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Center on Budget and Policy Priorities cbpp.org Health Coverage Enrollment Roles & Opportunities Center on Budget and Policy Priorities September 25, 2013.

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Presentation on theme: "Center on Budget and Policy Priorities cbpp.org Health Coverage Enrollment Roles & Opportunities Center on Budget and Policy Priorities September 25, 2013."— Presentation transcript:

1 Center on Budget and Policy Priorities cbpp.org Health Coverage Enrollment Roles & Opportunities Center on Budget and Policy Priorities September 25, 2013

2 Center on Budget and Policy Priorities cbpp.org Topics Assistance sites can provide in the upcoming tax season – Education about 2014 coverage opportunities – Education about 2014 coverage obligations – Application assistance – Reporting family /income changes to the Marketplace

3 Center on Budget and Policy Priorities cbpp.org In 2014: New opportunities for health coverage New requirement to have insurance coverage New penalty for failure to obtain coverage What Every Tax Site Should Know in the 2014 Filing Season

4 Center on Budget and Policy Priorities cbpp.org Education about 2014 Coverage Opportunities 3

5 Center on Budget and Policy Priorities cbpp.org Timeline for Enrollment and Opportunities for Involvement in /1/14 - Marketplace Launch Marketplace Open Enrollment 10/1/13 – Open Enrollment Begins 3/31/14 – Open Enrollment Ends TY2013 Tax Season 4/15/14 – End of Tax Season

6 Center on Budget and Policy Priorities cbpp.org ChildrenChildless Adults Working Parents Jobless Parents Pregnant Women 250% Subsidized Unsubsidized 37% 61% Coverage Landscape in % 185% Medicaid and CHIP coverage, based on 2012 eligibility levels in a typical state Source: Kaiser Commission on Medicaid and the Uninsured FPL 400% 100% 133% 200% 300% Current Medicaid / CHIP Eligibility Expansion Coverage Gap

7 Center on Budget and Policy Priorities cbpp.org How Do I Enroll? Your state’s health insurance marketplace – Websites launch 10/1/13 or earlier Website will help people find: – Navigators in your area – Other in-person assistance – Certified application counselors Not the IRS

8 Center on Budget and Policy Priorities cbpp.org When Can I Enroll? Medicaid: Any time Private insurance: – Open enrollment For 2014 coverage, 10/1/13 – 3/31/14 For subsequent years, 10/15 – 12/7 – Special enrollment Outside of open enrollment, one of the following triggers must be met: – Loss of other coverage – Gaining or becoming a dependent – New eligibility/ineligibility for premium tax credits – Moving

9 Center on Budget and Policy Priorities cbpp.org Education about 2014 Coverage Obligations 8

10 Center on Budget and Policy Priorities cbpp.org In general, everyone is required to have health insurance beginning in 2014 – Many exceptions for people with low-incomes or high health insurance costs Why require insurance? – Necessary to implement other important insurance rules Guaranteed issue No denial due to pre-existing health conditions – Pool together the sick and healthy Requirement to Have Health Coverage

11 Center on Budget and Policy Priorities cbpp.org What Coverage Satisfies the Mandate? (Minimum Essential Coverage) Medicare and Medicaid/CHIP Veterans and military coverage Nearly all employer-sponsored insurance Any health plan sold in the individual market (both inside and outside of the exchange) Self-funded student plans (in 2014 only) Other plans, as designated by the Secretary of HHS

12 Center on Budget and Policy Priorities cbpp.org The Penalty for Failure to Obtain Coverage Penalties are low in 2014 for failure to have coverage Taxpayer is responsible for penalty for every uninsured person on her tax return If the penalty isn’t paid, it can be collected out of a future refund – However, taxpayer is not subject to criminal prosecution, liens or levies on property.

13 Center on Budget and Policy Priorities cbpp.org The Penalty for Failure to Obtain Coverage *Penalties will be calculated by the number of months uninsured. Divide each amount by 1/12 for monthly figure. Annual Penalty* is the GREATER of: Flat dollar amountPercentage of income 2014 ADULT: $95 1% of “applicable income” (Applicable income = income above the filing threshold) CHILD: ½ of $95 CAP: $285 cap 2015 ADULT: $325 2% of applicable income CHILD: ½ of $325 CAP: $ & beyond ADULT: $ % of applicable income CHILD: ½ of $695 CAP: $2,085 cap

14 Center on Budget and Policy Priorities cbpp.org Exemptions from the Penalty that Can bBe Filed Prospectively (early 2014) ExemptionHow is certification made? When can it be made? Religious conscienceMarketplace Prospective or retrospective Indian tribe membership Marketplace or tax filing Prospective or retrospective Hardship (Insurance is unaffordable based on projected income) MarketplaceProspective

