You can remain covered as a dependent on your parent’s policy until you turn 26. Once you lose eligibility as a dependent, you will qualify for a special enrollment opportunity. At that point, you will also be able to apply for health coverage and assistance through the Marketplace, even though it won’t be during a regular Open Enrollment period. In addition, if your parent’s policy is a group plan offered by an employer with at least 20 workers, you would also be able to continue coverage under the policy through COBRA for up to 3 years. However, the employer contribution to the premium would end and Marketplace subsidies cannot be applied to the COBRA coverage.
If you are currently enrolled in a student health plan, you can still qualify for Marketplace policies and subsidies if you apply during Open Enrollment. During Open Enrollment, you can sign up for a Marketplace plan and, if your income is between 100% and 400% of the poverty level you can also apply for premium tax credits. You will have to drop your student health coverage by December 31 in order to remain eligible for premium tax credits for the following year.
Outside of Open Enrollment, you cannot voluntarily drop your student health plan coverage in order to qualify for Marketplace coverage and premium tax credits. However, if you involuntarily lose eligibility for student health plan coverage mid-year – for example, if you drop out of school and so lose eligibility for the student health plan – you will qualify for a “coverage loss” special enrollment opportunity and be able to apply for Marketplace coverage and premium tax credits. The “coverage loss” special enrollment period (SEP) will last 60 days from the date your student health coverage ends. If you know in advance when coverage will end, you can also apply for the SEP up to 60 days in advance. If you apply in advance, you can elect to have new coverage begin the following day and avoid a gap in coverage.
If you live in a HealthCare.gov state, you will need to provide proof of coverage loss to qualify for this SEP — for example, a letter or notice from the school stating when coverage will end.
Log into your HealthCare.gov account to apply for the SEP and select a new health plan. You will then 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 SEP. 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.
If you have questions contact a Navigator or other Marketplace assister program for help.
This is unclear. So far, the federal government has not established a clear appeals process for problems that arise under the rule that permits insurers to refuse to renew Marketplace coverage for nonpayment. It is important that you sign up for coverage before the end of Open Enrollment. At this point, options to consider include:
Ask your insurer to reconsider. Be sure to present your cancelled check or other proof that you paid.
Report this problem to the Marketplace and to your state insurance regulator and ask their help resolving the problem
Review Marketplace plan options offered by any other insurers and consider signing up for one of those if you can’t get this problem resolved before December 15.
Your employer is not required to fill out the form that asks about affordability of your job-based health plan. If for any reason you cannot obtain this information from your employer, you should report to the Marketplace what you know, yourself, about your eligibility for employer sponsored coverage, the cost of that coverage, and whether it meets minimum value. The Marketplace may try to follow up with your employer and collect or verify this information. The Marketplace will determine your eligibility for subsidies based on the information you provided or based on any information the Marketplace was able to obtain on its own through other follow up with your employer.
Although employers aren’t required to provide you this information up front, most are expected to do so. All employers are required to provide you with this information at year end. In January, your employer will be required to provide you with a Form 1095-C that indicates whether health benefits they offered to you in the prior calendar year meet the requirements for affordability and minimum value.
This will depend on the reason for your appeal and the documentation needed to decide your appeal. Contact the Marketplace for more information about your appeal.
You can request an appeal of any Marketplace decision, including decisions about
Your eligibility to buy coverage in the Marketplace
Your eligibility for, or the amount of, premium tax credits or cost sharing reductions
Your eligibility for an exemption from the penalty for not having health insurance
Untimely (late) notice from the Marketplace about a decision
To make your appeal, start by reviewing the Marketplace’s decision. You will have received the decision (called a determination notice) online if you initially applied online, or in the mail if you submitted a paper application. So far, in the federal Marketplace, the notice will not provide much detail to explain the reasons for the decision, but it will describe the process you should follow if you want to appeal.
If you have questions about what the notice says or if you want to appeal, consider asking for help from a Navigator or other in-person assister program. The Marketplace website will have a link to programs in your area.
Generally you have 90 days from the date on your eligibility decision notice to request an appeal. If you need health services right away and a delay could jeopardize your health, you can request an expedited appeal.
To request an appeal in federal Marketplace states, you’ll have to submit the appeal in writing. You can write a letter or use appeal forms available on healthcare.gov and submit your appeal by mail or by fax. Your written appeal should provide your name and contact information and an explanation of what you are appealing and why. If you are requesting an expedited appeal, indicate that on the form or state it in your letter.
You can submit documents to the Marketplace that support your case. You can submit documents along with your initial appeal request or at any time during the appeal process, up until a hearing.
The Marketplace may offer you the option of receiving temporary benefits while your appeal is pending. You can accept the temporary benefits or waive them. If you accept temporary benefits during the appeals process and then lose your appeal, you might have to pay back the benefits you weren’t eligible for.
The Marketplace will review your completed appeal once it is submitted. Then the Marketplace will let you know its decision. If you still disagree with the decision, you can request a hearing. While you are waiting for the hearing to take place, the Marketplace may contact you to try to resolve the dispute informally.
You can appeal the Marketplace’s decision to reduce your tax credit. Information on how to appeal will be included on the final determination notice. If your appeal is successful, your tax credit will be restored retroactively.
Generally, if the Marketplace hasn’t received the requested information within 90 days and you didn’t already ask for an extension, the Marketplace will make a determination based on the information it has.
Yes, assuming your coverage is purchased in a state that allows the tobacco surcharge. An insurer can adjust the premiums of health plans sold to small businesses based on the number of workers who use tobacco.