Month: September 2021

OE9 Webinar:
September 2021

Part V Plan Design

In this Beyond the Basics webinar presented by the Center on Budget and Policy Priorities on September 30, 2021, Inna Rubin covers the ins and outs of how health insurance plans work. She also provides an overview of the different types of cost-sharing charges consumers may encounter and how subsidies on the health insurance marketplace can reduce those costs.

↓ View Presentation Slides (PDF)

OE9 Webinar

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Elements of Qualified Health Plans (QHPs)

  • Overview of QHPs
  • Essential health benefits
  • Overview of plan networks
  • Overview of formularies
  • Premiums & cost-sharing charges

Overview of Cost-Sharing Charges

  • Types of cost-sharing charges
  • Maximum out-of-pocket limit
  • Summary of benefits & coverage
  • Overview of family cost-sharing charges
  • Surprise billing protections

Actuarial Value

  • Overview of actuarial value
  • Cost-sharing differences between metal tiers
  • Impact of actuarial value on cost-sharing charges

Cost-Sharing Reductions

  • Overview of cost-sharing reductions
  • Examples of how cost-sharing reductions impact cost

Skimpy Plans

  • Overview of skimpy plans
  • Risks associated with skimpy plans
  • Coverage restrictions and exclusions in short-term plans

Additional Resources

OE9 Webinar: Part VI Plan Selection Strategies

Plan Comparison Worksheet

Key Facts About Cost-Sharing Reductions

Key Facts About Cost-Sharing Charges

OE9 Webinar:
September 2021

Part IV Preventing & Resolving Data Matching Issues

In this Beyond the Basics webinar presented by the Center on Budget and Policy Priorities on September 28, 2021, Tara Straw, Director of Health Insurance and Marketplace Policy, and Shelby Gonzales, Vice President for Immigration Policy, provide guidance on how to help consumers complete the Marketplace documentation requirements. They explain both how to prevent data matching issues from occurring and how to resolve them when they do occur.

↓ View Presentation Slides (PDF)

OE9 Webinar

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Overview of Data Matching Issues

  • Use of electronic data matching & limitations
  • What happens when there is a data matching issue
  • Data matching issue notices

Verification of Citizenship & Immigration Status

  • Citizenship verification process on the marketplace
  • Reasons citizenship data matching may be unsuccessful
  • Documents that can be used to verify citizenship
  • Immigration status verification process on the marketplace
  • Reasons immigration status data matching may be unsuccessful
  • Documents that can be used to verify immigration status
  • Examples

Verification of Household Income

  • Reasons data matching may be unable to verify income
  • General rules for income verification
  • Documents that can be used to verify income
  • Guide to resolving income data matching issues
  • Examples

Verification of Other Minimum Essential Coverage

  • Overview of minimum essential coverage data matching issues
  • Periodic data matching notices

General Tips to Prevent & Resolve DMIs

  • Tips to prevent data matching issues
  • Tips to resolve data matching issues

Identity Proofing for HealthCare.gov

  • Process for identity proofing
  • Documents used for identity proofing
  • Troubleshooting failed identity proofing

Additional Resources

Reference Guide to Immigration Documents

Yearly Income Guidelines and Thresholds

Troubleshooting Failed Identity Verification

OE9 Webinar:
September 2021

Part III Immigrant Eligibility

In this Beyond the Basics webinar presented by the Center on Budget and Policy Priorities on September 24, 2021, in partnership with the National Immigration Law Center, Shelby Gonzales, Vice President for Immigration Policy, and Gabrielle Lessard, Senior Policy Attorney at the National Immigration Law Center, provide an overview of immigration status-related eligibility requirements for Medicaid, the Children’s Health Insurance Program, and for enrollment in marketplace plans.

↓ View Presentation Slides (PDF)

OE9 Webinar

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Eligibility for Marketplace Coverage Based on Immigration Status

  • Immigration statuses eligible for marketplace coverage

Eligibility for Medicaid & CHIP Based on Immigration Status

  • Immigration statuses eligible for Medicaid & CHIP
  • 5-year bar in Medicaid & CHIP
  • State residency for Marketplace, Medicaid, & CHIP
  • Health coverage for people coming from Afghanistan

Other Important Eligibility Rules for Families that Include Immigrants

  • Special premium tax credit rule
  • Special marketplace rules for seniors
  • Examples

Options for People Ineligible for Insurance Affordability Programs Due to Immigration Status

  • Medicaid payment for emergency services
  • People who are undocumented or have DACA status
  • Programs that don’t restrict eligibility based on status
  • Health services related to COVID-19

Public Charge Update

Navigating the Application Process

  • How the marketplace verifies citizenship
  • Documents that can be used to prove citizenship
  • How the marketplace verifies immigration status
  • Documents that can be used to prove immigration status

Additional Resources

Reference Guide to Immigration Documents

Key Facts: Immigrant Eligibility for Health Coverage Programs

Key Facts: Helping Families That Include Immigrants Apply for Health Coverage

OE9 Webinar:
September 2021

Part II The Premium Tax Credit

In this Beyond the Basics webinar presented by the Center on Budget and Policy Priorities on September 16, 2021, Tara Straw, Director of Health Insurance and Marketplace Policy, provides an in-depth review of eligibility rules for premium tax credits—including how offers of employer-sponsored insurance can affect eligibility—as well as how premium tax credits are calculated.

