Capping Costs for Consumers Act of 2021

To expand cost-sharing reductions with respect to qualified health plans offered through an Exchange, and for other purposes. 1. Short title This Act may be cited as the Capping Costs for Consumers Act of 2021 2. Expanding cost-sharing reductions under Exchange plans (a) In general Section 1402 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18071 (1) in subsection (b)— (A) in paragraph (1), by striking who enrolls subject to the last sentence of this subsection, who enrolls (B) by adding at the end the following sentence: With respect to plan years beginning on or after January 1, 2023, paragraph (1) shall be applied as if the reference to the silver level of coverage were a reference to the gold level of coverage. (2) in subsection (c)(1)(B)(i)— (A) in subclause (II), by striking an eligible insured described in paragraph (2)(B) , with respect to plan years beginning before January 1, 2023, an eligible insured described in paragraph (2)(B)(i) and, with respect to plan years beginning on or after January 1, 2023, an eligible insured described in paragraph (2)(B)(ii) (B) by amending subclauses (III) and (IV) to read as follows: (III) with respect to plan years beginning before January 1, 2023— (aa) 73 percent in the case of an eligible insured whose household income is more than 200 percent but not more than 250 percent of the poverty line for a family of the size involved; and (bb) 70 percent in the case of an eligible insured whose household income is more than 250 percent but not more than 400 percent of the poverty line for a family of the size involved; and (IV) with respect to plan years beginning on or after January 1, 2023, 85 percent in the case of an eligible insured described in paragraph (2)(C)(ii). ; (3) in subsection (c)(2), by amending subparagraphs (B) and (C) to read as follows: (B) in the case of— (i) with respect to plan years beginning before January 1, 2023, an eligible insured whose household income is more than 150 percent but not more than 200 percent of the poverty line for a family of the size involved, increase the plan's share of the total allowed costs of benefits provided under the plan to 87 percent of such costs; and (ii) with respect to plan years beginning on or after January 1, 2023, an eligible insured whose household income is more than 150 percent but not more than 300 percent of the poverty line for a family of the size involved, increase the plan's share of the total allowed costs of benefits provided under the plan to 87 percent of such costs; and (C) in the case of— (i) with respect to plan years beginning before January 1, 2023, an eligible insured whose household income is more than 200 percent but not more than 250 percent of the poverty line for a family of the size involved, increase the plan's share of the total allowed costs of benefits provided under the plan to 73 percent of such costs; and (ii) with respect to plan years beginning on or after January 1, 2023, an eligible insured whose household income is more than 300 percent but not more than 400 percent of the poverty line for a family of the size involved, increase the plan's share of the total allowed costs of benefits provided under the plan to 85 percent of such costs. ; and (4) by adding at the end the following new subsection: (h) Funding Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary such sums as may be necessary for payments under this section. . (b) Conforming amendments to State basic health programs for certain low-Income individuals Section 1331(a)(2) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18051(a)(2) (1) in subparagraph (A)(i), by striking the applicable second lowest cost silver plan (as defined in section 36B(b)(3)(B) , with respect to plan years beginning before January 1, 2023, the applicable second lowest cost silver plan (as defined in section 36B(b)(3)(B) (2) in the matter following subparagraph (B), by striking or the applicable second lowest cost silver plan or, with respect to plan years beginning before January 1, 2023, the applicable second lowest cost silver plan (or, with respect to plan years beginning on or after January 1, 2023, the applicable second lowest cost gold plan 3. Premium assistance credit amount determined using applicable second lowest cost gold plan (a) In general Section 36B (1) by striking silver gold (2) in the header of subsection (b)(3)(B), by striking silver gold (b) Effective date The amendments made by this section shall apply to taxable years beginning after December 31, 2022.

Summary: Capping Costs for Consumers Act of 2021 This bill expands and provides funding for assistance to certain individuals who enroll in plans through health insurance exchanges. Specifically, it increases the premium assistance tax credit by revising, from the second-lowest cost silver plan to the second-lowest cost gold plan, the benchmark plan on which the credit amount is based. The bill also requires individuals to enroll in a gold plan to be eligible for cost-sharing reductions and it extends the reductions to individuals with a higher maximum household income. These changes apply to plan and tax years beginning on or after January 1, 2023.