---
kind: "section"
citation: "42 C.F.R. § 600.520"
title: "42"
number: "600.520"
heading: "General cost-sharing protections."
url: "https://uscodex.org/cfr/42/600.520"
---

# §600.520. General cost-sharing protections.

- (a) **Cost-sharing protections for lower income enrollees.** The State may vary premiums and cost sharing based on household income only in a manner that does not favor enrollees with higher income over enrollees with lower income.
- (b) **Cost-sharing protections to ensure enrollment of Indians.** A State must ensure that standard health plans meet the standards in accordance with 45 CFR [156.420(b)(1)](/cfr/45/156.420.md?p=b-1) and [(d)](/cfr/45/156.420.md?p=b-d).
- (c) **Cost-sharing standards.** A State must ensure that standard health plans meet:
  - (1) The standards in accordance with 45 CFR [156.420(c)](/cfr/45/156.420.md?p=c) and [(e)](/cfr/45/156.420.md?p=e); and
  - (2) The cost-sharing reduction standards in accordance with [45 CFR 156.420(a)(1)](/cfr/45/156.420.md?p=a-1) for an enrollee with household income at or below 150 percent of the FPL, and [45 CFR 156.420(a)(2)](/cfr/45/156.420.md?p=a-2) for an enrollee with household income above 150 percent of the FPL.
  - (3) The State must establish an effective system to monitor compliance with the cost-sharing reduction standards in [paragraph (c)](#c) of this section, and the cost-sharing protections to ensure enrollment of Indians in [paragraph (b)](#b) of this section to ensure that enrollees are not held responsible for such monitoring activity.
- (d) **Acceptance of certain third party payments.** States must ensure that standard health plans must accept premium and cost-sharing payments from the following third party entities on behalf of plan enrollees:
  - (1) Ryan White HIV/AIDS Programs under title XXVI of the Public Health Service Act;
  - (2) Indian tribes, tribal organizations or urban Indian organizations; and
  - (3) **State and federal government programs.**

## Notes

### Authority

Authority: 42 U.S.C. 300gg, 1395, and 18051.

### Source

Source: 79 FR 14140, Mar. 12, 2014, unless otherwise noted.