1. Apply for Coverage in the Marketplace
Updated Streamlined Application Process for Consumers New to the Marketplace
This presentation is part of a series that helps users navigate the Health Insurance Marketplace. The online application begins with account creation (including verifying your identity/aka identity proofing) and ends with the applicant seeing their eligibility results. The applicant will then move on to compare plans and select a Qualified Health Plan (QHP), if eligible to enroll in a QHP through the Marketplace. The following includes an in-depth look into how the online application will look and work for new consumers, who have simple household situations and have not previously applied for Marketplace coverage. The family scenario depicted and other data shown in this presentation are provided only as illustrative examples, and do not represent any actual family information.
The information presented is for CMS partners. It is not intended for press purposes and is not on the record. If you are a member of the press, please the press office at
This CMS National Training Program presentation provides basic information about the Marketplace program. You should always consult the relevant statutes, regulations, and rulings for official legal guidance.
The information in this presentation was correct as of March Please note the HealthCare.gov website undergoes updates on a regular basis so screenshots and language may change as part of the ongoing effort to improve consumer experience.
May 2015

2. Meet the Weiss Family (Simple Household Scenario)
Joy
Judy
Anton
The Weiss family needs health coverage. They visit HealthCare.gov to view their Marketplace coverage options.
This scenario will illustrate one tax household . The mom, dad and child all applying for coverage. Mom and dad are married and file a joint tax return with their child claimed as a tax dependent.
May 2015
Marketplace Streamlined Application

3. Anton Visits HealthCare.gov to Shop for Affordable Health Care
The family lives in Montgomery, Alabama.
HealthCare.gov allows everyone to enter their state and automatically be directed to the proper Marketplace.
May 2015
Marketplace Streamlined Application

4. Get Coverage/ Select Your State
Anton picks his state to create a Marketplace account and start an application for coverage.
To begin he selects the “Get Coverage” tab from the header on HealthCare.gov homepage. Anton picks his state to create a Marketplace account.
He selects Alabama, which is a Federally Facilitated Marketplace. If you live in a state with a Federally Facilitated Marketplace or state that Partners with the federal government for their Marketplace you will use this website to view, compare and enroll in a plan. If your state runs its own Marketplace (a state-based Marketplace) the message will display the name of the Health Insurance Marketplace that will serve your state, and provide a direct link to their website. Once you choose your state, click APPLY to continue.
May 2015
Marketplace Streamlined Application

5. Create an Account Your email address is also username
Real-time verification of typos
Green checkmarks that dynamically pop up as you successfully complete each section and meet password criteria
He begins by creating a Marketplace account. There are 3 parts to the account creation screen. Anton will enter his information on one single page to CREATE ACCOUNT.
First, he provides basic information (first and last name), then he creates a username which is his address The system provides real-time verification for typos. For example, suggests “gmail.com” if user accidentally types “gnail.com.” Green checkmarks dynamically pop up as you complete each section and your password meets each criteria.
The next part allows him to set up security questions to use if he forgets his account password. He selects questions from the drop down list that can only be answered by him, and types his corresponding answer. He indicates whether he wants to have updates sent to his address, and finally reads the HealthCare.gov privacy policy and checks that he understands and agrees with the privacy policy.
May 2015

6. Marketplace Streamlined Application
Verify Your
Notification includes a direct link to major providers
Some addresses will not include a direct link
Once you click Create Account a “Check Your ” notice will display on the same page with a reminder to check your , and click verification link to continue your application. An added enhancement is the direct link to open your in the same notice. This will work for major providers like Gmail, etc. Some addresses will not include a direct link to just the “Check your ” notice and reminder to check your and click verification link.
Marketplace Streamlined Application

7. Marketplace Streamlined Application
Verify Your
You will get an from the “Health Insurance Marketplace” with the subject line “Marketplace Account Created.” Once you click the verification link in your you’ll see the “Please wait processing.”
May 2015
Marketplace Streamlined Application

8. Marketplace Streamlined Application
Account Created
Once your account is processed you will see the “Success” screen. Click, the green continue button to log in for the first time.
May 2015
Marketplace Streamlined Application

9. Log In to Marketplace Account
Now that Anton’s account is created, he can log in to the Marketplace with his address and password to apply for coverage and shop for plans.
May 2015
Marketplace Streamlined Application

