Fact Sheets & Frequently Asked Questions (FAQs)
Additional FAQs and resources related to the Affordable Care Act may be available on other agencies’ websites, including:
Affordable Care Act
FAQs
- September 20, 2010
Affordable Care Act Implementation FAQs (Set 1)
This set of FAQs addresses implementation topics including compliance, grandfathered health plans, claims, internal appeals and external review, dependent coverage of children, out-of-network emergency services, and highly compensated employees.
- October 8, 2010
Affordable Care Act Implementation FAQs (Set 2)
This set of FAQs addresses grandfathered health plans, dental and vision benefits, rescissions, preventive health services, and ACA effective date for individual health insurance policies.
- October 12, 2010
Affordable Care Act Implementation FAQs (Set 3)
This set of FAQs addresses the exemption for group health plans with less than two current employees.
- October 29, 2010
Affordable Care Act Implementation FAQs (Set 4)
This set of FAQs addresses grandfathered health plans.
- December 22, 2010
Affordable Care Act Implementation FAQs (Set 5)
This set of FAQs addresses a variety of ACA implementation topics, the HIPAA nondiscrimination and wellness program rules, and the Mental Health Parity and Addiction Equity Act of 2008.
- April 1, 2011
Affordable Care Act Implementation FAQs (Set 6)
This set of FAQs addresses grandfathered health plans.
- November 17, 2011
Affordable Care Act Implementation FAQs (Set 7)
This set of FAQs addresses the Summary of Benefits and Coverage and Uniform Glossary requirements of PHS Act §2715 and the Mental Health Parity and Addiction Equity Act of 2008.
- February 9, 2012
Frequently Asked Questions from Employers Regarding Automatic Enrollment, Employer Shared Responsibility, and Waiting Periods (PDF - 93 KB)
This Bulletin provides information on questions from employers and other stakeholders regarding the provisions of the Affordable Care Act governing automatic enrollment, employer shared responsibility, and the 90-day limitation on waiting periods.
- March 19, 2012
Affordable Care Act Implementation FAQs (Set 8)
This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
- May 11, 2012
Affordable Care Act Implementation FAQs (Set 9)
This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
- August 7, 2012
Affordable Care Act Implementation FAQs (Set 10)
This FAQ addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
- January 24, 2013
Affordable Care Act Implementation FAQs (Set 11)
This set of FAQs addresses the employer notice of coverage options, health reimbursement arrangements, disclosure of information related to firearms, employer group waiver plans supplementing Medicare Part D, fixed indemnity insurance and payment of PCORI fees. Related information: CMS Bulletin on Non-Medicare Supplemental Drug Benefits.
(**Note: See Technical Release 2013-03 for comprehensive guidance addressing health reimbursement arrangements that was issued after the date of these FAQs.).
- February 20, 2013
Affordable Care Act Implementation FAQs (Set 12)
This set of FAQs addresses limitations on cost-sharing under the ACA and coverage of preventive services under the ACA.
- March 8, 2013
Affordable Care Act Implementation FAQs (Set 13)
This set of FAQs addresses expatriate health plans.
- April 23, 2013
Affordable Care Act Implementation FAQs (Set 14)
This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
- April 29, 2013
Affordable Care Act Implementation FAQs (Set 15)
This set of FAQs addresses annual limit waiver expiration date based on a change to a plan or policy year, provider non-discrimination, coverage for individuals participating in approved clinical trials and transparency reporting.
- September 4, 2013
Affordable Care Act Implementation FAQs (Set 16)
This set of FAQs addresses the employer notice of coverage options and the 90-day waiting period limitation.
- November 8, 2013
Affordable Care Act Implementation FAQs (Set 17)
This set of FAQs addresses the implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by the Affordable Care Act.
- January 9, 2014
Affordable Care Act Implementation FAQs (Set 18)
This set of FAQs addresses coverage of preventive services, limitations on cost-sharing, expatriate health plans, wellness programs, fixed indemnity insurance, and the Mental Health Parity and Addiction Equity Act of 2008.
- May 2, 2014
Affordable Care Act Implementation FAQs (Set 19)
This set of FAQs addresses updated DOL model notices, limitations on cost-sharing, coverage of preventive services, health FSA carryover and excepted benefits, and the Summary of Benefits and Coverage requirements of PHS Act §2715.
- July 17, 2014
Affordable Care Act Implementation FAQs (Set 20)
This set of FAQs addresses coverage of preventive services.
