In This Issue:
·
Resources for Plan Year
2016 Open Enrollment
o
“Operational Updates and
Announcements for Agents and Brokers Participating in the FFMs” Webinar Slides
Now Available
o
“Plan Year 2016 Open
Enrollment: A Primer for Agents and Brokers Participating in the FFM” Webinar
Slides Now Available
o
New Facility Look-up
Feature Now Available at HealthCare.gov
o
“Marketplace Frequently
Used Terms – Spanish” Now Available
·
Key Tips for Assisting
Consumers with Tax Readiness
·
Small Business Health
Operations Program (SHOP) Corner
o
Create a Profile in the
SHOP Marketplace Agent/Broker Portal
o
Happy New Year from the
SHOP Marketplace!
o
Learn What Small
Employers Are Thinking about the SHOP Marketplace
·
Spotlight on Eligibility
and Enrollment (E&E)
o
Open Enrollment Trends
Prior to the Deadline to Enroll in Coverage Effective January 1, 2016
o
New Marketplace
Functionality to Help Immigrant Consumers with Incomes Under 100% of the
Federal Poverty Level (FPL)
o
Five Facts for Consumers
about the Fee for Not Having Health Coverage
·
Plan Year 2016 Agent and
Broker FFM Registration Completion List
·
Did You Know? Partnering with Community Health Centers on Outreach and
Enrollment Activities
·
Follow Us on Twitter
·
Contact Us
Resources for Plan Year 2016 Open Enrollment
“Operational Updates and Announcements for Agents and Brokers
Participating in the FFMs” Webinar Slides Now Available
CMS
has posted slides from weeks eight, nine, ten, and eleven of the “Operational
Updates and Announcements for Agents and Brokers Participating in the FFMs”
webinar series. Information about what these webinars covered is available on
the Agents
and Brokers Resources webpage. You can review the
slides by selecting one of the following sessions:
CMS continues to host weekly sessions through the end of Open
Enrollment on Tuesdays from 3:00 PM to 4:00 PM Eastern Time (ET). Please see
the Agents
and Brokers Resources webpage for instructions on how to register for an
upcoming session.
“Plan Year 2016 Open Enrollment: A Primer for Agents and Brokers
Participating in the FFM” Webinar Slides Now Available
CMS hosted
two sessions of the “Plan Year 2016 Open Enrollment: A Primer for Agents and
Brokers Participating in the FFM” webinar on October 21 and 28, 2015. The
slides cover key information for agents and brokers on Open Enrollment, FFM
enrollment pathways, the Individual Marketplace online application, highlights
on the SHOP Marketplace, and an overview of next steps for consumers who fail
to file and reconcile advance payments of the premium tax credit (APTC) for
plan year 2014. The slides also review the process to revoke the agent/broker
role for agents and brokers who did not complete plan year 2016 FFM
registration prior to the expiration of their plan year 2015 Agreements with
CMS. The slides from the webinar series are now available here.
New
Facility Look-up Feature Now Available at HealthCare.gov
HealthCare.gov
now includes a new Facility Look-up feature that allows consumers to look up
their medical facilities (in addition to doctors and prescription drugs).
Consumers can see in the plan results if their medical facilities are covered
by each qualified health plan (QHP). This new feature is an enhancement of the See Plans & Prices
functionality located at HealthCare.gov. Note that this feature is not
currently available for the SHOP Marketplace. Consumers can access the Facility
Look-up feature when they see a webpage indicating they can search for
“doctors, medical facilities, and drugs” by selecting “Continue” to search for
and add their medical facilities. You can find more information about the
Facility Look-up feature, including a walkthrough with screenshots of the
functionality, in the “Weekly
Updates for Agents and Brokers Participating in the FFM for Plan Year 2016 Open
Enrollment — Week 8” webinar slides.
“Marketplace Frequently Used Terms – Spanish” Now Available
CMS has recently
published a glossary of the most frequently used Health Insurance Marketplace
terms in Spanish. You may find this tool useful when enrolling Spanish-speaking
clients. You can find this helpful list of terms here.
Key Tips for Assisting Consumers with Tax
Readiness
The 2015 tax season started on January 1, 2016.
To ensure you understand the process, review the “Weekly
Updates for Agents and Brokers Participating in the FFM for Plan Year 2016 Open
Enrollment — Week 10” webinar slides. This presentation provides details
about what consumers need to know, including information on the APTC
reconciliation process, the content of Form 1095-A, what forms they will
receive, tax tools, exemption information, and how to access the Form 1095-A
online. In addition to information for consumers, this presentation also
presents example consumer enrollment scenarios and what agents and brokers need
to know about tax communications.
While you may provide information to your
clients about the APTC reconciliation process and the forms that they will
receive, it is important that agents and brokers not provide any tax filing
advice or answer any tax filing questions. Please refer clients seeking answers
to their questions or advice regarding their personal situation to a tax
professional for assistance or to the tax assistance options available at IRS.gov/freefile
or IRS.gov/VITA.
Small Business Health Options Program (SHOP)
Corner
Create a Profile in the SHOP Marketplace Agent/Broker Portal
Agents and
brokers who have completed the 2016 SHOP Marketplace Privacy & Security
Agreement have access to the SHOP
Marketplace Agent/Broker Portal where they can assist with client
applications, manage coverage, and handle other SHOP Marketplace tasks.
Once you
are registered to sell in the SHOP Marketplace, you must establish your profile
on the SHOP Marketplace Agent/Broker Portal. Once you have established your
profile, small employers will be able to authorize you to assist them with
their SHOP Marketplace enrollment.
Find out
more about assisting your small business clients in the SHOP Marketplace here.
Happy New Year from the SHOP Marketplace!
The SHOP
Marketplace is open, and ready to serve small employers with more options and
advantages in 2016. Now, more than ever, the SHOP Marketplace is ready to offer
businesses an easier way to offer health insurance to employees and valuable
new features.
Starting
with coverage that takes effect after January 1, 2016, through the SHOP
Marketplace small employers can:
·
Offer employees more choices.
Through the SHOP Marketplace, employers in all states may offer a single health
insurance plan, or let employees select any plan within a coverage category.
·
Choose an offering that meets their
needs. Through the SHOP Marketplace, small employers can offer a
health plan only, health and dental coverage, or dental coverage only.
·
Meet the SHOP Marketplace
participation rate more easily. Beginning in 2016, all employees
offered coverage can be included in the participation rate, so long as they are
enrolled in SHOP coverage or other forms of health insurance. The Minimum
Participation Rate (MPR) calculator at HealthCare.gov can help predict if
your clients will meet the MPR for their state.
·
Renew SHOP Marketplace coverage
online, without having to fill out a new application.
We save the information provided in the SHOP Marketplace application from year
to year to make the renewal process simple and easy. All employers need to do
is log-in, review the application, and update the account and offer of coverage
as needed. SHOP Marketplace registered agents and brokers who are authorized
can also help to complete the renewal online.
For more
information on what is new in the SHOP Marketplace for 2016, please visit HealthCare.gov.
Learn What Small Employers Are Thinking about the SHOP
Marketplace
The Robert
Wood Johnson Foundation commissioned focus groups and a national survey to
research small employers’ feelings about offering health insurance and their
awareness and interest in the SHOP Marketplace. You can read the report and
learn more about its research findings here.
Spotlight on Eligibility and Enrollment
(E&E)
Open Enrollment Trends Prior to the Deadline to Enroll in
Coverage Effective January 1, 2016
Agents and brokers played a crucial role in helping almost 6
million people sign up for health coverage at HealthCare.gov through the
deadline for January 1, 2016 coverage. This number is a large increase compared
to last year, when about 3.4 million people had signed up by the first
enrollment deadline. Of the nearly 6 million total consumers already enrolled
for plan year 2016 coverage, 2.4 million are new consumers, compared to 1.8
million new consumers in the same period for Open Enrollment Year 2 (plan year
2015).
If you would like more information on enrollment trends prior to
December 17, 2015 (the deadline to enroll in coverage effective January 1,
2016), click here. To get a
more detailed look at plan selection across states using the HealthCare.gov
platform, including point-in-time estimates of weekly plan selections,
Marketplace Call Center activity, and visits to HealthCare.gov and CuidadoDeSalud.gov,
you can view the weekly Health Insurance Marketplace Open Enrollment Snapshots.
New Marketplace Functionality to Help Immigrant Consumers with
Incomes Under 100% of the Federal Poverty Level (FPL)
Immigrant
consumers who have an annual household income under 100% of the FPL may be
eligible to receive APTC and cost-sharing reductions (CSRs) if they are
eligible for Marketplace coverage and are not eligible for Medicaid due to
their immigration status. In most cases, the Marketplace electronically
verifies these consumers’ immigration status in real time through the
Department of Homeland Security (DHS), and then awards APTC and CSRs, when
immigrant consumers are eligible. However, when the Marketplace cannot
electronically verify these consumers’ immigration statuses, the Marketplace
sets an immigration status data matching issue (DMI) and consumers are not
eligible to receive APTC or CSRs until they resolve the DMI.