10. Accept Terms & Conditions
Anton accepts the terms and conditions
May 2015
Marketplace Streamlined Application

11. Marketplace Streamlined Application
Consumer Paths
Anton
will be applying for family coverage
Once Anton logs in to his Marketplace Account and accepts the terms and conditions, he’s directed to his “My Account” landing page, and can choose where he’d like to go. Here consumers are funneled into Groups: Individuals & Families or Employers/Employees. This presentation will focus on “Individuals & Families” Marketplace coverage. Anton clicks “Visit the Marketplace for Individuals and Families” button to continue.
May 2015
Marketplace Streamlined Application

12. Marketplace Streamlined Application
Guiding Question
Anton is ready to Apply for 2015 coverage. The “My Landing Page” page guiding questions will help direct him.
May 2015
Marketplace Streamlined Application

13. Marketplace Streamlined Application
State Application
Anton gathers the information he will need.
Once you’ve created an account and logged in to your account at HealthCare.gov, you’re ready to begin the application process. You click “Next” to continue.
Let’s join Anton as he applies and shops for family coverage using the Marketplace in the state of Alabama.
May 2015
Marketplace Streamlined Application

14. Enter Your Information
Anton enters his information as it appears on his drivers license or Social Security card.
Anton enters his information as it appears on his drivers license or Social Security card to verify his identity.
May 2015
Marketplace Streamlined Application

15. Marketplace Streamlined Application
Verify Your Identity
And answers questions based on information he provided to verify his identity
Next, Anton answers 4 identity questions only he knows to help protect his personally identifying information.
The exact questions that he’s asked to answer will depend on his situation. Questions may ask about things such as the county you live in, a previous address, a current or previous employer, or a previous phone number.
Once he’s finished answering the questions, he clicks the “Verify My Identity” button. If he passes the identity proofing process, the next page will appear.
May 2015
Marketplace Streamlined Application

16. Marketplace Streamlined Application
Privacy Policy
Anton understands and checks he agrees with how his information will be used
Anton’s identity is verified. The Privacy and the use of your information page lets Anton know how the information he enters will be used, and that data from other sources will be accessed to verify his information. Integrated systems will check his eligibility by retrieving information from other Federal agencies including the IRS, Social Security, and the Department of Homeland Security. Before he can continue, Anton must check the box to indicate that he agrees to have his information retrieved from data sources for his application. Then, clicks the “Take Me to the Application” button.
May 2015
Marketplace Streamlined Application

17. Household Information
Anton’s response to these questions will divert him between two possible paths:
Financial Assistance
Non- Financial Assistance
Anton’s household income is less than $83,000, and wants to know whether he qualifies for help paying for coverage.
NEW Screener
On the “Before You Get Started” page Anton answers a few more personal questions. Anton selects he is married and has 1 dependent (Joy). Note: Dependents are only to include children (not spouse or step children). Help text is linked to explain each question further.
The new screener question for who’s applying for coverage was added to …..
The optional question on this page about your income range can help determine whether you’re eligible for financial assistance to help pay for a Marketplace plan. The income threshold is configured based on whether you’re single or married and how many dependents are indicated on your tax return. The amount is set to 420% of the Federal Poverty level which generally qualifies you for an Advanced Premium Tax Credit. Anton indicates he makes less than that amount and selects “Yes” to see if he qualifies for help paying for coverage.
If he was not interested in getting help paying for coverage, he won’t be asked any additional income information during the application process.
Note: Applying for insurance affordability programs is optional. If you choose to apply only for eligibility to purchase a Qualified Health Plan (QHP) through the Marketplace, you will be required to provide only limited information on residency , immigration status, and incarceration status, and no household information will be required.
Eligibility for Medicaid, Children’s Health Insurance Program, and Advance Payments of Premium Tax Credits is based on household size and income. The Marketplace will determine what affordability programs Anton is eligible for (Medicaid, Children’s Heath Insurance Program , or lower costs for premiums and cost-sharing amounts). The advance payments of the premium tax credit will be applied when you sign up for the QHP coverage and the payment will go directly to the insurance company.
May 2015