- October 10, 2014
Affordable Care Act Implementation FAQs (Set 21)
This set of FAQs addresses limitations on cost sharing under the ACA.
- November 6, 2014
Affordable Care Act Implementation FAQs (Set 22)
This set of FAQs addresses compliance of premium reimbursement arrangements.
- February 13, 2015
Affordable Care Act Implementation FAQs (Set 23)
This set of FAQs addresses excepted benefits.
- March 30, 2015
Affordable Care Act Implementation FAQs (Set 24)
This set of FAQs addresses proposed changes to the SBC regulations, as well as a new SBC template and associated documents.
- April 16, 2015
Affordable Care Act Implementation FAQs (Set 25)
This set of FAQs addresses the wellness program requirements.
- May 11, 2015
Affordable Care Act Implementation FAQs (Set 26)
This set of FAQs addresses coverage of preventive services.
- May 26, 2015
Affordable Care Act Implementation FAQs (Set 27)
This set of FAQs addresses limitations on cost sharing and provider non-discrimination.
- August 11, 2015
Affordable Care Act Implementation FAQs (Set 28)
This set of FAQs addresses transparency reporting for non-QHP issuers and non-grandfathered group health plans.
- October 23, 2015
Affordable Care Act Implementation FAQs (Set 29)
This set of FAQs addresses coverage of preventive services, wellness programs, and the Mental Health Parity and Addiction Equity Act of 2008.
- March 11, 2016
Affordable Care Act Implementation FAQs (Set 30)
This set of FAQs addresses the summary of benefits and coverage (SBC)
- April 20, 2016
Affordable Care Act Implementation FAQs (Set 31)
This set of FAQs addresses coverage of preventive services, rescissions, out-of-network emergency services, coverage for individuals participating in approved clinical trials, limitations on cost-sharing under the Affordable Care Act, the Mental Health Parity and Addiction Equity Act and the Women's Health and Cancer Rights Act.
- June 21, 2016
Affordable Care Act Implementation FAQs (Set 32)
This set of FAQs addresses notice of coverage options – COBRA and the Health Insurance Marketplace.
- October 21, 2016
Affordable Care Act Implementation FAQs (Set 33)
This set of FAQs addresses premium reduction arrangements for student health plan coverage
- October 27, 2016
Affordable Care Act Implementation FAQs (Set 34)
This set of FAQs addresses coverage of preventive services under the Affordable Care Act and the Mental Health Parity and Addiction Equity Act
- December 20, 2016
Affordable Care Act Implementation FAQs (Set 35)
This set of FAQs addresses special enrollment for group health plans, coverage of preventive services under the Affordable Care Act and qualified small employer health reimbursement arrangements.
- January 9, 2017
Affordable Care Act Implementation FAQs (Set 36)
This set of FAQs addresses coverage of contraceptive services
- January 12, 2017
Affordable Care Act Implementation FAQs (Set 37)
This set of FAQs addresses health reimbursement arrangements and Code section 162(m)(6).
Consumer Support and Information
Consumer Assistance Program Grants
Fact Sheets
FAQs
External Appeals
Fact Sheets
*Updated February 9,2015
Summary of Benefits and Coverage and Uniform Glossary
Fact Sheets
FAQs
Outreach and Education Resources
Consumer Fact Sheets
Consumer Posters and Brochures
Language Access Taglines for Exchanges, Qualified Health Plan (QHP) Issuers, and Web-Brokers
FAQs
Content Requirements for Plan Finder
Fact Sheets:
Pre-Existing Condition Insurance Plan (PCIP)
Fact Sheets
FAQs
Health Insurance Marketplaces
Fact Sheets
- January 13, 2013
State Health Insurance Marketplaces (List of Conditionally Approved Exchanges)
- May 31, 2013
Progress Continues in Building Exchanges
Marketplace Timeline (PDF - 240 KB)
Narrative Description of Marketplace Timeline (PDF - 204 KB)
- June 14, 2013
Notice of Proposed Rulemaking on Program Integrity
- June 24, 2013
Marketplace Outreach Timeline [PDF, 195KB]
- June 26, 2013
HHS Final Rule and Treasury Notices on Individual Shared Responsibility Provision Exemptions, Minimum Essential Coverage, and Related Topics
- July 5, 2013
Eligibility Final Rule: Strengthening Medicaid, The Children’s Health Insurance Program and The New Health Insurance Marketplace
- August 28, 2013