15 Center on Budget and Policy Priorities cbpp.org Exemptions from the Penalty that are Granted During the Calendar Year or at Tax Filing ExemptionHow is certification made? Income below the filing threshold(No tax filing necessary) Insurance is unaffordable (>8% of household income) Tax filing Hardship (e.g., difficulty paying bills)Marketplace Undocumented residentTax filing Short coverage gap (< 90 days)Tax filing IncarcerationMarketplace or tax filing Health care sharing ministryMarketplace or tax filing

16 Center on Budget and Policy Priorities cbpp.org Penalty for a Single Individual John earned $30,000 in He had insurance through his job from January to August but was uninsured from September to December. First, does John qualify for any exceptions? No, John had an offer of affordable coverage, faced no hardship, etc. If not, what is John’s penalty? Greater of: 1) Flat Penalty Amount: $95 x 1/12 = $7.90/mo x 4 months = $32 OR 2) Applicable Percentage: Standard deduction ($6,100) + personal exemption ($3,900) = $10k (applicable income) $30,000 - $10,000 = $20,000 x 1% x 1/12 = $16.67/mo x 4 months = $67 John’s penalty is $67

17 Center on Budget and Policy Priorities cbpp.org Application Assistance 16

18 Center on Budget and Policy Priorities cbpp.org The Application Process Will Be Challenging Lengthy application Requests sensitive and private information Requests information that consumers may need assistance to obtain

19 Center on Budget and Policy Priorities cbpp.org Many People Will Want Help Limited knowledge about new options Negative feelings about enrollment Source: Michael Perry & Tresa Undem. Informing Enroll America's Campaign Findings from a National Study. February 2013

20 Center on Budget and Policy Priorities cbpp.org Navigators and In-Person Assisters – Conduct outreach, provide help with the application and enrollment process including impartial help with plan selection and referral to other resources. – Must be trained and maintain expertise, have no conflict of interest and ensure privacy and confidentiality. Certified Application Counselors (CAC) – Marketplaces also must have CAC programs that certify organizations to provide assistance with applications and plan selection. – State Medicaid agencies can also have a CAC program. – Can’t charge for services, must comply with some conflict of interest standards and agree to keep information private and confidential Who Will Provide Help?

21 Center on Budget and Policy Priorities cbpp.org Source: Kaiser Family Foundation Streamlined Enrollment Dear ______, You are eligible for… Real-Time Eligibility Determinations Data Hub $ # Use of Electronic Data to Verify Eligibility Medicaid CHIP Exchange HEALTH INSURANCE Single Application for Multiple Programs Multiple Ways to Enroll

22 Center on Budget and Policy Priorities cbpp.org Reporting Changes In Family and Income 21

23 Center on Budget and Policy Priorities cbpp.org Household Changes that Affect Eligibility for the Premium Tax Credit Birth or adoption – Increases household size, which lowers the expected family contribution Marriage – Special calculation for newly married Divorce – Credit can be allocated 50/50 or any other way Separation – Cannot file as married filing separately

24 Center on Budget and Policy Priorities cbpp.org Income Changes that Affect Eligibility for the Premium Tax Credit Eligibility for and final amount of credit based on actual income At tax filing time, advance payments received are reconciled with actual credit amount – If income increases, may have to repay – If income decreases, may get more credit at tax time To avoid repayment, can reduce the amount of advance payment received during the year

25 Center on Budget and Policy Priorities cbpp.org Cap on Amount of Advance Credits that Must Be Paid Back Income as percentage of poverty line Annual income for an individual (2013 $) Single taxpayers Annual income for a family of four (2013 $) Married taxpayers filing jointly Under 200% Under $22,980$300Under $47,100$600 At least 200% but less than 300% $22,980 - $34,470 $750 $47,100 - $70,650 $1,500 At least 300% but less than 400% $34,470 - $45,960 $1,250 $70,650 - $94,200 $2, % and above $45,960 and higher Full reconciliation $94,200 and higher Full reconciliation

26 Center on Budget and Policy Priorities cbpp.org Premium Credit Check-Up If a taxpayer has already qualified for premium tax credits, ask: – Are premium payments affordable? People who are delinquent on payments will lose coverage – Have your income or household changed since you qualified for premium tax credits? Report changes asap! – Note any red flags on current return If the taxpayer files MFS for TY 2013 but is collecting premium tax credits, remind him that he’ll need to file jointly in 2014.

27 Center on Budget and Policy Priorities cbpp.org Contact Info Tara Straw,


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