18. Response to These Questions Direct Consumer to Proper Application
NEW
Questions have been re-grouped and organized
Anton’s response to questions directs him to the shorter streamlined application.
At this point in the application process Anton is asked these additional questions (17), and depending on answers to some of the questions , other questions may or may not appear. The screening questions have been re-grouped and organized, and will determine whether Anton will complete the short streamlined application , or go through the more detailed application for those who have more complex household scenarios. The questions screens for applicants who meet the following criteria:
All live in the same permanent home and are not temporarily living out of state.
All applying are a U.S. citizen or national
All applying for coverage have Social Security Numbers
Is everyone who’s applying for coverage claimed as tax dependents on your federal tax return for 2014? (Select NO if someone will also be claiming you or your spouse as a dependent on their return).
All of these dependents your children who are 25 or younger AND not married.
Are any of the dependents your stepchildren?
Are not currently detained or in jail.
Are neither American Indian nor Alaska Native
Are neither a naturalized nor derived citizen.
Are not under a different name than the one on their Social Security card
Are neither eligible for health coverage through their job, someone else’s job, or COBRA
Are not pregnant or had a child in the last 60 days.
Are not a full-time student aged 18-22
Currently age and was in foster care at 18.
Responsible for a child 18 or younger that lives with you, but isn’t on your tax return.
Dependents living with a parent who’s not on your tax return.
Note: The last 4 “Additional Questions” are only offered when children or young adults are on the application:
May 2015

19. Marketplace Streamlined Application
Contact Information
Anton enters his information as the point of contact for his household.
On his Contact information page, Anton answers a few questions about: home and mailing address, contact phone numbers, and the language he prefers to speak and read. He can also let us know how he prefers to be contacted: by traditional paper notices, electronic notices, text message, or by .
If Anton has questions or needs help with his application there are several resources available, including a toll-free call center ( ) for customer service assistance 24 hours a day 7 days a week including Thanksgiving, Christmas and New Year’s Day. The call center is closed on Memorial Day, 4th of July, and Labor day. In person assistance is also available going through certified assisters and agents and brokers. If Anton was getting help with his application the in-person assister must select the appropriate box (Navigator, Certified application counselor, agent or broker from the drop down menu) and enter their Organization name and ID number for tracking purposes.
May 2015
Marketplace Streamlined Application

20. Marketplace Streamlined Application
Contact Information Continued
May 2015
Marketplace Streamlined Application

21. Adding Household Members
Because the system can analyze and integrate answers with other information, each applicant’s questions automatically update to reflect the answers they have entered. This allows questions to be asked about each applicant by name. Using names makes the process easier for Anton to understand and removes the potential for incorrect answers.
Once his contact information and household family members have been entered, Anton will click “Continue.”
May 2015
Marketplace Streamlined Application

22. Marketplace Streamlined Application
Income Information
Anton will now provide his household income. Eligibility for Medicaid, Children’s Health Insurance Program, and Advance Payments of Premium Tax Credits is based on household size and income. The Marketplace will determine what affordability programs he is eligible for (Medicaid, Children’s Heath Insurance Program , or lower costs for premiums and cost-sharing amounts). The advance payments of the premium tax credit will be applied when he signs up for the Qualified Health Plan (QHP) coverage and the payment will go directly to the insurance company.
May 2015
Marketplace Streamlined Application

23. Marketplace Streamlined Application
Anton’s Income
On the “Income information” page, Anton enters the amount of income earned by each person on the application, including the type of income, how much was earned, and whether there are any deductions from income to claim.
May 2015
Marketplace Streamlined Application

24. Marketplace Streamlined Application
Spouse Income
Anton adds his spouse’s income for a total household income
May 2015
Marketplace Streamlined Application

25. Special Circumstances
This section/series of questions helps determine whether or not Anton may have special circumstances that may qualify for additional assistance or certain protections. The questions help screen people for non-MAGI (Modified Adjusted Gross Income) based Medicaid programs.
Anton answers that he does not have a physical disability that limits his ability to function on a daily basis.
These few questions help determine whether Anton qualifies for Medicaid programs.
May 2015
Marketplace Streamlined Application

26. Marketplace Streamlined Application
Current Coverage
Next, Anton answers questions about any additional health coverage he may have.
May 2015
Marketplace Streamlined Application

27. Marketplace Streamlined Application
Life Changing Events
These questions help determine whether Anton may be eligible for a special enrollment period to join a Marketplace plan outside of open enrollments.
May 2015
Marketplace Streamlined Application

28. Marketplace Streamlined Application
Renewal of Coverage
If You Disagree
To make it easier to determine Anton’s eligibility for help paying for coverage in future years, Anton needs to agree to allow the Marketplace to use his income data from tax returns, for future years. Anton can make any changes and opt out at any time.
May 2015
Marketplace Streamlined Application

29. Marketplace Streamlined Application
Application Summary
Anton reviews the information entered for accuracy and can make any corrections using the edit function.
On the “Application Summary” page, you can review the information you’ve entered into the application for accuracy. You also have the opportunity to edit any incorrect information. If the information is correct, you can submit your application from this page.
May 2015
Marketplace Streamlined Application

30. Review Household Income
If the amount of your expected 2014 income you report isn’t accurate, you may not get the right amount of savings. If you earn more income than the eligible household income level, the amount of the Premium Tax Credit for which you are eligible will be lower when you file your tax return. In this case, you might owe money at the end of the year. But if you make less than you expected, you may be eligible to receive a refund based on a higher Premium Tax Credit at the end of the year. You would do this on your next tax return.
With most tax credits, you have to wait until you file your taxes to get the credit. But the new Advanced Premium Tax Credit (APTC) available through the Marketplace lets you reduce your premiums right away or wait to receive the Premium Tax Credit (PTC) until tax time.
Any changes in financial circumstances or family size should be reported immediately.
May 2015
Marketplace Streamlined Application

31. Review Basic Household Questions
The information Anton entered will be verified including, residency, that you live in the service area of that Marketplace, your incarceration status, Indian status, household income and size, eligibility for other essential coverage including employer or government programs like Medicare, Medicaid, CHIP, VA and TRICARE.
May 2015

32. Review Additional Questions and Current Coverage
The information Anton entered will be verified including, residency, that you live in the service area of that Marketplace, your incarceration status, Indian status, household income and size, eligibility for other essential coverage including employer or government programs like Medicare, Medicaid, CHIP, VA and TRICARE.
May 2015
Marketplace Streamlined Application

33. Agree & Confirm, Sign & Submit Application
Anton provides electronic signature and submits his application
To receive his eligibility results, when he’s ready, Anton must review and agree to the list of statements on the Sign and Submit page. The statements are configured based on programs for which he is potentially eligible. He can then sign his application electronically and officially submit it to the Marketplace.
May 2015
Marketplace Streamlined Application

34. Eligibility Results IMPORTANT INFORMATION
On the Eligibility Results page, Anton clicks “View Eligibility Results” and gets a list of the programs for which he qualifies and finds out next steps.
Anton can print the eligibility page, and have his eligibility determination saved to his electronic account.
In this example, Anton qualifies for Advance Payments of the Premium Tax Credit. With the application process complete Anton can view and compare his plan options and enroll in a Marketplace health plan and apply his tax credit right away!
By clicking on the links on this page, Anton can also receive more information such as how his eligibilities were determined and how to file an appeal.
May 2015
Marketplace Streamlined Application

35. View Eligibility Results
May 2015
Marketplace Streamlined Application

36. Marketplace Streamlined Application
Key Points to Remember
Updated, shorter Marketplace application will be used with consumers who have simple household situations who are applying for the first time
Consumers will be automatically routed through the correct application process for their situation
You won’t see the updated application for every consumer you help
Consumers coming to report a change will see the traditional application
A new, shorter Marketplace application is available for consumers who have simple household situations and are applying for the first time.
Consumers will be automatically routed through the correct application process based on their specific situations.
Assisters won’t see the updated application for every consumer you help.
Remember this streamlined application is for first time applications only. Consumers who come back to the Marketplace to report a change will see the traditional application.
May 2015
Marketplace Streamlined Application

37. Marketplace Streamlined Application
Marketplace.cms.gov
You can get up-to-date information to help you counsel people who may benefit from the Heath Insurance Marketplace at Marketplace.cms.gov. There is access to consumer materials, training materials (including videos), research and more. You can sign up for updates as well. This is also where organizations can apply to become Certified Application Counselors and Champions for Coverage.
May 2015
Marketplace Streamlined Application

38. Want More Information about the Marketplace?
Stay connected
Sign up to get and text alerts at HealthCare.gov/subscribe
CuidadoDeSalud.gov for Spanish
Updates and resources for organizations are available at Marketplace.cms.gov
Facebook.com/Healthcare.gov
Need more information about the Health Insurance Marketplace?
Sign up to get and text alerts at healthcare.gov/subscribe/
(cuidadodesalud.gov/es/ ) provides the HealthCare.gov information in Spanish).
Updates and resources for partner and stakeholder organizations are available at Marketplace.cms.gov.
Like us on Facebook and follow us on Twitter!
May 2015
Marketplace Streamlined Application