Program Integrity Rule: Exchanges, SHOP, Eligibility Appeals: Safeguarding Federal Funds and Furthering Consumer Protection
- October 24, 2013
Program Integrity Rule: Exchanges, Premium Stabilization Programs and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014
- May 6, 2016
Special Enrollment Periods and the Consumer Operated and Oriented Plan Program
- December 12, 2016
Pre-Enrollment Verification for Special Enrollment Periods
- December 12, 2016
Promoting Transparency and Appropriate Coverage for Dialysis Patients
FAQs
- November 29, 2011
State Exchange Implementation Questions and Answers (PDF – 135 KB)
- November 9, 2012
Frequently Asked Questions on the Blueprint for Exchanges
- December 10, 2012
Exchanges, Market Reforms and Medicaid Frequently Asked Questions (PDF - 356 KB)
- March 29, 2013
Frequently Asked Questions on Reuse of Exchange for Ancillary Products (PDF - 127 KB)
- May 14, 2013
Frequently Asked Questions on Health Insurance Marketplaces (PDF – 86 KB)
- July 10, 2013
Question and Answer on Assessment Fees Collected in a State-based Marketplace (PDF – 124 KB)
- August 5, 2013
Question and Answer on Health Insurance Marketplaces and Income Verification (PDF – 104 KB)
- September 30, 2013
Question and Answer on Members of Congress and Staff Accessing Coverage through Health Insurance Exchanges (Marketplaces) [PDF, 168KB]
- October 28, 2013
Question and Answer on Enrollment Period [PDF, 143KB]
- November 4, 2013
Question and Answer on Third Party Payments of Premiums for Qualified Health Plans in the Marketplaces [PDF, 112KB]
- December 13, 2013
Question and Answer on Choice of Methodology for Cost-Sharing Reduction Reconciliation [PDF, 105KB]
- February 7, 2014
Third Party Payments of Premiums for Qualified Health Plans in the Marketplaces [PDF, 172KB]
- February 21, 2014*
Question and Answer on Medicaid Managed Care Contractors Outreach to Former Enrollees [PDF, 167KB]
*Updated January 15, 2015
- May 9, 2014
Question and Answer on Cost-Sharing Reductions for Contract Health Services [PDF, 110KB]
- June 12, 2014
Frequently Asked Questions on Essential Community Providers (PDF – 106 KB)
- June 1, 2015
Frequently Asked Questions on State-Based SHOP Direct Enrollment
- July 28, 2015
Frequently Asked Questions on State-based Marketplace Options for Implementing Exemptions from the Shared Responsibility Payment
- September 18, 2015
Frequently Asked Questions Regarding Agents and Brokers Operating in the SHOP Marketplace
- September 18, 2015
Frequently Asked Questions Regarding the Federally-Facilitated Marketplace’s (FFM) 2016 Employer Notice Program
- September 28, 2015
Frequently Asked Questions Regarding Periodic Data Matching in the Federally-facilitated Marketplaces
- October 23, 2015
Frequently Asked Questions On The Applicability Of The Minimum Acceptable Risk Standards for Exchanges (MARS-E) 2.0 To Qualified Health Plan (QHP) Issuers
- May 3, 2016
Frequently Asked Questions on Incarceration and the Marketplace
- July 21, 2016
Frequently Asked Questions on Annual Income Threshold Adjustment
- August 1, 2016
Frequently Asked Questions on Summer/Fall 2016 Medicaid/CHIP Periodic Data Matching
In-Person Assistance
Fact Sheets
FAQs
Plan Management
Fact Sheets
FAQs
- February 17, 2012
Frequently Asked Questions on the Essential Health Benefits Bulletin (PDF – 88 KB)
- February 20, 2013
State Evaluation of Plan Management Activities of Health Plans and Issuers (PDF - 35 KB)
- August 8, 2016
Auto Re-enrollment for QHPs no longer available in the Marketplace
- October 14, 2016
Frequently Asked Questions on Health Insurance Marketplace Standards
- December, 16, 2016
Second Lowest Cost Silver Plan Technical FAQs
- December 23, 2016
FAQ on Compliance Safe Harbor for Issuers Affected by the Extension of the Enrollment Deadline to December 19, 2016
- January 3, 2017
Frequently Asked Questions on Medicaid Managed Care Organizations
- January 19, 2017
Machine-Readable FAQ for FF-SHOP QHPs
Exchange Planning and Establishment Grants
Fact Sheets
FAQs
- June 29, 2012
Exchange Establishment Cooperative Agreement Funding FAQs
- November 9, 2012
Consolidated Exchange Establishment Cooperative Agreement Funding FAQs
This page contains information from the funding opportunity announcement and frequently asked questions from applicants.
