1. COBRA Coverage and 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. ACA Basics

3. AFFORDABLE CARE ACT Protection, Prevention & Education
On March 23, 2010; two existing laws combined together as ONE created the Affordable Care Act
The Marketplace is a one-stop shop to find Affordable health care with subsidy and Essential Health Benefits!
Ambulatory Patient Services
Emergency Services
Maternity & Newborn Care
Hospitalization
Mental Health & Substance Disorders
Prescription Drugs
Laboratory Services
Pediatric Services (which includes oral & vision)
Rehabilitative & Habilitative Services
Free Preventative & Wellness Services
We ALL Benefit:
No more pre-existing conditions, annual limits or caps
Children under age 26 can stay on parents plan
No Co-pays for preventive care and screenings
More affordable health insurance options
This slide information gives an overview of how the ACA law was presented to congress for vote and the benefits that the law obtained for the consumer.  The second piece of information on this slide is the definition of health benefits that are in all insurance plans that are on the Health Insurance Exchange or Marketplace.

4. Free Preventive Services
Well visits (1 per year)
Blood pressure & cholesterol screening 
Cancer screenings 
Depression screening 
Diabetes screening 
Diet counseling for adults with chronic diseases
HIV/STD screening and counseling
Obesity screening and counseling
Immunizations
Alcohol/tobacco use screening and counseling
Contraception

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. Enrollment Periods
When eligible individuals can enroll in a Qualified Health Plan (QHP)
Marketplace will determine eligibility to enroll in a plan, determine eligibility for financial assistance and assess eligibility for Medicaid
A person can only enroll in a QHP during Open Enrollment or during a Special Enrollment Period (SEP)
Applies to QHPs on the Marketplace and those off the Marketplace

7. 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 .

8. Information Needed to Apply
Household Size
Based on tax filing principles
Identity of Household Members
Name and contact information
Social Security Number
Immigration status
Estimated Yearly Income
Modified Adjusted Gross Income (MAGI)
Expected household income for the year you want coverage, NOT last year’s income
For everyone in your household, even if they are not applying for coverage
Availability of employer-based coverage

9. MAGI: Modified Adjusted Gross Income
Count:
Taxable wages/salary
Profit from self-employment
Social Security benefits (SSDI, retirement)
Unemployment benefits
Alimony received
Most retirement benefits (including VA pensions)
Interest (including tax-exempt interest)
Rental income
Do not count:
Child support received
Supplemental Security Income (SSI)
Workers’ compensation payments
Veteran’s benefits (service-related disability)
Gifts/Inheritances
Pre-tax deductions (IRAs, childcare, health)
Alimony paid
Social Security of dependents who aren’t required to file taxes

10. Financial Help: 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.

11. 2017 Federal Poverty Level (FPL)

12. APTC & RECONCILITION
If you had a Marketplace plan and used APTC to lower your monthly payment, you’ll have to “reconcile” when you file your federal taxes. This means you’ll compare 2 figures:
The amount of premium tax credit you used in advance during the year. (This was paid directly to your health plan so your monthly payment was lower.)
The premium tax credit you actually qualify for based on your final income for the year.
You will need:
1095 A – sent by the Marketplace
Form 8962 – IRS Form
Federal Poverty Level
Single
Married
Less than 200%
$300
$600
200%- 300%
$750
$1,500
300%- 400%
$1,275
$2,550
Over 400%
Return APTC

13. Don’t Pay A Penalty! Exemptions 2017: The Greater of
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
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:

14. COBRA v. THE MARKETPLACE
When you lose job-based insurance, you may be offered COBRA continuation coverage by your former employer, however this is often very expensive.
Losing job-based coverage qualifies you for a Special Enrollment Period (SEP) to enroll in Marketplace coverage. This means you have 60 days before and 60 days after you lose coverage to enroll in a health plan, even if it’s outside the annual Open Enrollment Period.
You may be eligible for financial assistance to purchase insurance through the Marketplace, but cost is only one important factor to consider!

15. Comparing Plans What are the costs of each plan?
Premiums
Deductibles
Co-payments and co-insurances
Are your current doctors and hospitals covered?
Are your current medications covered?
Do you have any planned medical treatment?
Do any of your current medications or planned procedures require prior authorization?
How much have you already spent on healthcare this year? Have you met your deductible?

16. Other things to consider
Other coverage options
Spouses job-based plan
Medicaid (applications accepted year-round)
Medicare
Once you opt out of COBRA, you will not have the opportunity to opt back into it.
If you go without coverage you will have to pay a penalty when you file your taxes, unless you qualify for an exemption.
Free assistance is available to help you complete a Marketplace application and compare plans!

17. When can I enroll in a Marketplace plan?

18. ADDITIONAL HEALTHCARE OPTIONS
Sliding Scale Clinics
Healthcare coverage is based on income and might have pharmacy help
Health Care Centers (FQHC)
Have primary care doctors plus more , operate on a sliding scale up to 200% FPL, and do not turn away insured patients.
Free Clinics
Offer free services for the uninsured with little to no income and have volunteer doctors
Our education extends to various types of clinics due to not having Medicaid expansion.
Private Family Practice
This is a typical medical practice NOT a sliding scale or free clinic

19. Appointment Hotline: 888-392-5132
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: