Assister Regional Roundtables: Marketplace Enrollment in Maine - PDF document

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 www.mainecahc.org About Consumers for Affordable Health Care 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 1

3/13/2014 Agenda • Welcome & Introductions • Enrollment & Eligibility Updates • BREAK • Roundtable Discussion: Best practices and biggest challenges • Panel: Understanding the QHPs on Maine’s Marketplace • Lunch www.mainecahc.org 3 Enrollment & Eligibility Updates 1. The coverage gap 2. Applying for exemptions 3. Filing for appeals 12/3/13 www.mainecahc.org 2

3/13/2014 12/3/13 www.mainecahc.org 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 12/3/13 www.mainecahc.org 3

3/13/2014 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 12/3/13 www.mainecahc.org Maine’s Safety Net Programs • Hospital Free Care • Sliding Scale Clinics, Free Clinics • Prescription Assistance Programs • MedAccess • CarePartners • Other local programs? 12/3/13 www.mainecahc.org 4

3/13/2014 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 12/3/13 www.mainecahc.org Repayment Caps From Kaiser Family Foundation (kff.org) 12/3/13 www.mainecahc.org 5

3/13/2014 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 12/3/13 www.mainecahc.org 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 12/3/13 www.mainecahc.org 6

3/13/2014 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 12/3/13 www.mainecahc.org 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 12/3/13 www.mainecahc.org 7

3/13/2014 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 12/3/13 www.mainecahc.org 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 12/3/13 www.mainecahc.org 8

3/13/2014 How To Appeal • Eligibility notice should include detailed information on appeal, including timeframe • Consumers have right to representation 12/3/13 www.mainecahc.org 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 12/3/13 www.mainecahc.org 9

3/13/2014 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 12/3/13 www.mainecahc.org 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. 12/3/13 www.mainecahc.org 10

3/13/2014 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! 12/3/13 www.mainecahc.org Special Enrollment Periods Triggering Event Plan Selection Date Coverage Effective Date Loss of minimum essential Any day of the month First day of following coverage month following (but not due to failure of payment) plan selection Marriage Any day of the month First day of following month following plan selection Birth, adoption, or placement in Date of birth, adoption, foster care or placement Change in status to become a Same rules as open Same rules as open citizen or lawfully present enrollment enrollment Enrolled or not enrolled due to Same rules as open Same rules as open error by exchange enrollment enrollment 12/3/13 www.mainecahc.org 11

3/13/2014 Special Enrollment Periods Triggering Event Plan Selection Date Coverage Effective Date Future loss of employer coverage Any day of the month First day of the month (within next 60 days) following the date of the loss of coverage Access to new QHP through a Same rules as open Same rules as open permanent move enrollment enrollment Certain Native Americans can enroll or change plans once a month Exceptional circumstances, Same rules as open Same rules as open including loss of eligibility for a enrollment enrollment hardship exemption 12/3/13 www.mainecahc.org Questions www.mainecahc.org 24 12

3/13/2014 Thank You! www.mainecahc.org 25 13