- April 23, 2013
Using Section 1311(a) Funding for Marketing Activities in a Plan Management State Partnership Marketplace or Federally-facilitated Marketplace
- May 13, 2013
Allowable Uses of Section 1311 Funding for States in a State Consumer Partnership Marketplace
- May 13, 2013
Allowable Uses of Section 1311 Funding for States in a State Partnership Marketplace or in States with a Federally-Facilitated Marketplace
- December 5, 2013
Frequently Asked Questions on Use of 1311 funding for Change Orders and Congressional Inquiries
- December 30, 2013
State-based Marketplaces (SBMs): Frequently Asked Questions on the State-based Marketplace Annual Reporting Tool (SMART)
- February 27, 2014
CMS Bulletin to Marketplaces on Availability of Retroactive Advance Payments of the PTC and CSRs in 2014 Due to Exceptional Circumstances
- March 14, 2014
Use of 1311 Funds and No Cost Extensions
- September 19, 2014
The Use of 1311 Funds, Project Periods, and Updating the Cost Allocation Methodology
- June 8, 2015
Clarification of the Use of 1311 Funds for Establishment Activities
Early Innovator Grants
Fact Sheets
Territory Cooperative Agreements
FAQs
Premium Stabilization Programs
Fact Sheets
- November 30, 2012
Technical Fact Sheet: Draft Notice of Payment and Benefit Parameters (PDF – 117 KB)
- March 1, 2013
HHS Notice of Benefit and Payment Parameters
- March 11, 2013
Technical Fact Sheet: HHS Notice of Benefit and Payment Parameters for 2014 (PDF - 234 KB)
- November 25, 2013
Proposed 2015 HHS Notice of Benefit and Payment Parameters
- November 21, 2014
Proposed 2016 HHS Notice of Benefit and Payment Parameters Fact Sheet
- February 20, 2015
Final 2016 HHS Notice of Benefit and Payment Parameters Fact Sheet
- November 20, 2015
Proposed 2017 HHS Notice of Benefit and Payment Parameters Fact Sheet
- February 29, 2016
Final 2017 HHS Notice of Benefit and Payment Parameters Fact Sheet
- August 29, 2016
Proposed 2018 HHS Notice of Benefit and Payment Parameters Fact Sheet
- December 16, 2016
Final 2018 HHS Notice of Benefit and Payment Parameters Fact Sheet
FAQs
Consumer Operated and Oriented Plan (CO-OP) Program
FAQs
Fact Sheets
Other Insurance Protections
COBRA
Fact Sheets
FAQs
Mental Health Parity
Fact Sheets
Newborns' and Mothers Health Protection
Fact Sheets
Women's Health and Cancer Rights
Fact Sheets
Health Insurance Market Reforms
Fact Sheets
FAQs
- April 26, 2013
Questions and Answers Related to the Health Insurance Market Reforms
- May 16, 2014
Frequently Asked Questions on Health Insurance Market Reforms and Marketplace Standards
- June 3, 2014
Frequently Asked Question on Qualified Health Plans and Guaranteed Availability Standards
- April 16, 2015
Frequently Asked Questions on Health Insurance Market Reforms and Wellness Programs
- June 15, 2015
Frequently Asked Questions on Uniform Modification and Plan/Product Withdrawal
- October 19, 2015
Frequently Asked Questions on the Impact of PACE Act on State Small Group Expansion
*Updated December 17, 2015
- February 29, 2016
Frequently Asked Questions on the 2017 Moratorium on Health Insurance Provider Fee
- May 26, 2016
Frequently Asked Question on Health Insurance Market Reforms and Marketplace Standards
- December 16, 2016
Frequently Asked Questions on Agent/Broker Compensation and Discriminatory Marketing Practices
Annual Limits
FAQs
Coverage for Young Adults
Fact Sheets
FAQs
Grandfathered Plans
Fact Sheets
Medical Loss Ratio
Fact Sheets
Prevention
Fact Sheets
Review of Insurance Rates
Fact Sheets
FAQs
Student Health Plans
Fact Sheet
FAQs
Self-Funded, Non-Federal Governmental Plans
Fact Sheet