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2021 ACA Special Enrollment Period in response to the COVID-19 Emergency

Second Chance for Health Insurance in 2021 as ACA Marketplace Reopens with Special Enrollment Period

The new SEP begins Feb. 15th, as millions of people have lost their jobs and insurance in the pandemic

The coronavirus disease 2019 (COVID-19) national emergency has presented unprecedented challenges for the American public. Millions of Americans are facing uncertainty and millions of Americans are experiencing new health problems during the pandemic. Due to the exceptional circumstances and rapidly changing Public Health Emergency (PHE) impacting millions of people throughout the US every day, many Americans remain uninsured or underinsured and still need affordable health coverage. In accordance with the Executive Order issued on 1/28/2021 by President Biden, the Centers for Medicare & Medicaid Services (CMS) determined that the COVID-19 emergency presents exceptional circumstances for consumers in accessing health insurance and will provide a Special Enrollment Period (SEP) for individuals and families to apply and enroll in the coverage they need. This SEP will be available to consumers in the 36 states served by Marketplaces that use the HealthCare.gov platform, and CMS will conduct outreach activities to encourage those who are eligible to enroll in health coverage. CMS strongly encourages states operating their own Marketplace platforms to make a similar enrollment opportunity available to consumers in their states.

Starting on February 15, 2021 and continuing through May 15, 2021, Marketplaces using the HealthCare.gov platform will open up to make a SEP available to all Marketplace-eligible consumers who are submitting a new application or updating an existing application. These consumers will newly be able to access the SEP through a variety of channels, including a network of over 50,000 agents and brokers who are registered with the Marketplace and ready to assist consumers with their application for coverage.

Some consumers may already be eligible for other existing SEPs, Medicaid, or the Children’s Health Insurance Program (CHIP) – they can visit HealthCare.gov now to find out if they can enroll even before this new SEP. Starting February 15, consumers seeking to take advantage of this SEP can find out if they are eligible by visiting HealthCare.gov, and are no longer limited to calling the Marketplace call center to access this SEP. Consumers who are eligible and enroll under this SEP will be able to select a plan with coverage that starts prospectively the first of the month after plan selection. Consumers will have 30 days after they submit their application to choose a plan. Current enrollees will be able to change to any available plan in their area without restriction to the same level of coverage as their current plan. In order to use this SEP, current enrollees will need to step through their application and make any changes if needed to their current information and submit their application in order to receive an updated eligibility result that provides the SEP before continuing on to enrollment. This SEP opportunity will not involve any new application questions, or require consumers or enrollment partners to provide any new information not otherwise required to determine eligibility and enroll in coverage. In addition, consumers won’t need to provide any documentation of a qualifying event (e.g., loss of a job or birth of a child), which is typically required for SEP eligibility.

As always, consumers found eligible for Medicaid or CHIP will be transferred to their state Medicaid and CHIP agencies for enrollment in those programs.

For more information about the Health Insurance Marketplace or Healthcare.gov, contact your local agents at Hummingbird Insurance today!

What Does the Texas Ruling Against Obamacare Mean?


By Daniel Murphy

After the December 14th ruling by a federal judge against the legality of ACA healthcaremany people are wondering whether or not they will continue to have coverage. Catchy headlines ran on news media for weeks implying all sorts of possible scenarios. Between the media war and political noise, the average person hasn’t been able to piece together exactly what to expect. Here at the office it’s been one of the most common questions for the past two weeks; “Is Obamacare still going to be around for 2019?” So as professionals in the industry, here are our thoughts down at Hummingbird.

 

This entire event needs to be put in it’s actual context. The supreme court did not strike down Obamacare – a federal judge in Texas did. Though this has powerful implications, especially in a judiciary system where establishing precedent is important for future laws, it can not bring everything to a grinding halt all by itself. There is almost always an appeal process. The ruling in Texas is important, but it will take many months ifnot several years to see precisely how it is going to pan out.

 

For some added perspective, consider that this is actually the seventieth time that the ACA has been challenged in court and/or sued by an assembly of politicians. The Supreme Court itself has even examined it once before and upheld the entire structure as legal and constitutional. There is a lot of political attention and validation in certain groups for the mere effort to bring down the Affordable Care Act. This results in many symbolic attacks against the law for the sake of bolstering one’s constituency and increasing funding for political campaigns. More often than notthese lawsuits are just tigers without teeth.

 

A majority of people want to continue to see some sort of inclusive healthcare for our country, and this is true on both sides. Laws often get empowered or diminished in a democratic system whose hallmark is a revolving door of different parties, people, and plans. Different ideologies hold power throughout any given era. Often times, however, the core laws are upheld. The ACA, I think at least, has become a core law in the United States. That doesn’t mean it won’t be transformed or even renamed as time goes on, but it does mean that some form of government-supported healthcare that accepts most pre-existing conditions is here to stay. Even President Donald Trump has voiced his support for a healthcare structure that provides this sort of coverage.

