Health Coverage Enrollment Roles & Opportunities

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

2. 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. What Every Tax Site Should Know in the 2014 Filing Season In 2014: • New opportunities for health coverage • New requirement to have insurance coverage • New penalty for failure to obtain coverage

4. Education about 2014 Coverage Opportunities

5. Timeline for Enrollment and Opportunities for Involvement in 2014 3/31/14 – Open Enrollment Ends 10/1/13 – Open Enrollment Begins 1/1/14 - Marketplace Launch Marketplace Open Enrollment TY2013 Tax Season 2014 2013 4/15/14 – End of Tax Season

6. Coverage Landscape in 2014 FPL Unsubsidized 400% 300% 250% Subsidized 185% 200% 133% 100% 61% Coverage Gap Current Medicaid / CHIP Eligibility Expansion 37% 0% Pregnant Women Childless Adults Children Working Parents Jobless Parents Medicaid and CHIP coverage, based on 2012 eligibility levels in a typical state Source: Kaiser Commission on Medicaid and the Uninsured

7. 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. 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. Education about 2014 Coverage Obligations

10. Requirement to Have Health Coverage • 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

11. 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. 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. 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.

14. Exemptionsfrom the Penalty that Can bBe Filed Prospectively (early 2014)

15. Exemptionsfrom the Penalty that are Granted During the Calendar Year or at Tax Filing

16. Penalty for a Single Individual John earned $30,000 in 2014. 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. Application Assistance

18. The Application Process Will Be Challenging • Lengthy application • Requests sensitive and private information • Requests information that consumers may need assistance to obtain

19. Many People Will Want Help • Limited knowledge about new options • Negative feelings about enrollment Source: Michael Perry & TresaUndem. Informing Enroll America's Campaign Findings from a National Study. February 2013

20. Who Will Provide Help? • 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

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

22. Reporting Changes In Family and Income

23. 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. Income Changes that Affect Eligibility for the Premium Tax Credit • Eligibility for and final amount of credit based on actualincome • 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. Cap on Amount of Advance Credits that Must Be Paid Back

26. 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. Contact Info www.centeronbudget.org www.HealthReformBeyondTheBasics.org • Tara Straw, tstraw@cbpp.org