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