In this Health Reform: Beyond the Basics webinar presented on October 31, 2019 in partnership with the American Association on Health and Disability, Karl Cooper, Director of Public Health Programs at AAHD, addresses disability etiquette and basic accessibility considerations for anyone doing enrollment work. Karl also provides an overview of questions a person with a disability needs to think about when considering their health care options in the marketplace.

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Additional Resources

American Association on Health and Disability (AAHD) | Find out more

AAHD | National Disability Navigator Resource Collaborative (NDNRC)

• Guide to Disability for Health Insurance Navigators
• Topical and population-specific fact sheets
• Community Outreach Collaboratives

AAHD | NDNRC: Health Insurance Jeopardy Series | NDNRC YouTube channel

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

Tools and Resources | View all tools and resources

Frequently Asked Questions | View FAQs

In this explainer video, the Center on Budget and Policy Priorities provides an explanation of the Healthcare.gov auto-renewal process for 2018 coverage and covers both the process for plan enrollment and redetermination of eligibility for premium tax credits.

Presentation Slides

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Overview

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• Two-step auto-renewal process
• Renewal notices
  • Marketplace open enrollment notices (MOEN)
  • Insurer notices
  • If insurer is no longer offering plans in the Marketplace

Redetermination of APTC

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• Auto-renewal process for APTC
  • Eligible for redetermination of APTC
  • Not eligible for redetermination of APTC
• Not eligible for auto-renewal (Medicare Anti-Duplication Provision) OR (member of an enrollment group has Medicare coverage)
• Redetermination of APTC

Auto-Enrollment for 2018 Plans

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• Auto-enrollment process
  • Option 1: Auto-enrolled into current plan
  • Option 2: Auto-enrolled into new plan
  • Option 3: Auto-enrolled into new plan with new insurer
• Special enrollment period when auto-enrolled in new plan

Tips for Assisters

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• Tips for assisters
• Resources on premium increases for 2018

Additional Resources

Key Facts: Auto-Renewal of APTC for 2018 in Healthcare.gov | View key facts

Key Facts: Past-Due Premiums in the Marketplace | View key facts

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

In this special webinar presented on October 24, 2017, Karl Cooper, Director of Public Health Programs at the American Association on Health and Disability (AAHD), helps you think about what questions a person with a disability needs to think about when they are considering their health care options in the Marketplace and provides an introduction to the resources available through the National Disability Navigator Resource Collaborative (NDNRC). Additionally, it addresses disability etiquette and basic accessibility considerations for anyone doing enrollment work.

Presentation Slides

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Overview

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• AAHD mission
• Health disparities for people with disabilities
• Disability law and the Affordable Care Act

National Disability Navigator Resource Collaborative (NDNRC)

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• Overview of resources available through NDNRC
• Resource: Guide to Disability for Health Insurance Navigators
• Resource: Topical and population-specific fact sheets
• Community Outreach Collaboratives

Considerations When Assessing Health Options

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Health Insurance Jeopardy: It’s not about the answer. It’s about asking the right question!

• Topical questions
• Population specific questions
• Disability etiquette
• Resource: Health Insurance Jeopardy Series | View NDNRC YouTube channel

Ongoing Challenges

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• Limited provider networks
• Limited formularies
• Discriminatory pharmacy design
• Plan transparency
• High out-of-pocket costs
• Confusion on the definition of “rehabilitation” and “habilitation” services and supports
• Confusion on the coverage of prosthetic devices and durable medical equipment
• Confusion about coordinating exchange coverage with Medicare and Medicaid
• Delays in getting plan information once they are enrolled
• Communication Issues for deaf and hard of hearing

Disability Etiquette

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• People with all types of disabilities
• People with mobility disabilities
• People who are blind or low vision
• People who are deaf or hard of hearing
• People with speech and language disorders
• People with cognitive or intellectual disabilities
• People with mental health or behavioral health disabilities
• Disability accessibility and accommodations

Q&A

Additional Resources

Resources links | View resource links

American Association on Health and Disability (AAHD) | Find out more

AAHD | National Disability Navigator Resource Collaborative (NDNRC) | Find out more

AAHD | NDNRC: Guide to Disability for Health Insurance Navigators | View guide

AAHD | NDNRC: Topical and population-specific fact sheets | View fact sheets

AAHD | NDNRC: Health Insurance Jeopardy Series | View NDNRC YouTube channel

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

In this webinar presented on October 18, 2017, Shelby Gonzales, Senior Policy Analyst, and Halley Cloud, Health Outreach Manager, detail what happens when Healthcare.gov determines that information applicants provide as to their income and citizenship or immigration status doesn’t match information available to federal data sources, and how assisters can help people resolve these data-matching issues.

Presentation Slides

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Data-Matching Process

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Data-matching process to verify eligibility factors

Notice of data-matching issue

Verification of Citizenship and Immigration Status

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How Healthcare.gov verifies citizenship (video section, slides)

• Reasons data matching may be unsuccessful
• Documents that can be used to prove U.S. citizenship

How Healthcare.gov verifies immigration status (video section, slides)

• Reasons data matching may be unsuccessful
• Documents and needed document numbers to prove immigration status
• Examples of document types

Example: Immigration and citizenship verification (video section, slides)

Verification of Household Income

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How Healthcare.gov verifies income

• General rules for income verified through data matching

When an income data-matching issue is triggered (video section, slides)

• Example documents that can be used to verify income
• Marketplace guide for income data-matching issues

Examples: (video section, slides)

• Expected income goes down
• No previous tax data
• Early retirement

Failure to resolve income data-matching issue (video section, slides)

Verification of Other Minimum Essential Coverage

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Resolving data-matching issues regarding minimum essential coverage

Identity Proofing

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Healthcare.gov process for identity proofing

• Documents that can be used to prove identity
• If identity can’t be verified

General Tips to Prevent and Resolve DMIs

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Tips:

• To resolve data-matching issues
• On sending documentation to resolve data-matching issues
• To prevent data-matching issues

Additional Resources

Resources | View resources links

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

In this webinar presented in partnership with the National Immigration Law Center (NILC) on October 4 and 24, 2017, Sonya Schwartz, a consultant with NILC, Shelby Gonzales, a Senior Policy Analyst at the Center on Budget and Policy Priorities, and Halley Cloud, the Health Outreach Manager at CBPP, provide an overview of immigrant eligibility polices for coverage programs and help explain how to navigate the application process for families that include immigrants.

Presentation Slides

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Eligibility for Medicaid and CHIP Based on Immigration Status

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Eligible immigration statuses for Medicaid and the Children’s Health Insurance Program (CHIP)

• “Qualified” immigrants
• 5-year bar restriction
• State flexibility

Eligibility for Marketplace Coverage Based on Immigration Status

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Eligible immigration statuses for Marketplace coverage

• Example: Eligibility based on immigration status

Special Marketplace and PTC Eligibility

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Special Marketplace rules for seniors

• Example: Tax dependents and applying for PTC

PTC for certain lawfully present people with low income

• Example: Family with income under 100% FPL

Understanding & Addressing Concerns Immigrants May Have When Applying for Health Programs

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Addressing concerns related to:

• Use of public benefits
• Privacy
• Non-applicants’ protections related to immigration status

Requests for Social Security Numbers

• Applicants
• Non-applicants

Tips for talking about immigration status

• Example: Starting a conversation

Navigating the Application Process

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Eligibility verification

• Why data matching may be unsuccessful
• Tips to prevent and resolve data-matching issues
• Documents to prove immigration status
• Documents to prove citizenship

Data-matching issues for certain lawfully present people with low income

• Process A: Appears eligible for Medicaid
• Process B: Treated as if in the Medicaid coverage gap

Additional Resources

Resources | View  NILC resources and general resources

NILC | Tips for Addressing Immigrant Families’ Concerns When Applying for Health Coverage Programs | View resource

Webinar: Preventing and Resolving Data-Matching Issues | View webinar

Key Facts: Immigrant Eligibility for Health Insurance Affordability Programs | View key facts

Key Facts: Application Process for Families that Include Immigrants | View key facts

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

In this webinar presented on September 28, 2017, Tara Straw, Senior Policy Analyst, explains who can qualify for an exemption from the individual shared responsibility payment, the different types of exemptions that are available, and how to calculate the penalty for people who don’t maintain health coverage or qualify for an exemption.

This is Part IV in a four-part series on key elements of eligibility and enrollment.

Presentation Slides

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Shared Responsibility Payment

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Individual shared responsibility payment (the penalty)

• Calculating the penalty

Exemptions

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Exemptions from the shared responsibility payment

• Exemptions granted by the Marketplace
• Exemptions granted by the IRS

Marketplace exemptions (video section, slides)

• Medicaid coverage gap
• Affordability
• Hardship

Approaching exemptions (video section, slides)

IRS exemptions (video section, slides)

• Income below filing threshold
• Short coverage gap
• Medicaid coverage gap
• Certain noncitizens
• Affordability
• Incarceration
• Member of an Indian Tribe

Q&A

Additional Resources

Resources links | View resource links

Part I: Premium Tax Credits | View webinar

Part II: Determining Households and Income | View webinar

Part III: Plan Design and Selection | View webinar

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

In this webinar presented on September 26, Sarah Lueck, Senior Policy Analyst, and Halley Cloud, Health Outreach Manager, provide an overview of health plan design—including cost-sharing charges in Marketplace plans, eligibility for cost-sharing reductions, and how cost sharing affect costs for consumers—and detail how to evaluate Marketplace plans based on cost sharing and plan design.

This is Part III in a four-part series on key elements of eligibility and enrollment.

Presentation Slides

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Elements of Plan Design

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Premiums vs. cost-sharing charges

Basic elements of plan design

Cost-sharing charges (video section, slides)

• Types of cost-sharing charges
• Maximum out-of-pocket (OOP) limit
• Metal level plan tiers
• Actuarial value
• Example: How cost sharing works
• Individual vs. family cost-sharing
• In-network vs. out-of-network cost-sharing

Cost-Sharing Reductions

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Definition of cost-sharing reductions (CSR)

• Eligibility for CSR
• Comparing CSR variations
• Zero cost-sharing plans for American Indians and Alaska Natives (AI/AN)

Evaluating Qualified Health Plans

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Summary of benefits and coverage (SBC)

• Visit limits on covered services
• Other covered services

Prescription drug formulary

Provider networks

Comparing Plan Options

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Scenario 1: General plan comparison

Scenario 2: Managing chronic diseases (video section, slides)

Scenario 3: Comparing out-of-pocket costs (video section, slides)

Q&A

Additional Resources

Marketplace Plan Comparison Worksheet | View worksheet

Part I: Premium Tax Credits | View webinar

Part II: Determining Households and Income | View webinar

Part IV: Exemptions | View webinar

Key Facts: Cost-Sharing Charges | View key facts

Key Facts: Cost-Sharing Reductions | View key facts

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

In this webinar presented on September 21, 2017, Shelby Gonzales, Senior Policy Analyst, and Tara Straw, Senior Policy Analyst, detail the rules used to determine household size and explain what counts as income when determining eligibility for premium tax credits and Medicaid.

This is Part II in a four-part series on key elements of eligibility and enrollment.

Presentation Slides

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Note: The December 2017 tax law changed some minor aspects of calculating MAGI for 2018. The relevant slides have been updated as of June 19, 2018. The webinar video has not been updated. For more information on the changes, please see Update: How the Tax Bill Affects MAGI in 2018.

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Why Household Size Matters

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Calculating percent of federal poverty line (FPL)

• Effect on expected premium contribution

Why Tax Filing Status Matters

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Overview of tax filing statuses

• Marital status and premium tax credits

Determining Households for Premium Tax Credits

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Households for PTC

Determining tax dependents (video section, slides)

• Example: Who can be claimed as a tax dependent?

Determining Households for MAGI Medicaid

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Which eligibility groups use MAGI rules?

Determining households for Medicaid (video section, slides)

• Example: Married couple with children
• Example: Three-generation household
• Example: Non-married parents

What Counts as Income for PTC and Medicaid

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Definition of MAGI

General rules about counting income

When to count a dependent’s income (video section, slides) *slides updated June 19, 2018

• Example: Single adult with dependent

How Marketplaces and Medicaid Combine Household and Income Rules to Determine Eligibility

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Example: Three-generation household

Example: Non-married parents

Q&A

Additional Resources

Part I: Premium Tax Credits | View webinar

Part III: Plan Design and Selection | View webinar

Part IV: Exemptions | View webinar

Key Facts: Income Definitions for Marketplace and Medicaid Coverage | View key facts

Key Facts: Determining Household Size | View key facts on Medicaid Households and PTC Households

Health Care Assister’s Guide to Tax Rules | View guide

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

In this webinar presented on September 19, 2017, Judy Solomon, Vice President for Health Policy, provides a detailed discussion of eligibility for premium tax credits and explains how premium tax credits are calculated.

This is Part I in a four-part series on key elements of eligibility and enrollment.

Presentation Slides

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Overview of Upcoming Open Enrollment Period

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Shorter open enrollment

• States with extended open enrollment

Premium Tax Credit Eligibility

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Definition of premium tax credits

Eligibility requirements for premium tax credits

1. Enrollment in a qualified health plan (QHP) (video section, slides)
2. Income requirements (video section, slides)
3. Eligible filing status (video section, slides)
4. Ineligible for other minimum essential coverage (MEC) (video section, slides)

Calculation of the Premium Tax Credit

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How is the amount of the PTC calculated? (video section, slides)

• Benchmark plan
• Expected premium contribution
• Rating factors that affect the cost of the benchmark plan
• Other factors affecting premiums

Examples: Calculating the PTC (video section, slides)

• Impact of benchmark plan
• Impact of expected contribution
• Impact of age
• Impact of tobacco use
• Impact of plan choice on premiums

Q&A

Additional Resources

Minimum Essential Coverage Reference Chart | View chart

Part II: Determining Households and Income | View webinar

Part III: Plan Design and Selection | View webinar

Part IV: Exemptions | View webinar

Key Facts: Employer-Sponsored Coverage and PTC Eligibility | View key facts

Key Facts: Premium Tax Credits | View key facts

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

In this webinar presented on July 7, 2017, Shelby Gonzales, Senior Health Policy Analyst, and Halley Cloud, Heath Outreach Manager, discuss 2017 changes to special enrollment periods (SEPs) and provide a detailed explanation of the new pre-enrollment verification process for SEPs.

Presentation Slides

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Review of Special Enrollment Periods

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SEP overview

Changes to SEP Eligibility and Use

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Prior coverage requirement for marriage SEP

Restrictions on plan selection for current Marketplace enrollees (video section, slides)

SEP Pre-Enrollment Verification Process

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SEP verification issue (SVI)

• SEPs subject to pre-enrollment verification

General process (video section, slides)

• Notices
• Coverage effective dates once SVI is resolved

List of documents to resolve SVI (video section, slides)

• Loss of other coverage
• Permanent move

Complex example

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SVI vs. data-matching issue vs. identity proofing

• Example: SVI and DMI (video section, slides)

Resources:

• Documents to resolve an SVI
• SEP Reference Chart
• General resources

Q&A

Additional Resources

SEP Reference Chart | View resource

Webinar: Overview of Changes in the Marketplace | View webinar

Webinar: Supporting Assisters in Uncertain Times | View webinar

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts