Open Enrollment and Special Enrollment

Covered California has said they will allow extended enrollment through 2/22/15 for certain scenarios.

To take advantage of the extra time, they must have been, and be, working with a certified insurance agent, enrollment counselor or county eligibility worker.

After this Open Enrollment window closes, only Qualifying Events (or Special Enrollment Periods) allow consumers to change plans or enroll in a new plan.

EXAMPLE OF QUALIFYING LIFE EVENTS FOR SPECIAL ENROLLMENT:

  • Getting married or entering into a domestic partnership.
  • Having a child or adopting a child, receiving a child into foster care, or placing a child in adoption or in a foster home.
  • Change in place of residency, which allows a consumer to gain access to new Covered California health insurance plans. This includes moving to California from another state. This also applies to individuals who are released from jail or prison.
  • Losing health coverage. For example, consumers are no longer eligible for Medi-Cal, or they lose health coverage through their job.
  • Income changes so much that a consumer becomes newly eligible or ineligible for help paying for their insurance. For example, if a consumer is already getting help paying for their insurance premium, and their income goes down, they may be able to get extra help.
  • Becoming citizens, national or lawfully present individuals. This event applies only to people who were not previously citizens, nationals or lawfully present.
  • The consumer’s enrollment was wrong, due to the misconduct or misrepresentation of their health insurance company, Covered California or a non-Covered California entity (such as a Certified Enrollment Counselor).
  • Being a member of a federally recognized American Indian or Alaska Native tribe. A consumer in this category may enroll in health insurance or change health insurance plan once a month even if the open enrollment period is over.
  • Covered California can also determine, on a case-by-case basis, that the consumer experienced an exceptional circumstance, which could allow for a special enrollment period.

Eligible consumers with a low income, who qualify, can apply for Medi-Cal anytime throughout the year.

For more information, you can view the Covered California link below.  To enroll in a plan and explore your options, contact Steve Downey, or any Covered California Certified Insurance Agent.

http://www.coveredca.com/individuals-and-families/getting-covered/special-enrollment/

Covered CA – Consumer Income Reconciliation Notice

Covered California will be sending a notice next week to health plan enrollees that received APTC, or “premium assistance,” encouraging them to report any changes in income or household size since enrolling in a Covered California health plan.

Enrollees who received premium assistance this year will need to file taxes for 2014. When they file, the IRS will check to see if the amount of income they reported to Covered California is the same as the amount of income they actually made. The IRS will also check to see if their family size is the same as when they applied. The IRS will compare, or “reconcile,” the amount of premium assistance they qualify for based on their actual income and family size reported on their tax return with the premium assistance they received during the taxable year.

Enrollees who experienced a change in income or household size but have not reported this information to Covered California are at risk of having to pay more at tax time. If needed, Covered California can work with these enrollees to reduce their current premium assistance to minimize this consequence.

Covered CA Notice sent to (some) Clients

From COVERED CA:

Notices with Incorrect Open Enrollment Dates

In the past two weeks, about 11,000 Denial of Coverage notices were generated and sent to consumers with the incorrect Open Enrollment dates for the Individual Marketplace. These notices were sent to consumers that applied outside of Covered California’s Open Enrollment period.  Although the dates indicated were correct at the time the notices were sent, a change in the law resulted in a change to the Open Enrollment period indicated.

The incorrect dates on the notice were October 15, 2014 through December 7, 2014. The 2015 Open Enrollment period is November 15, 2014 to February 15, 2015.

Please [be aware if you were] affected by this notice [and take note of] the new Open Enrollment dates. Be sure to also check whether [you] qualify for Covered California’s Special Enrollment Period.

If eligible, you can call [today for questions about enrolling in this special enrollment period].

[If you] are not eligible for Covered California’s Special Enrollment Period, [you] can apply during Open Enrollment this fall for coverage beginning January 1, 2015.

Changes in Circumstances can affect your Premium Tax Credit

Excellent reminder from the IRS re: Premium Tax Credits:         

If you receive advance payment of the premium tax credit in 2014 it is important that you report changes in circumstances, such as changes in your income or family size, to your Health Insurance Marketplace.

Most people already have insurance and they won’t have to do anything new. If you are looking for health insurance, you may be able to get it through the Health Insurance Marketplace and you may qualify for the premium tax credit.  You can “get it now” as an advance payment or you can “get it later” when you file your tax return.

Advance payments of the premium tax credit provide financial assistance to help you pay for the insurance you buy through the Health Insurance Marketplace. Having at least some of your credit paid in advance directly to your insurance company will reduce the out-of-pocket cost of the health insurance premiums you’ll pay each month.

