Program Overview

The Early Retiree Reinsurance Program will provide much-needed financial relief for employers so that they can maintain affordable insurance coverage for their retirees

Quality, Affordable Care for Early Retirees

  • The Affordable Care Act provides $5 billion in financial assistance to employers to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare.
  • Employers can use the savings to either reduce their own health care costs, provide premium relief to their workers and families or a combination of both.

Relief for Businesses

  • This temporary program will make it easier for employers to provide coverage to early retirees. SO ACT QUICKLY!
  • Employers who are accepted into the program will receive reinsurance reimbursement for health benefit claims for retirees age 55 and older who are not eligible for Medicare, and their spouses, surviving spouses, and dependents.
  • Health benefits that qualify for relief include medical, surgical, hospital, prescription drug, and other benefits that may be specified by the Secretary of Health and Human Services, as well as coverage for mental health services.
  • The amount of this reimbursement to the employer plan is up to 80% of claims costs for health benefits between $15,000 and $90,000. Claims incurred between the start of the plan year (often January 1) and June 1st are credited towards toward the $15,000 threshold for reimbursement. However, only medical expenses incurred after June 1, 2010 are eligible for reimbursement under this program.

For Example

If an individual incurs costs of $30,000 between the start of the plan year and June 1, and $40,000 after that date. The amount which may be reimbursed is $40,000 - the costs above the $15,000 threshold that occur after June 1. If a plan incurs $90,000 or more in expenses before June 1, it is treated as having met the $15,000 threshold and is eligible for reimbursement for costs incurred after June 1.

  • These limits apply and claims are filed for individual’s costs. Firms cannot add two or more individuals together to attain the threshold.
  • Both self-funded and insured plans can apply, including plans sponsored by private entities, state and local governments, nonprofits, religious entities, unions, and other employers.

Budget to 2014

  • HHS will begin the Early Retiree Program on June 1, 2010, in advance of the June 21 start date required by the Affordable Care Act, allowing more claims to qualify for reinsurance payments for plans this year.
  • Eligible employers can apply for the program through the Department of Health and Human Services. Applications will be available by the end of June. Plans will be subject to audits to assure fiscal integrity.
  • To receive assistance, plans must have their applications approved, document claims, and implement programs and procedures that have or have the potential to generate cost savings for participants with chronic and high-cost conditions.
Back to top