The Center for Consumer Information & Insurance Oversight
Advance Payments of the Premium Tax Credit (APTC) Audits
Sections 1401 of the Patient Protection and Affordable Care Act (ACA) established the Advance Payments of the Premium Tax Credit (APTC) program to lower the monthly premium for eligible individuals. Section 1311 of the ACA allows the Federally-Facilitated Exchanges (FFEs) to charge participating issuers user fees to support FFE operations. Additionally, Office of Management and Budget (OMB) Circular A-25 allows the FFEs and State-based Exchanges on the Federal platform (SBE-FPs) to calculate, collect, and expend user fees.
Regulations at 45 CFR §§ 156.480, 156.705, and 156.715 allow the Department of Health and Human Services (HHS) to conduct audits of issuers that offer a Qualified Health Plan (QHP) in the individual market through an Exchange to assess compliance with the APTC and FFE user fee program requirements. The goals of these audits are to:
- Safeguard Federal funds;
- Instill confidence in payment data quality among regulated entities;
- Evaluate health insurance issuer compliance with program rules and regulations; and
- Efficiently use taxpayer resources while minimizing the unnecessary burdens on issuers and consumers.
CMS APTC Audit Reports
The CMS APTC Audit program commenced in 2017 with review of data reported for the 2014 FFE reporting year. This page contains CMS APTC reports that are organized by the reporting year. Reports will be uploaded as each audit year is completed for each audit type.
CMS APTC Audit Reports by Reporting Year:
FFE Audit Summary Reports
2019 FFE
2018 FFE
2017 FFE
2016 FFE
2015 FFE
2014 FFE
- Alliance Health and Life Insurance Company (PDF)
- Alliant Health Plan, Inc (PDF)
- AmeriHealth Insurance Company of New Jersey (PDF)
- Anthem Insurance Companies (PDF)
- Anthem Health Plans of ME (PDF)
- Blue Cross Blue Shield Healthcare Plan of Georgia (PDF)
- Health Net Life Insurance Company (PDF)
- Healthkeepers Inc (PDF)
- Humana Employers Health Plan of Georgia Inc (PDF)
- Humana Medical Plan Inc (PDF)
- Keystone Health Plan East Inc (PDF)
- AultCare Insurance Company (PDF)
- Blue Cross and Blue Shield of Florida Inc (PDF)
- Blue Cross and Blue Shield of Kansas Inc (PDF)
- Blue Cross and Blue Shield of South Carolina (PDF)
- Blue Cross Blue Shield of Arizona (PDF)
- Blue Cross Blue Shield of Illinois (PDF)
- Blue Cross Blue Shield of Michigan Mutual Insurance Company (PDF)
- Blue Cross Blue Shield of Montana (PDF)
- Blue Cross Blue Shield of Oklahoma (PDF)
- Blue Cross Blue Shield of Texas (PDF)
- Blue Cross of Idaho Health Service Inc (PDF)
- BlueCross BlueShield of Tennessee, Inc (PDF)
- CareSource (PDF)
- Coventry Health Care of Florida Inc (PDF)
- Coventry Health Care of Virginia, Inc (PDF)
- Dean Health Plan (PDF)
- Highmark WV (PDF)
- Maine Community Health Options (PDF)
- Medical Health Insuring Corporation of Ohio (PDF)
- Molina Healthcare of Texas, Inc (PDF)
- Sendero Health Plans, Inc (PDF)
- Summa Insurance Company, Inc (PDF)