1. 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.

2. 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

3. 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

4. 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

5. 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

6. 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.

7. 2017 Federal Poverty Level (FPL)

8. 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

9. Enrollment Process

10. 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)!

11. 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 .

12. 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 tax year, $10,300, single under tax year, $20,600, married under 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
$695 per adult ($ 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:

13. Appointment Hotline: 434-336-7757
Who is ENROLL Virginia!?
Appointment Hotline:
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 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:
Enroll Virginia Hotline: