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Category: What To Know

What health plans are offered through the Marketplace?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

All health plans offered through the Marketplace must meet the requirements of “qualified health plans.” This means they will cover essential health benefits, limit the amount of cost sharing (such as deductibles and co-pays) for covered benefits, and satisfy all other consumer protections required under the Affordable Care Act.

Health plans may vary somewhat in the benefits they cover. Health plans also will vary based on the level of cost sharing required. Plans will be labeled Bronze, Silver, Gold, and Platinum to indicate the overall amount of cost sharing they require. Bronze plans will have the highest deductibles and other cost sharing, while Platinum plans will have the lowest. Health plans will also vary based on the networks of hospitals and other health care providers they offer. Some plans will require you to get all non-emergency care in-network, while others will provide some coverage when you receive out-of-network care.

What happens if I want to quit a Marketplace health plan during the year?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

It is important that you contact both the Marketplace and the health plan and let them know you no longer need coverage.  In HealthCare.gov states, you can log into your Marketplace account, select the “terminate coverage” option, and enter the required information.

If you have a family policy and want to remove one person from the policy but keep coverage in effect for others, in HealthCare.gov states, log in to your Marketplace account, select the “reporting a life change” option, and enter the required information.

If you have questions about these changes, contact one of the agents here at Hummingbird. We will be happy to assist you in updating your information through Healthcare.gov.

Making these changes through your Marketplace account will create a written record that you tried to end coverage.

Do not simply stop paying the premium for your Marketplace health plan as a way to terminate coverage.  Nonpayment will eventually cause your coverage to end, but in the future, if you try to enroll in coverage again with that insurer, you might be prevented from doing so until you repay the missed premium.

I’m leaving my job and will be eligible for COBRA. Can I shop for coverage and subsidies on the Marketplace instead?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

Yes, leaving your job and losing eligibility for job-based health coverage will trigger a special enrollment opportunity that lasts for 60 days. You can apply for Marketplace health plans and (depending on your income) for premium tax credits and cost sharing reductions during that period. If you enroll in COBRA coverage through your former employer, however, you will need to wait to the next Marketplace Open Enrollment period if you want to switch to a Marketplace plan.

I have COBRA and am finding it difficult to afford, but Open Enrollment is over. Can I drop my COBRA and apply for non-group coverage outside of Open Enrollment?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

No, voluntarily dropping your COBRA coverage or ceasing to pay your COBRA premiums will not trigger a special enrollment opportunity. You will have to wait until you exhaust your COBRA coverage or until the next Open Enrollment (whichever comes first) to sign up for other non-group coverage.

I have COBRA and it’s too expensive. Can I drop it during Open Enrollment and enroll in a Marketplace plan instead?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

During Open Enrollment, you can sign up for a Marketplace plan even if you already have COBRA. You will have to drop your COBRA coverage effective on the date your new Marketplace plan coverage begins. After Open Enrollment ends, however, if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment opportunity and will have to wait until the next Open Enrollment period. Only exhaustion of your COBRA coverage triggers a special enrollment opportunity.  

Do I have to prove eligibility for a special enrollment period?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

Yes, in most states.  The federal Marketplace (HealthCare.gov) requires people to provide documentation of eligibility for special enrollment before you can enroll in coverage.  Pre-enrollment verification is required for the following qualifying events:

  • Loss of minimum essential coverage
  • Permanent move
  • Marriage
  • Adoption, placement for adoption, placement for foster care, or child support or other court order, and

If you experience one of these qualifying events and apply for coverage in a federal Marketplace state, HealthCare.gov will let you select a health plan, but will delay the effective date of coverage while it verifies your eligibility for the SEP.

HealthCare.gov will tell you what documents are acceptable to verify your eligibility for the SEP and how to submit them.  Once you apply for the SEP and select a health plan, you will have 30 days to provide documentation to the Marketplace.  Once the Marketplace verifies your eligibility, you will be able to complete enrollment in the plan you selected.

It is very important to act quickly to complete this verification process.  If you do not submit the required documentation within 30 days, your plan selection will be cancelled and you will no longer be eligible for the SEP.

If you submit documentation on time but the Marketplace determines it to be insufficient, you can apply for an extension of the 30-day review period to submit additional documentation.  However, you cannot apply for an extension of your special enrollment period.  If your eligibility is not verified by the end of your 60-day SEP, your plan selection will be cancelled and you will not be able to enroll until the next open enrollment period.

How does the “permanent move” special enrollment work?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

If you move to or within a HealthCare.gov state, you will be eligible for a special enrollment period only if you had previously been enrolled in other coverage.  You must have been enrolled in minimum essential coverage (such as a job-based plan, Marketplace plan, or Medicaid) for at least 1 day in the 60 days preceding the date of the permanent move in order to qualify for the permanent move special enrollment period.

There are exceptions to this rule:

  • If you previously lived in a state that did not expand Medicaid eligibility and were ineligible for Marketplace coverage in that state because your income was below the poverty level, and if you move to another state where you become newly eligible for premium tax credits, you will be eligible for the permanent move special enrollment period when you move to the new state
  • If you moved from outside of the United States or a U.S. territory, you are eligible regardless of prior coverage
  • If you are newly released from incarceration, you are eligible regardless of prior coverage

The permanent move SEP lasts 60 days from the date of your move.  Coverage will start on the first day of the following month; or, if you select your new plan after the 15th of the month, new coverage will start on the first day of the second following month.  In HealthCare.gov states, you will not be able to apply for the permanent move SEP in advance of your move date.    As a result, people who move to or within HealthCare.gov states may experience a break in coverage while they wait for their new plan to take effect.

When you apply for the permanent move SEP in a HealthCare.gov state, you will be required to provide documentation of your prior address, your new address, and evidence of loss of prior coverage.

How does the “new dependent” special enrollment period work?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

When you have a baby – or when you adopt a child, a child is placed with you for adoption or foster care, or if you gain a dependent through a court order – you can qualify for a new dependent special enrollment period.  You and your dependents can enroll in coverage through the Marketplace.

The new dependent SEP lasts for 60 days from the date of the child’s birth (or adoption, court order, etc.).  New coverage generally will take effect retroactive to the date of birth (adoption, court order, etc.)

If you are already enrolled in Marketplace coverage through HealthCare.gov, you can add your new dependent to your Marketplace plan or buy a different, separate policy for the child.  You cannot use the “new dependent” SEP to change health plans for already-covered family members.

This limitation on plan selection does not apply if you are an American Indian or Alaska Native.  In addition, if your current Marketplace plan doesn’t cover dependents, you and your dependents can enroll together in a new plan at the same metal level as your current Marketplace plan.