Countdown to the Health Insurance Marketplace

Posted by AzBlueMeanie:

I attended a stakeholders Health Inurance Marketplace training session today sponsored by the Centers for Medicare & Medicaid Services (CMS) and the Cover Arizona Coalition.

The question I most often receive about the Marketplace is about how the tax credits and subsidies for health insurance will work. This is included in the application and enrollment process beginning on October 1. Your estimated income for 2014 will determine the amount of the tax credit and cost-sharing subsidy for which you will qualify.

The Advanced Premium Tax Credit (APTC) will apply to reduce your premium payment. The subsidies will apply to reduce your cost-sharing part of coverage for copays, coinsurance, etc. For example, let's say you select a "Silver Plan" that has a premium of $2000 per month, and has a cost-sharing of 30 percent. In this example, your income level may qualify you for a tax credit that reduces your monthly premium to $1,500 per month and reduces your cost-sharing amount to 20 percent. These credits and subsidies are paid to the insurance provider through the billing process. You will not receive any payment from the government. It is my understanding that the cost-sharing subsidies only apply to the "Silver Plans."

Estimating your 2014 income may be easy for people with a stable income. For independent contractors, small businesses and sole proprietors, and people with part-time jobs or seasonal employment, this may prove a bit trickier. Should you over-estimate your income, reducing the amount of the tax credit for premiums and reducing the subsidy for cost-sharing to which you otherwise would have been entitled, you will receive a tax credit on your income taxes, presumably reducing your tax liability and possibly resulting in  a tax refund. Should you under-estimate your income, which would overstate the amount of the tax credit for premiums and the subsidy for cost-sharing that you receive, this amount will increase your tax liability for which you may owe taxes. This is being called the "reconciliation" process.

Those uninsured individuals who do not enroll in a health insurance plan beginning January 1, 2014 will be subject to a tax penalty of $95 or one percent of your income in 2014, whichever amount is more. This tax penalty is scheduled to increase substantially in coming years.

The Arizona Health Insurance Marketplace can only be found at the official government web site, HealthCare.gov. Click on the "get insurance" button. This page will instruct you to "select your state." The Health Insurance Marketplace is primarily designed for individuals, but there is also a Small Business Health Options Program (SHOP) for small businesses with fewer than 50 employees, and sole proprietors.

Prior to starting, you should collect all the information you are going to need. Gather basic information about your household income to see if you qualify for lower costs on Marketplace coverage. Use this checklist to get started.

You can apply for health coverage, compare all your options, and
enroll in a plan in one streamlined application through the Health
Insurance Marketplace.
When open enrollment begins October 1, 2013, you can fill out your application and see the health coverage options available to you.

1. Create an account

First provide some basic information. Then choose a user name, password, and security questions for added protection.

2. Apply for Marketplace coverage

Enter information about you and your family, including your income, household size, and more. Use this checklist now to help you gather the information you’ll need.

3. Pick a plan

Next you’ll see all the health insurance plans and programs you’re eligible for and compare them side-by-side. You’ll also find out if you can get lower costs on Marketplace coverage.

4. Enroll

Choose a health insurance plan that meets your needs and enroll! Coverage starts as soon as January 1, 2014.

If you need help with your Marketplace application,
there are people trained and certified to help you understand your
health coverage options and enroll in a plan in every state. And
remember that you can contact us anytime by phone or live web chat for help with a Marketplace question.

For low-income individuals, at or below 133% of the Federal Poverty Level (FPL), you may be directed to your state's Medicaid (in Arizona this is AHCCCS) program; those of you with minor children may also be directed to the CHIP program. The health insurance exchange "hub" shares this information between government agencies to direct you to the proper coverage.

If you qualify for Medicaid (AHCCCS) you will be directed to this program. You do not qualify for the Heath Insurance  Marketplace. You will have to complete the application for AHCCCS programs. See healthearizona.org. The instructor today suggested that, if in doubt, individuals should complete both application processes "Because there are only two answers – yes or no." You will qualify for one or the other program. Coverage under Arizona's expanded Medicaid (AHCCCS) program begins January 1, 2014.

Attention Seniors: Medicare is not part of the Health Insurance Marketplace, and you should not try to enroll. This may result in a penalty. Your coverage is under Medicare Parts A-D, depending upon the Parts for which you qualify.

Coveraz.org has links to resource materials and webinars of recent programs available online.

Below are some instructional videos shown today that walk you through the application process and enrollment process with a "fictional single man from Arizona, William Doe." Note: The appearance of the Arizona Health Insurance Marketplace may differ from the one depicted in these instructional videos.

Application Process

Enrollment Process