Assister Regional Roundtables: Marketplace Enrollment in Maine - - PDF document

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Assister Regional Roundtables: Marketplace Enrollment in Maine - - PDF document

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3/13/2014 Assister Regional Roundtables: Marketplace Enrollment in Maine Emily Brostek, MPH, CHES Consumers for Affordable Health Care Advocating the right to health care for every man, woman, and child 1-800-838-0388

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Assister Regional Roundtables:

Marketplace Enrollment in Maine

Emily Brostek, MPH, CHES

Consumers for Affordable Health Care

“Advocating the right to health care for every man, woman, and child” 1-800-838-0388 www.mainecahc.org

Non-profit, non-partisan mission-driven research and advocacy organization based in Augusta (founded in 1988) Our mission is to make quality health care more affordable for every one in Maine

Consumer Assistance Program and HelpLine (1-800- 965-7476) Public Policy Research and Advocacy

About Consumers for Affordable Health Care

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www.mainecahc.org 3

Agenda

  • Welcome & Introductions
  • Enrollment & Eligibility Updates
  • BREAK
  • Roundtable Discussion: Best practices and

biggest challenges

  • Panel: Understanding the QHPs on

Maine’s Marketplace

  • Lunch

Enrollment & Eligibility Updates

  • 1. The coverage gap
  • 2. Applying for exemptions
  • 3. Filing for appeals

www.mainecahc.org 12/3/13

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www.mainecahc.org 12/3/13

The Coverage Gap: What this means for Mainers

  • Anyone whose income is over 100% FPL

may qualify for tax credits

  • For those with income under 100% FPL
  • Parents & children: May qualify for MaineCare
  • People with disabilities: May qualify for MaineCare
  • Everyone else: Catastrophic coverage, hospital free

care, or other safety net programs

www.mainecahc.org 12/3/13

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Talking to People in or Near the Coverage Gap

  • Make sure their income projection is

accurate:

  • Does it include all countable sources of income?

(some people may not include Social Security)

  • Is it based on projections for 2014 rather than past

years?

  • Make sure they understand why this gap

exists – and who can change it

www.mainecahc.org 12/3/13

Maine’s Safety Net Programs

  • Hospital Free Care
  • Sliding Scale Clinics, Free Clinics
  • Prescription Assistance Programs
  • MedAccess
  • CarePartners
  • Other local programs?

www.mainecahc.org 12/3/13

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Working with People Just Over 100% FPL

  • If at year end, income turns out to be less

than 100% FPL, they are not required to repay their tax credits. Instead, their tax credit would be calculated based on actual annual income

  • When estimating income, remember:
  • Must be a good faith projection of income
  • May have to provide documentation if very different

www.mainecahc.org 12/3/13

Repayment Caps

www.mainecahc.org 12/3/13 From Kaiser Family Foundation (kff.org)

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Filing for Exemptions

  • In 2014, people without coverage may

have to pay a penalty:

  • 1% of income, or
  • $95 per person ($47.50 per child; $285 max per

family))

  • To avoid the penalty, people must have

health coverage, or qualify for an exemption

www.mainecahc.org 12/3/13

Exemptions you must get through the Marketplace

  • Hardship exemption
  • Member of a religious sect whose

members object to insurance

  • Eligible for services through an Indian

health care provider

www.mainecahc.org 12/3/13

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Exemptions you can get through the Marketplace or at tax time

  • Coverage is unaffordable
  • Member of a health care sharing ministry
  • Member of a recognized tribe
  • Incarcerated

www.mainecahc.org 12/3/13

Exemptions you get at tax time (or automatically):

  • Income is below tax filing threshold (even

if you may still file taxes to get a refund)

  • Coverage gap of less than 3 months

www.mainecahc.org 12/3/13

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Is there a benefit to getting exemptions ahead of time?

  • Affordability exemption
  • Opens up possibility of getting catastrophic coverage
  • Based on projected income – but if projection is

wrong, exemption still covers for the entire year

  • Hardship exemption
  • Opens up possibility of getting catastrophic coverage

www.mainecahc.org 12/3/13 www.mainecahc.org 12/3/13

When To Appeal

You can appeal all these decisions:

  • Whether you are eligible for a QHP
  • Whether you are eligible for subsidies
  • The amount of savings you are eligible for
  • Whether you’re eligible for Medicaid or CHIP
  • Whether you have to pay a fee for not having

insurance

  • Whether you can enroll during a special

enrollment period

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www.mainecahc.org 12/3/13

How To Appeal

  • Eligibility notice should include

detailed information on appeal, including timeframe

  • Consumers have right to

representation

www.mainecahc.org 12/3/13

How to File a Marketplace Appeal

  • 1. Log into “My Account” at

Healthcare.gov/marketplace/individu al

  • 2. Call the Call Center
  • 3. Mail in an appeal request form
  • 4. Write a letter to: Health Insurance

Marketplace, 465 Industrial Blvd, London, KY 40750-0061

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www.mainecahc.org 12/3/13

How to File a Marketplace Appeal

  • 1. Log into “My Account” at

Healthcare.gov/marketplace/individu al

  • 2. Call the Call Center
  • 3. Mail in an appeal request form
  • 4. Write a letter to: Health Insurance

Marketplace, 465 Industrial Blvd, London, KY 40750-0061

www.mainecahc.org 12/3/13

Is An Appeal My Only Option?

If consumer’s eligibility results are wrong because they filled out their application incorrectly, they may be able to discard their application and start over.

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Hard Questions & Troubleshooting

  • Resources:
  • CAHC’s HelpLine: 1-800-965-7476
  • In the Loop online community (enrollmentloop.org)
  • Online resources like the Kaiser FAQ page or CMS’

resources for assisters

  • You!

www.mainecahc.org 12/3/13

Special Enrollment Periods

www.mainecahc.org 12/3/13 Triggering Event Plan Selection Date Coverage Effective Date Loss of minimum essential coverage

(but not due to failure of payment)

Any day of the month First day of following month following plan selection Marriage Any day of the month First day of following month following plan selection Birth, adoption, or placement in foster care Date of birth, adoption,

  • r placement

Change in status to become a citizen or lawfully present Same rules as open enrollment Same rules as open enrollment Enrolled or not enrolled due to error by exchange Same rules as open enrollment Same rules as open enrollment

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www.mainecahc.org 12/3/13 Triggering Event Plan Selection Date Coverage Effective Date Future loss of employer coverage (within next 60 days) Any day of the month First day of the month following the date of the loss of coverage Access to new QHP through a permanent move Same rules as open enrollment Same rules as open enrollment Certain Native Americans can enroll or change plans once a month Exceptional circumstances, including loss of eligibility for a hardship exemption Same rules as open enrollment Same rules as open enrollment

Special Enrollment Periods

www.mainecahc.org 24

Questions

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www.mainecahc.org 25

Thank You!