An Overview Name Certified Navigator Phone Number THE MARKETPLACE An Overview Name Certified Navigator Phone Number Hello, my name is and I am a ? …. I work for Enroll Virginia and I thank you for having me. My goal today is to talk about Enroll’s Virginia’s role with the Marketplace.

Agenda The Health Insurance Marketplace Eligibility Guidelines Premium Tax Credits and Cost Sharing Reductions Information Needed to Apply The Enrollment Process Special Enrollment Periods Tax Penalty and Exemptions Questions

What is the Marketplace? VA uses the Federally Facilitated Marketplace (FFM) Place where individuals and small businesses can shop for Private health insurance plans Allows for comparisons of Qualified Health Plans Uses plain language to explain coverage options After submitting an application, there is no obligation to enroll in a health plan Financial assistance available only through FFM

Qualified Health Plans QHP/4 TIERS of COVERAGE 10 Essential Health Benefits (All Marketplace Plans Cover) Bronze = 60% Ambulatory Patient Services Emergency Services Silver = 70% Hospitalization Maternity & Newborn Care Gold = 80% Mental health & Substance disorders Prescription Drugs Platinum = 90% Rehabilitative & habilitative Services Laboratory Services Catastrophic (available for those who don’t qualify for PTCs or under 30) Preventive & Wellness Services Pediatric Services includes Oral & Vision

Eligibility for Marketplace Insurance To purchase insurance on the Marketplace Live in its service area Be a U.S. citizen or national, or be a non-citizen who is lawfully present in the U.S. Not be incarcerated To get financial assistance Not have access to other affordable and adequate insurance Have income between 100% and 400% of the federal poverty guidelines Not receiving or eligible for “minimum essential coverage”: Medicaid, FAMIS, Medicare “Affordable & Adequate ” job-based coverage Job-based coverage is not affordable/adequate if employee-only plan: cost to employee not ↑9.5% household income; or covers ↓60% healthcare costs & essential health benefits

Premium Tax Credits & Cost-Sharing Reductions Cost Sharing Reductions reduce the amount of your deductibles and out of pocket costs. Available for those with income at or below 250% of FPL Only applies if Silver Plan is purchased Premium Tax Credits (PTCs) reduce the amount of your monthly insurance premium.

2017 Federal Poverty Level (FPL)

Information needed to apply Availability of employer-based coverage Identity of Household Members Name and contact information Social Security Number Immigration status Household Size Estimated Yearly Income Application assistance available to help estimate anticipated income

Enrollment Process

Open Enrollment for 2018 is Over! November 1, 2017 – December 15, 2017 In order to enroll in coverage outside of Open Enrollment -you have to qualify for a Special Enrollment Period (SEP)!

Special Enrollment Periods Life Change Eligibility (60 Days) this isn't a comprehensive list GETTING MARRIED*** PERMANENTLY MOVING OUTSIDE PLAN’S COVERAGE** BIRTH, ADOPTION & FOSTER CARE INDIAN TRIBE OR ALASKA NATIVE NEWLY ELIGIBLE/INELIGIBLE FOR APTC OR COST SHARES LEAVING INCARCERATION GAINING ELIGIBLE IMMIGRATION STATUS LOSING OTHER HEALTH COVERAGE (NON-VOLUNTARY)* This explains all the reasons a consumer may qualify for Special Enrollment Period Bronze – 60% AV - low overall coverage, lower premiums but higher out-of-pocket costs. Platinum - 90% AV - best coverage, highest premiums. Catastrophic coverage for people under age 30 with very high deductible * Pick a plan by the last day of the month and your coverage can start the first day of the next month. ** Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. *** Propose to change .

Don’t Pay A Penalty! 2017: The Greater of Exemptions Coverage is considered unaffordable A Short coverage gap (less than 3 consecutive months, can only be used once in the year B Citizen living abroad or certain non-citizens (undocumented immigrants) C Aggregate self-only coverage considered unaffordable (if it exceeds 8% of household income) G Resident of state that did not expand Medicaid and your income falls below 138% FPL Member of tax household born, adopted, or died H Income Below Filing Threshold - 2015 tax year, $10,300, single under 65 - 2015 tax year, $20,600, married under 65 - 2015 tax year, $13,250, head of household under 65 Don’t Pay A Penalty! 2017: The Greater of 2.5% of your yearly household income above the federal tax return filing threshold (capped at the national average for a bronze plan) or $695 per adult ($347.50 per child under 18; family maximum $2,085) For 2017 tax returns:   -       All laws about health coverage and tax penalties still apply. -      IRS may process returns without health coverage information, but penalties can be assessed later. Enroll Virginia Hotline: 434-336-7757 www.enrollva.org

Appointment Hotline: 434-336-7757 Who is ENROLL Virginia!? Appointment Hotline: 434-336-7757 Check out upcoming events & workshops! Check out where to get help! ENROLL Virginia! is a nonprofit, nonpartisan entity that assists individuals and small businesses to obtain health insurance including commercial health coverage through the federally facilitated health insurance marketplace, to qualify for applicable tax subsidies, and to comply with the U.S. Patient Protection and Affordable Care Act and avoid penalties for failure to do so. The program is paid for by a federal grant (FOA CA-NAV-15-001 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services)  and administered by the Virginia Poverty Law Center.  The contents provided here are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. Statewide Toll-Free:1-888-392-5132 Enroll Virginia Hotline: 434-336-7757 www.enrollva.org