Joint Cover AZ Coalition Call Wednesday April 15, 2015.
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Transcript of Joint Cover AZ Coalition Call Wednesday April 15, 2015.
Joint Cover AZ Coalition CallWednesday April 15, 2015
Conference Call: 877-267-1577 code: 994 746 503
The Big Picture: The effect of increased coverage – Kim Van Pelt
Agenda
CMS updates – Kaihe Akahane, Jon
Langmead Tax SEP ends 4/30/2015 SEP overview Medicare & Marketplace COBRA & Marketplace Data Matching Issues
Ryan White Health Literacy Project – Cheri Tomlinson
Agenda
Enrollment from November 15 – February 22 http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/EnrollmentByZip/rpt_EnrollmentByZip_Apr2015.cfm
Marketplace Enrollment by Zip Code
Individual shared responsibility payments should be made only with a person’s tax return or in response to a letter from the IRS. The payment should never be made directly to an individual or return preparer.
Full IRS Bulletin: http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/Affordable-Care-Act-Consumer-Alert--Choose-Your-Tax-Preparer-Wisely
Affordable Care Act Consumer Alert: Choose Your Tax Preparer Wisely
Special Enrollment Periods in the Federally-facilitated
Marketplace
Special Enrollment Periods
Marketplace Special Enrollment Periods
8
You may obtain a SEP to enroll in 2015 coverage if you Aren’t currently enrolled in coverage through the Health
Insurance Marketplace for 2015, Were subject to owe the fee on your 2014 federal
income tax return for not having health coverage in 2014, and
Attest that you were unaware of, or didn't understand, the ACA requirement to maintain minimum essential coverage until after February 15, 2015 (the end of the 2015 Open Enrollment Period)
This Special Enrollment Period will end at 11:59 pm E.S.T. on April 30, 2015
2015 Limited Special Enrollment Period for Tax Season–Federally-
facilitated Marketplace
2015 Limited Special Enrollment Period for Tax Season–Federally-
facilitated Marketplace
March 2015
Life Changes That May Qualify You For a Special Enrollment Period
Life Changes That May Qualify You For a Special Enrollment Period
Getting married
Having a baby
Adopting a child or placing a child for adoption or foster care
Losing other health coverage (minimum essential coverage) due to
• Resigning, getting laid off, or getting fired
• Divorce
• COBRA coverage ending (but not cancelling it yourself before it expires)
• Aging off a parent’s plan when you turn 26
• Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
Continued on next slide
March 2015Marketplace Special Enrollment
Periods9
Life Changes That May Qualify You For a Special Enrollment Period (Continued)
Life Changes That May Qualify You For a Special Enrollment Period (Continued)
March 2015Marketplace Special Enrollment
Periods10
Permanently moving outside your plan’s coverage area
Gaining citizenship or lawful presence in the U.S.
Gaining or continuing status as a member of an Indian tribe or an Alaska Native shareholder
Leaving incarceration
For people already enrolled in Marketplace coverage Having a change in income or household status that
affects eligibility for premium tax credits or cost-sharing reductions
How to Use a Special Enrollment Period for a Life Change
How to Use a Special Enrollment Period for a Life Change
If you have a qualifying life change, you can contact the Marketplace Online at HealthCare.gov
Log into your account and click on Report a life change
By phone Call the Marketplace Call
Center at 1-800-318-2596 TTY 1-855-889-4325
March 2015Marketplace Special Enrollment
Periods11
You may be eligible for an SEP if you experienced other qualifying circumstances during Open Enrollment Enrollment errors Exceptional circumstances Misinformation, misrepresentation, or inaction Specific system issues Having current COBRA coverage Individual market plan renewal outside of Open Enrollment Members of AmeriCorps, VISTA, and NCCC programs
Types of Special Enrollment Periods - Other Qualifying Circumstances
Types of Special Enrollment Periods - Other Qualifying Circumstances
March 2015Marketplace Special Enrollment
Periods12
You chose a plan by the deadline, but Enrollment wasn’t processed by the Marketplace Insurer doesn’t have the enrollment, or You were enrolled in the wrong plan