If you decide to get the credit in advance, it’s important to report any changes in your income or family size to the Marketplace throughout the year. Reporting these changes will help you get the proper type and amount of financial assistance so you can avoid getting too much or too little in advance.

The government makes advance payments of the credit based on an estimate of the credit that you will claim on your tax return when you file in 2015. If you report changes in your income or family size to the Marketplace when they happen in 2014, the advance payments will more closely match the credit amount on your 2014 federal tax return.  This will help you avoid getting a smaller refund than you expected or even owing money that you did not expect to owe.

More Information

Find out more about the premium tax credit, as well as other tax-related provisions of the health care law at www.irs.gov/aca

 

Qualifying Life Events

Now that Open Enrollment has ended, you must have a “Qualifying Event” to make any changes or enroll in a new plan outside of Open Enrollment.  As of today’s regulations (always subject to change), the next Open Enrollment period will begin on Nov. 15th, 2014.

Examples of Qualifying Life Events:

In all state-based, federal and partnership exchanges, individuals may also enroll outside of the open enrollment window if they have a qualifying life event. The consumer and the agent should contact each specific exchange directly for their qualifying life event procedures. For your reference, qualifying life events include:

  • Marriage
  • Having a baby
  • Adopting a child or placing a child for adoption or foster care
  • Moving outside your insurer’s coverage area
  • Losing other health coverage—due to losing job-based coverage, divorce, the end of an individual policy plan year in 2014, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP and similar circumstances. Important: Voluntarily ending coverage doesn’t qualify you for a special enrollment period. Neither does losing coverage that doesn’t qualify as minimum essential coverage.
  • Gaining citizenship
  • Leaving incarceration
  • Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year.
  • 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

Apply by Monday 3-31-14, Open Enrollment will be OVER

 
Enrollees Who Want to Beat March 31 Deadline Rush Should Sign Up Now
 
SACRAMENTO, Calif. — Covered California™ today confirmed its March 31 deadline for open enrollment in an exchange health insurance plan and announced its policies for completing an application for health care coverage.
 
With five days left to enroll in a Covered California health insurance plan, the exchange is urging consumers to sign up before the deadline if they want to get affordable health care coverage and avoid a tax penalty.
 
“If you haven’t applied yet, do it now,” said Covered California Executive Director Peter V. Lee. “We are concerned that high numbers of people will come to our doors at the last minute and won’t be able to get enrolled in time. If that happens, consumers face a penalty for not getting insurance, and they may miss out on the peace of mind that comes with coverage.”
 
Covered California also clarified the process for completing applications for health coverage in 2014.
 
“Covered California is not extending its deadline for applying for a health plan,” Lee said. “However, we’re committed to helping all those who started an online application to cross the finish line.”
 
Individuals who start an online application by 11:59 p.m. on March 31, 2014, will have until 11:59 p.m. on April 15, 2014, to complete their application and select a plan. To start an application, the consumer must take at least the following steps:
 
  • Create an online account.
  • Fill out all required information on the “Apply for Benefits” page and click “Continue.” The page contains two required fields (see application screen images online athttp://news.coveredca.com/p/blog-page_26.html).
  • After clicking on “Continue,” individuals will be taken to the “Consent for Verification” page, where they need to click on “Save & Exit” or “Continue.”
  • They must return to their online account no later than April 15 to complete the application and select a plan. 
Covered California reminds consumers that they must make their first premium payment to the health insurance company by the due date to avoid the tax penalty.
 
Paper applications must be postmarked by March 31, 2014, to meet the open-enrollment deadline for 2014 Covered California plans. To guarantee coverage beginning May 1, 2014, however, consumers are encouraged to enroll online.
 
After the end of open enrollment on March 31, consumers may be eligible for Covered California’s special enrollment period, which can be triggered by one of several “qualifying life events,” as defined under the Affordable Care Act. Some of those qualifying events are:
 
  • Getting married.
  • Having a baby or adopting a child.
  • Permanently moving to a new area that has different health plan options.
  •  Losing other health care coverage that is considered minimum essential coverage.
  • A change in income that would affect an enrollee’s eligibility for financial assistance.
 
Low-cost or no-cost coverage through Medi-Cal is also available to consumers year-round, and they can check their eligibility and sign up on the Covered California website, through its Service Center or with the help of assisters.
 
Covered California also operates its Small Business Health Options Program (SHOP) year-round for businesses with 50 employees or fewer.
 
Covered California’s next open enrollment, for 2015 coverage, will begin in fall 2014, likely mid-November.