 

The Texas decision may indeed climb its way to the supreme court. A newly confirmed Republican on the seat there is a valid concern for people afraid that the Supreme Court may overturn its own earlier ruling. No matter what the outcome this is going to be a long and cumbersome process. Even if the law were repealed in totality tomorrow, there would still be at least a year involved in actually dismantling it. That means that for 2019, at least, no one should need to worry too much about their coverage. The future is harder to predict, but I’m comfortable betting that some form of inclusive healthcare will continue to exist at the federal level indefinitely, hopefully as a reliable pillar of U.S. law.

What if I don’t know what my income will be next year?

When you apply for the premium tax credit, you will be asked to estimate your expected income for the upcoming year. Often a good place to start is to consider what your income is this year, or what income you reported on your tax return last year. However, if your circumstances have changed since then, for example, if you recently lost your job, you should make your best estimate of what your income will be next year. The health insurance Marketplace will compare your income estimates against records at the Internal Revenue Service, Social Security Administration and other sources. If your estimate and official records don’t match, or aren’t sufficiently close, but you meet all other eligibility requirements, you might be asked to provide documentation to support your income projections.

In general, if the income amount shown on that official record is more than 25% or $6,000 (whichever is greater) higher than the amount you put on your application, you might receive a data match inconsistency notice from the Marketplace and you’ll need to provide more documentation.

If you don’t have that documentation handy, the Marketplace will provide subsidies for up to 90 days while you gather and submit your documentation for verification. It is very important that you provide any documentation requested by the Marketplace in a timely manner; if you don’t your subsidies might be reduced or terminated.

Keep in mind that if you estimate your income incorrectly and end up claiming more help than you are eligible for, you may have to pay back some or all of the premium tax credit you received. If you over-estimate your income and end up claiming less help than you are entitled to, the difference will be refunded to you when you file your income taxes the following year.

I’m raising my grandchild and claim her as a dependent. If I apply for Marketplace subsidies, will we be considered a household of two?

Yes, you will be considered as a household of two for both Medicaid and premium tax credits. However, your grandchild will be considered as her own household for Medicaid and CHIP and your income will not count in determining her eligibility for these programs. Assuming she does not have her own income she will likely be eligible for Medicaid or CHIP and not eligible for premium tax credits for coverage in the Marketplace. You could of course purchase coverage for her in the Marketplace but you would not be eligible for a premium tax credit to help pay for her plan.  Whether you could include her on your policy would depend on what insurers offer in your Marketplace.

I understand eligibility for premium tax credits is based on our household income. Who counts as being in my household?

A household, for purposes of determining eligibility for premium tax credits, includes any individuals whom you list on the federal tax form. That includes yourself, your spouse, and dependents. Dependents include children who meet certain requirements:

  • U.S. citizen or resident of the U.S, Mexico or Canada
  • Live with you for more than half the year
  • Under age 19 at the end of the year (or under age 24 if a full-time student); a child is considered to live with the taxpayer while he or she is temporarily away from home due to education, illness, business, vacation or military service.
  • Doesn’t provide more than 50% of his or her own support

Other adults who can count as dependents include relatives, in-laws or full-time members of your household who:

  • Are a U.S. citizen or resident of the U.S, Mexico or Canada
  • Receive more than 50% of their support from you
  • Are related to you or live in your home all year
  • Make less than $4,150 (in 2018), generally excluding Social Security

A household can include individuals even if they are ineligible for tax credits (for example, individuals who are not lawfully present). Your household size can change during a year due to family changes, including the birth or adoption of a child, a child moving out of the house, and divorce or legal separation. When such changes take place you should report them to the Marketplace as they may affect your eligibility for subsidies. Family changes also can trigger a special enrollment opportunity when you can change health plans, even outside of the regular Open Enrollment period.

Note that the definition of household for determining eligibility for premium tax credits sometimes differs from the definition of household for determining Medicaid eligibility. Ask your Marketplace for more information about who should be counted in your household.

My spouse and I have a teenage daughter who has a part-time job. Do we count her income as part of our household income when we apply for Marketplace subsidies?

The answer depends on whether she earned enough income to be required to file a federal income tax return on her own. Generally, kids who qualify as tax dependents aren’t required to file a federal income tax return or pay taxes on their income if they earned less than a threshold amount ($12,000 in 2018.) If your daughter earned less than that, you would not count her income as part of your household income.

I’m divorced and I pay alimony to my ex-spouse. Should I deduct that from my income in determining my eligibility for subsidies?

For divorces after December 31, 2018, alimony payments are no longer deductible for the paying spouse and alimony is not included as income for the recipient spouse.

For pre-2019 divorces, old tax rules apply.  The paying spouse can deduct alimony payments from income and the recipient spouse must report alimony payments as income on the federal tax return.  However, divorced couples have the option of modifying their pre-2019 divorce agreement to adopt the new tax rules.

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