Examples of enrollment errors Missing enrollment records Defective enrollments
Enrollment ErrorsEnrollment Errors
March 2015Marketplace Special Enrollment
Periods13
Serious situations that prevent you from enrolling by the appropriate deadline Medical emergency Natural disaster Planned system outage
Must submit documentation of medical emergency or natural disaster
Exceptional CircumstancesExceptional Circumstances
March 2015Marketplace Special Enrollment
Periods14
Misconduct by a non-Marketplace entity that caused you To not be enrolled in a plan To be enrolled in the wrong plan To not get lower costs for which you’re eligible
Non-Marketplace entity may be an insurer, Navigator, certified application counselor, agent or broker
Misinformation, Misrepresentation, or Inaction
Misinformation, Misrepresentation, or Inaction
March 2015Marketplace Special Enrollment
Periods15
1. Call the Marketplace Call Center to request an SEP at 1-800-318-2596 (TTY 1-855-889-4325)
2. Call Center asks questions to determine if you’re eligible
3. If granted, the Call Center activates the SEP4. You can enroll online or through the Call Center5. If your SEP request is denied, you can appeal
General Process for Other Circumstance Special Enrollment Periods (SEPs)
General Process for Other Circumstance Special Enrollment Periods (SEPs)
March 2015Marketplace Special Enrollment
Periods16
COBRA qualifies as minimum essential
coverage enroll in COBRA do not pay a penalty
Replacing COBRA with Marketplace coverage Outside of OEP
If COBRA is ending Qualify for a SEP
Consumer voluntarily ends COBRA coverage Can not enroll in a Marketplace plan
COBRA coverage and the Marketplace
Replacing COBRA with Marketplace coverage
During OEP Can drop coverage
Enroll in a Marketplace plan qualify for premium tax credits qualify for cost share reduction
COBRA Coverage: https://www.healthcare.gov/unemployed/cobra-coverage/
COBRA coverage and the Marketplace
Lose job-based health insurance outside of OEP
Two options Option 1: Get a Marketplace plan
Eligible for SEP enroll into a Marketplace plan
Option 2: Get COBRA coverage keep job based insurance not eligible for a SEP
Lose job based coverage: https://www.healthcare.gov/have-job-based-coverage/if-you-lose-job-based-coverage/
COBRA coverage and the Marketplace
Become eligible for Medicare after enrolling in a Marketplace plan Once eligible for Medicare Part A
consumers are not eligible for any tax credits and reduced cost-sharing for a Marketplace plan
Medicare & Marketplace fact sheet: https://www.medicare.gov/Pubs/pdf/11694.pdf
Medicare & the Marketplace
Become eligible for Medicare after enrolling in a Marketplace plan Cancel the Marketplace plan with at least a 14 day notice
Cancellation will take effect 14 days after the day the consumer cancels the plan Consumer cancels on May 1st , the plan will end on May 14th
set the cancellation date to a future date Consumer cancels on May 1st, can request cancellation to be
effective on June 1st.
Cancelling plans:
https://www.healthcare.gov/reporting-changes/cancel-plan/#everyone
Medicare & the Marketplace
Resources
COBRA & Marketplace: https://www.healthcare.gov/unemployed/cobra-coverage/
Medicare & Marketplace: https://www.healthcare.gov/have-job-based-coverage/if-you-lose-job-based-coverage/
Resources
COBRA & Marketplace: https://www.healthcare.gov/unemployed/cobra-coverage/
Losing Job Coverage: https://www.healthcare.gov/have-job-based-coverage/if-you-lose-job-based-coverage/
Resources
Medicare & Marketplace fact sheet: https://www.medicare.gov/Pubs/pdf/11694.pdf
Cancelling plans: https://www.healthcare.gov/reporting-changes/cancel-plan/#everyone
Resources
Special Enrollment Periods: https://marketplace.cms.gov/technical-assistance-resources/training-materials/special-enrollment-periods.pptx
Data Matching Issues: https://marketplace.cms.gov/technical-assistance-resources/resolve-data-match-issues.pdf
OEP for 2016 begins November 1, 2015 and continues until January 31, 2016
Payment Notice Fact Sheet: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/2016-PN-Fact-Sheet-final.pdf
2016 Open Enrollment Period
Wednesday May 20, 2015 from 10 – 11:30 am
Next Meeting