On November 1, the sixth open enrollment period begins for marketplace coverage under the Affordable Care Act (ACA). We at CHIR will soon re-launch our updated Navigator Resource Guide, made possible thanks to the support of the Robert Wood Johnson Foundation. The Guide provides information on recent policy changes, a list of enrollment tools for consumers and assisters, and answers to hundreds of frequently asked questions (FAQs), ranging from questions about eligibility for marketplace subsidies, post-enrollment issues, small employer coverage and the challenges young adults might face as they transition off of a parent’s health plan.

The updated Navigator Resource Guide will include FAQs answering new and emerging issues that will confront consumers this open enrollment season, such as:

• Individual Mandate Penalty: The Tax Cuts and Jobs Act that was signed into law in December 2017 eliminated the tax penalty for not complying with the ACA’s individual responsibility requirement in 2019. The law still requires individuals to have minimum essential coverage, but those who fail to obtain coverage and do not qualify for an exemption will no longer be required to pay a penalty after 2018.
• Failure to File and Reconcile Taxes: The marketplace will discontinue premium tax credits and cost-sharing reductions for consumers who failed to file a tax return for a prior year during which they received ACA tax credits, or who filed a tax return but did not reconcile premium tax credits using IRS Form 8962. In prior years, the marketplaces would not discontinue the tax credits unless they first directly notified consumers of the change. For 2018, the marketplaces are no longer required to directly notify consumers of their tax filing status.
• Data Matching Issues: In prior years, the marketplaces were required to ask for additional documentation of income from a consumer who projected having an income that was substantially lower than indicated by available government data sources. For 2018, the marketplaces are now required to ask for additional income documentation if: a consumer attests to income between 100 and 400 percent of the federal poverty line (FPL); the marketplace’s data indicates the consumer’s income is below 100 percent FPL; the marketplace has not determined whether the consumer’s income makes them eligible for Medicaid or CHIP; and the consumer’s projected income exceeds the income reflected by the marketplace’s data. This change is expected to affect individuals who have income close to the poverty line and who live in states that haven’t expanded Medicaid.
• Emergence of New Coverage Options: The ACA set certain standards for health insurance sold to individuals and small employers, including requiring coverage of ten essential health benefits and prohibiting insurers from denying coverage to individuals with pre-existing conditions. For 2018, changes to federal and state rules allow for more coverage options that are not required to meet ACA standards, including short-term limited duration insurance and association health plans. Depending on the state, these options may not provide coverage of essential health benefits and may deny coverage to individuals with pre-existing conditions, among other restrictions.
• Navigator Programs: In prior years, states were required to have at least two Navigator entities to assist consumers in enrolling in coverage and at least one entity had to have a physical presence in the state, to provide in-person assistance. For 2018, this requirement has been eliminated and the state-based marketplaces are no longer required to support at least two Navigator entities. Additionally, federal grants to Navigator organizations have been substantially reduced. This means many states will have fewer Navigators to assist consumers during this enrollment period; a few states have no Navigators at all.
• Special Enrollment Periods (SEPs): There continue to be a number of SEPs for consumers who meet certain qualifying events. For 2018, three notable changes have been implemented:
  • HHS clarified that a dependent may be eligible for a SEP based on a qualifying event, such as losing coverage or becoming a dependent, and may then be added to an enrollee’s existing plan or enrolled into a separate plan.
  • Individuals who enroll in coverage using a SEP for birth, adoption, placement for adoption or placement in foster care will be eligible for the same coverage effective dates as those that apply to individuals gaining or becoming a dependent.
  • Women who lose access to pregnancy-related CHIP coverage and who are otherwise eligible for marketplace coverage are now eligible for a SEP in the 60 days prior to loss of CHIP coverage until 60 days after the loss of CHIP coverage.
• Proposed Public Charge Rule: The Department of Homeland Security released a proposed rule that would broaden the types of public benefits that would count against an immigrant’s application for admission to the U.S. or permanent residency to include an individual’s application for health programs such as Medicaid, Medicare’s Low Income Subsidy, and possibly, the Children’s Health Insurance Program (CHIP). Some state-based marketplaces automatically generate a Medicaid application when consumers apply for marketplace coverage. Under the proposal, the marketplace’s submission of the Medicaid application could put an individual’s green card at risk, even if they never enroll in the program. However, at present, this policy is only a proposed rule and would need to be published in the Federal Register and open to public comment before it could be finalized. Therefore, the policy does not currently apply to this open enrollment period.

Other Recent Changes to Keep in Mind

• Short Open Enrollment Period: The open enrollment period for federally facilitated marketplaces (FFM) begins November 1, 2018 and ends December 15, 2018. This means new and returning consumers must apply for marketplace coverage by Saturday, December 15, 2018 for coverage to start January 1, 2019. After December 15^th, consumers can only enroll if they qualify for a special enrollment period. Some state-based marketplaces may have longer open enrollment periods.
• Past Due Premiums: Insurers may require individuals with past premiums due for coverage within the prior 12 months to pay these past-due premiums before enrolling into coverage for a new year. This applies to both open enrollment and special enrollment periods.

The updated and improved Navigator Resource Guide will be relaunched in just a few days. You’ll be able to access FAQs on the above topics and more here.