state exchange / marketplace by: greg town, [email protected]@enroll.us
TRANSCRIPT
State Exchange / Marketplace
• Texas does not have a state sponsored exchange
• Texas uses the Federally Facilitated Marketplace (FFM)
• Using the FFM is a good thing as a few State Exchanges have had significant problems and or are struggling
Texas – Carriers & Qualified Health Plans (QHP)Insurance Carriers (13) was 14 but Assurant is not writing new plans
Markets Carriers / QHPsAustin 8/105San Antonio 8/89Houston 7/65Dallas 4/44
Get covered (enrolled in Health Insurance)
• Be prepared, make list of your:• Medical Conditions / Concerns • Medical Providers / Medications• Household Members / Income• Other Personal Factors
• Call, ask questions, get help, get enrolled!
• Review all your Plan options and TX Premium Assistance Guidelines • Pick the plan that fits you best, note plan dates and requirements
Special Enrollment Period - Qualifying Life Events• Recently lost Minimum Essential Coverage (MEC) – For any reason!
• Recently released from Incarceration
• Recently moved from another state or service area
• Recently had a baby or adopted
• Recently married
• Recently gained citizenship or lawful presence in the U.S.
Special Enrollment Period - Complex Cases• Misinformation or misrepresentation
• Not getting enrolled in a plan
• Being enrolled in the wrong plan
• Enrollment error – “834 Issue”
• Display errors on HealthCare.gov
• If you applied for Medicaid through your state, or the Marketplace, but you weren’t eligible for Medicaid.
• Victims of domestic abuse/violence or spousal abandonment
Keep CoveredAct on Marketplace Request
September 15, 2014 5:16 PMMore than 8 million people enrolled in 2014 coverage through the federal and state marketplaces. But about 2.5 million submitted applications with missing entries or data that did not match federal records.
The New York Times: U.S. To End Coverage Under Health Care Law For Tens Of Thousands The Obama administration said on Monday that it planned to terminate health insurance for 115,000 people on Oct. 1 because they had failed to prove that they were United States citizens or legal immigrants eligible for coverage under the Affordable Care Act. It also told 363,000 people that they could lose financial aid because their incomes could not be verified (Pear, 9/15).
Texas, California and Florida took the biggest hit in 2014
2015 Marketplace Terminations – Much faster than 2014
Life & Income Changes
• Requirement of the ACA and Insurance Carriers • Most people did not properly report changes, resulting in:
• Not receiving Marketplace notices• Non-compliance of requested documentation & policy cancellation
• Receiving an over- payment or underpayment of the Advanced Premium Tax Credit• Resulting in “owing the IRS” • Not receiving the full Advanced Premium Tax Credit when needed
• Not receiving policy information and premium notices • resulting in their policy lapsing
Summary
• Texas uses the Federally Facilitated Marketplace (FFM)
• Always ask, you may be able to get coverage now
• Be prepared with your personal information to pick the right plan
• Keep coverage: respond to requests, give notice of changes
• Know your plan, utilize your insurance company’s tools and resources