Program Background

The Exchange Improper Payment Measurement (EIPM) program reviews a statistically valid random sample of health insurance applications to determine if the Federally-facilitated Exchange (FFE) properly paid Advance payment of the Premium Tax Credit (APTC) benefits under the statutory and regulatory requirements relating to eligibility and payment determinations.  The EIPM uses a statistically valid random sample of 2,000 health insurance applications.  The improper payment rate and amounts estimated from this sample reflect all health insurance applications with APTC payments processed by the FFE for calendar year 2021. 

Certain states do not use the FFE to administer the APTC program, and instead have elected to operate independent State-based Exchanges.  The improper payment rate and amounts for calendar year 2021 do not reflect APTC payments made by State-based Exchanges.   CMS continues to develop the improper payment measurement methodology for the State-based Exchanges and will continue to report updates on the measurement program development status.