MATCHING OBJECTIVE. The objective of the matching program is for the Centers for Medicare and Medicaid (CMS) and DoD to identify TRICARE beneficiaries who are entitled to Medicare Part A and/or Medicare Part B. TRICARE coverage is continued after the age of 65 for military retirees and their Medicare entitled dependents who have Medicare Part A and Part B. Retirees or retiree family members under age 65 and entitled to Medicare Part A are also required to have Medicare Part A and Part B to remain eligible for TRICARE. If it is determined that a TRICARE beneficiary has Medicare Part A only, they will no longer be eligible for healthcare coverage under TRICARE. If a beneficiary who is 65 or older does not have Medicare Part A and Part B, they must provide documentation showing they are not entitled to Medicare, in order to have continued TRICARE coverage.
MATCHING OBJECTIVE. The objective of the marketplace matching programs is to make initial eligibility determinations, redeterminations and renewals for enrollment in a qualified health plan, insurance affordability programs, and to issue certificates of exemption to individuals who are exempt from the individual mandate to maintain health insurance coverage. For those consumers who request financial assistance, they will be determined eligible for an amount of advanced premium tax credits (APTC) and cost sharing reductions, Medicaid, CHIP or BHP, where applicable. The Exchange and Medicaid/CHIP agencies verify data elements dependent on the eligibility determination they are performing. These may include citizenship or immigration status, household income, access to non-employer-sponsored and/or employer-sponsored minimum essential coverage. Non-employer-sponsored coverage includes coverage through TRICARE, Veteran’s Health Benefits, Medicaid, Medicare, or benefits through service in the Peace Corps. Employer-sponsored coverage for Federal Employee Health Benefits can be verified with the Office of Personnel Management. The matching programs provide a single streamlined process for making accurate and real-time assessments of each applicant’s eligibility and affordable insurance options and ensuring that the consumer can enroll in the correct applicable State health subsidy program2 or be properly determined to be exempt from needing coverage. MATCHING PROGRAM STRUCTURE The Patient Protection and Affordable Care Act, Public Law No. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law No. 111-152 (ACA) requires that each State develop secure electronic interfaces for the exchange of data under a matching program using a single application form for determining eligibility for all State health subsidy programs.
