supposed to make consumers who get routine sick care feel pain in the wallet -- and the new PPACA "cost-sharing reduction" rules.
To give users of the HSA tax break "skin in the game," the IRS sets minimum deductible levels for HSA-compatible health plans.
Meanwhile, the new PPACA cost-sharing reduction rules are supposed to provide subsidies to help low-income people cover the cost of health insurance deductibles, co-payment requirements and coinsurance bills, to reduce the pain in the wallet that those low-income consumers feel when they see the doctor or go to the hospital.
For low-income people who want to use HSAs, the problem is that getting help with paying deductibles could make it impossible for a "qualified health plan" purchased through an exchange to meet the HSA program "high-deductible health plan" requirements, CCIIO officials said in the new guidance.
"An individual who would not be eligible for the tax advantages of an HSA because the plan variation to which he or she would be assigned does not qualify as a [high-deductible health plan] may purchase the plan without cost-sharing reductions," officials said.
CCIIO officials also are urging insurers and exchanges to warn consumers about the potential problem, both during open enrollment and when an individual has a change in eligibility for cost-sharing reductions.
In the new batch of guidance, officials also answered questions about exchange reporting requirements and exchange plan broker requirements.
State-run exchanges will have to submit reports, including audited financial statements, to the Centers for Medicare & Medicaid Services (CMS), every year.
Exchanges will have to archive materials related to consumer complaints and audits for 10 years.
Brokers and other entities that help consumers sign up for exchange plan coverage will have to meet the data security standards described in the Minimum Acceptable Risk Standards for Marketplaces (MARS-E) package of documents, officials said.
The staff of the board of Covered California, the entity running California's health insurance exchange programs, explained how Covered California might apply the MARS-E rules in a brief posted on the Web in February.
The MARS-E rules require fingerprint-based criminal background checks before an entity hires any person who will have access to personal health information, according to the brief.