The
Marketplace has recently released a new functionality to make it easier for
immigrant consumers who have an annual household income below 100% of the FPL,
have an immigration status DMI, are eligible for a QHP, and are ineligible for
Medicaid based on their immigration status, to be determined eligible for APTC
and CSRs. You can learn more about this new functionality in the “Update to FFM Functionality for Immigrants with
Income Under 100% FPL” slide presentation.
Agents
and brokers can help these consumers understand the notices they receive from
the Marketplace, determine the correct documentation to submit to resolve their
DMIs, and enroll in Marketplace coverage with or without APTC and CSRs. Agents
and brokers are strongly encouraged to help immigrant consumers submit their
documents to resolve their immigration DMIs as soon as possible.
Five
Facts for Consumers about the Fee for Not Having Coverage
Kevin
Counihan, the Chief Executive Officer of the Center for Consumer Information
& Insurance Oversight (CCIIO) and Health Insurance Marketplace Director,
has provided important information for consumers about the fee for not having
health coverage in his article on the CMS blog titled, “5 Facts for Consumers
about the Fee for Not Having Health Coverage.” As you help consumers understand
their coverage options, it is good to review the following information with
them:
1.
The fee is calculated one of two
different ways, depending on your situation.
2.
The fee is increasing for 2016.
3.
Every month without coverage counts.
4.
For some people, exemptions from the
fee are available.
5.
If you need health coverage and want
to avoid the fee for 2016, enroll in a plan by January 31, 2016.
Please
note that a special enrollment period around the April 15, 2016 tax filing
deadline will not be offered this year. If consumers do not enroll by
January 31, 2016, they could have to wait another year to get coverage and may
have to pay the fee when they file their 2016 income taxes. For additional
details about each of these facts, review the full article here.
Plan Year 2016 Agent and Broker FFM Registration
Completion List
Check the Agents
and Brokers Resources webpage to view the current Agent and Broker FFM
Registration Completion List for Plan Year 2016, which includes the NPNs of
agents and brokers who have completed plan year 2016 registration requirements
for the FFM. Issuers can review the Agent and Broker FFM Registration
Completion List to confirm that agents and brokers with whom they have
agreements are authorized to assist consumers in selecting plans through the
FFM.
If you completed all of the plan
year 2016 agent and broker registration and training requirements for the FFM,
you should review the latest list to confirm your NPN is included. You can
search for your NPN by clicking the arrow in cell A1, or by using the “Ctrl +
F” (or “Command + F”) keystroke.
Did You Know?
Agents and brokers may want to
consider partnering with community health centers on outreach and enrollment
activities. Health centers are playing an essential role in the implementation
of the Affordable Care Act. Nationwide, health centers have expanded their
current outreach and enrollment assistance activities to facilitate the
enrollment of millions of eligible health center patients and service area
residents into affordable health insurance coverage through the Health
Insurance Marketplaces, Medicaid, or the Children’s Health Insurance Program.
Health centers are looking for partners who can promote the availability of the
health center as an enrollment assistance site, partner with them to reach out
to uninsured populations who may not yet be aware of the options available to
them through shared events, and who may be willing to share space with access
to computers to support enrollment assistance. Agents and brokers can review “Partnering with Community Health Centers on Outreach
and Enrollment Activities” for more information.
Follow Us on Twitter
You
can find important information and updates by following the CMS and HealthCare.gov
Twitter handles (@CMSGov and @HealthCareGov) or by searching the hashtags #ABFFM or #ABFFSHOP
on Twitter.
Contact Us
For
questions pertaining to the FFM agents and brokers program, including the FFM
registration requirements, or to subscribe to this newsletter, please contact
the FFM Producer and Assister Help Desk via email at FFMProducer-AssisterHelpDesk@cms.hhs.gov.
You
may also contact the Agent and Broker Call Center by calling 1-855-CMS-1515
(855-267-1515) and selecting option “1.” Call Center Representatives are
available Monday through Saturday from 8:00 AM to 10:00 PM Eastern Time.
As
noted above, this Call Center does not have access to consumer information and
is not able to handle specific questions or issues with a consumer’s
application. Please continue to call the Marketplace Call Center at
1-800-318-2596 for assistance related to enrolling consumers into coverage
through the Individual Marketplace. For assistance related to coverage through
the SHOP Marketplace, contact the SHOP Call Center at 1-800-706-7893.
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