↓ View Presentation Slides (PDF)

OE9 Webinar

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Premium Tax Credit Eligibility

  • What is the Premium Tax Credit (PTC)?
  • PTC Eligibility Requirements
  • Income Requirements
  • Eligible Tax Filing Status
  • Exceptions to Joint Filing Requirement for PTC
  • Special Rule for Certain Immigrants
  • Types of Minimum Essential Coverage (MEC)

Eligibility for Employer-Sponsored Insurance (ESI)

  • Eligibility for ESI
  • Affordability of ESI
  • Minimum Value of ESI
  • Health Reimbursement Arrangement (HRA)
  • Reconciliation of Overlapping Coverage

Calculation of the Premium Tax Credit

  • How is the PTC Calculated?
  • Expected Premium Contribution
  • Benchmark Plans
  • Factors that Affect the Cost of Benchmark Plans & Premiums
  • Reporting Changes that Impact PTC
  • PTC Repayment Caps

Additional Resources

Yearly Income Guidelines and Thresholds

Employer Coverage & Premium Tax Credit Eligibility Guide

Minimum Essential Coverage Reference Chart

Health Care Assister’s Guide to Tax Rules

OE9 Webinar:
September 2021

Part I Households & Income

In this Beyond the Basics webinar presented on September 14, 2021, Tara Straw, Director of Health Insurance and Marketplace Policy, and Jen Wagner, Director of Medicaid Eligibility and Enrollment, detail the rules used to determine household size and explain what counts as income when determining eligibility for premium tax credits and Medicaid.

↓ View Presentation Slides (PDF)

OE9 Webinar

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Why Household Size & Income Matter

  • ACA Eligibility Overview
  • How the federal poverty line (FPL) effects expected premium contribution

Why Tax Filing Status Matters

  • Overview of tax filing statuses
  • Marital status and premium tax credits (PTC)
  • Head of household questions
  • Exceptions to the joint filing requirement for PTC

Determining Households for Premium Tax Credits

  • Types of tax dependents

Determining Households for MAGI Medicaid

  • Medicaid household rules

What Counts as Income for PTC and Medicaid

  • Modified Adjusted Gross Income (MAGI)
  • Rules for counting income
  • Tips for counting self-employment income

Annual vs Monthly Income Counting

  • Entering monthly income
  • Entering annual income

Examples of Combining Household & Income Rules to Determine Eligibility

Additional Resources

Yearly Income Guidelines and Thresholds

Medicaid Household Rules

Determining Households for Medicaid and CHIP

Determining Households for PTC

Income Definitions for Marketplace and Medicaid Coverage

Self-Employment Income Estimator Tool

Health Care Assister’s Guide to Tax Rules

Yearly Income Guidelines and Thresholds

Eligibility for subsidies in the Marketplace is determined in part by using specific percentages and thresholds that are indexed and change each enrollment year.

In addition, people who received advance premium tax credits (APTC) in the prior enrollment year will need to complete a tax return for that year and will need to use percentages and thresholds applicable to that tax year.

This reference guide lists all the indexed guidelines and thresholds that change each enrollment year.

Coverage Year 2022 / Tax Year 2021

↓ View reference guide (PDF)

Coverage Year 2021 / Tax Year 2020

March 2021 (updated to reflect changes to premium tax credits in the American Rescue Plan)

↓ View reference guide (PDF)

Coverage Year 2020 / Tax Year 2019

↓ View reference guide (PDF)

Coverage Year 2019 / Tax Year 2018

↓ View reference guide (PDF)

Coverage Year 2018 / Tax Year 2017

↓ View reference guide (PDF)

September 2021

SEP Reference Charts

The Marketplace open enrollment period is the regular time each year when people can newly enroll in a qualified health plan or change to a different plan through the Marketplace. But certain events that occur during the year can trigger a special enrollment period (SEP), when a person may be able to newly enroll in a Marketplace plan or change to a different plan.

Guides to Special Enrollment Period (SEP) Triggers and Timing

This SEP Reference Chart is a tool for those who are helping people enroll in health coverage through a special enrollment period. It focuses on the circumstances that trigger a SEP in the Marketplace, who can trigger a SEP, and the effective date of coverage once a health plan is selected.

Amid the COVID-19 pandemic, and the economic crisis that came about as a result, this abbreviated SEP Reference Chart provides a list of the most common SEPs used during this time.

People who missed their SEP window due to COVID-19 can still enroll in Marketplace coverage using the “FEMA SEP.” This fact sheet explains what the FEMA SEP is and how it works.

Additional Resources

Webinar: Special Enrollment Periods | View webinar

Minimum Essential Coverage Reference Chart | View chart

September 2021

Premium Tax Credit Calculator

This calculator provides an estimate of the amount of financial help a person may be eligible for and how much they could expect to pay for health insurance on the marketplace. The information provided is based on premiums for 2022 plans and reflects the increase to premium tax credits in the American Rescue Plan.

This tool was developed by the Kaiser Family Foundation.

Health Reform: Beyond the Basics is a project of the Center on Budget and Policy Priorities designed to provide training and resources that explain health coverage available through Medicaid, CHIP, and the Marketplace. It is aimed at navigators, advocates, state and local officials and others who help consumers get and keep their health coverage.

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Washington, DC 20002

Beyondthebasics@cbpp.org

Robert Wood Johnson Foundation

Support for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

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