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Individual and Family Plans

American Rescue Plan Act of 2021 (ARP)

On March 11, 2021, President Biden signed into law the American Rescue Plan Act of 2021 (ARP). The purpose of the ARP is to improve accessibility and affordability of Marketplace insurance plans by lowering premiums and expanding access to insurance plans in general. The ARP also expands access and makes some changes to COBRA. 

How will premium tax credits be calculated?

For those eligible for a premium tax credit under the new legislation, an individual or family’s tax credit amount is calculated using the following factors.

  • Household’s total expected annual income
  • Number of people in the household filing taxes
  • The “benchmark” plan cost of the second-lowest priced Silver plan’s premiums available in that person or family’s area

Will I still be eligible for premium tax credits regardless of my/my household’s income?

It depends. The changes CMS is making are to expand who is eligible for Marketplace coverage. If you, or your family’s income is greater than 400 percent of the federal poverty level (FPL), you will not have to pay more than 8.5 percent of your income for healthcare coverage. If you make more than 400 percent of the FPL, you may not receive tax credits if the cost of the benchmark plan is less than 8.5 percent of your household income.

If you have Marketplace coverage and premium tax credits during the year, you will need to file your federal income tax returns for that year and reconcile the amount of tax credits you received (in advance) with the final premium tax credit calculation as part of your tax return. If your income turns out to be higher than what you estimated on your Marketplace plan application, you may need to pay back some, or all, of the excess premium tax credits you received (in advance) when you file your return. Depending on individual situations, the amount “owed back” may be capped.

Do I have to choose a plan that costs exactly 8.5 percent of my household income?

No. Individuals and households are free to choose a plan that costs more or less than the 8.5 percent of the benchmark cost if they would like. The 8.5 percent is used only to calculate the premium tax credits and is not a requirement placed on the purchaser.

When will the premium tax credits be available on Healthcare.gov?

April 1, 2021.

What tax years do the recalculated premium tax credits apply to?

2021 and 2022.

If I’m already enrolled in a Marketplace plan, how do I get my tax credits?

Current enrollees, including new enrollees from the most recent SEP, can update their applications beginning April 1 to apply for the tax credits. You will need to reselect your current plan for the change to take effect.

What if I don’t update my plan or I miss the period to do so?

You can still claim the premium tax credits when you file your taxes for 2021.

If I’m already paying low premiums or no premiums, should I still do anything?

Yes. You should still review your available plan options because you may be able to get lower premiums, more generous cost-sharing, or lower out-of-pocket expenses.

Early July 2021 – Potential Additional Savings

Also, beginning in early July on HealthCare.gov, consumers who have received, or have been determined eligible to receive unemployment compensation for any week during 2021, may be able to get another increase in savings when enrolling in new Marketplace coverage or updating their existing Marketplace application and enrollment. These savings to be made available starting in early July for eligible consumers are in addition to the increased savings available to consumers on HealthCare.gov starting April 1st. HealthCare.gov will have more information available this summer.

If a member calls and they have contacted the Marketplace and were told they will be given a change in their APTC, do the following.

Advise the member it can take one to two weeks before that information is provided to Network Health

Depending of the point in the billing cycle, the change may be reflected on the member’s next month’s invoice and retroactively be applied to the current month based on the information provided by the Marketplace

  • When did the Marketplace say the change is going to start? The CURRENT month or the NEXT month?
  • Billing Cycle
  • Is it BEFORE the 10th of the month? The new bills for the NEXT month have NOT run yet
  • Is it AFTER the 10th of the month but before the 1st of the NEXT month? The member needs to wait until the NEXT billing cycle to run between the 1st and 10th of the next month for the updated information

When will I get any refunds?

Refunds will automatically be added to the next month’s balance due and will be reflected on the next billing statement with a lower monthly balance due. This is the best/preferred option.

If the member would rather have a refund of the difference, do the following.

  • Send an email to accounts receivable at accountrec@networkhealth.com
  • Use the subject line SECURE HIX APTC Refund
  • Include the following information
    • Member Name
    • Member IFP Number
  • Let the member know refunds are done by the method of payment made on the accoun
    • Checks/Lockbox payments take two to three weeks
    • ACH payments take two to three days
    • CC/DEBIT Cards take seven to ten business days depending on the member’s institution
  • When a refund is processed, a response of “DONE” will be emailed to the representative and a notification will appear on the member’s account in JET
  • Refunds CANNOT be processed until the update from the Marketplace is received

Invoices may be updated sooner depending on when Network Health receives the information from the Marketplace. This will automatically update as the information comes through to Network Health. The Finance team will not be updating the information manually; the invoices will either update on a case by case basis as information is received, or at the billing cycle.

Special Enrollment Period (SEP)

President Biden issued Executive Order on Strengthening Medicaid and the Affordable Care Act on January 28, 2021. The Secretary of Health and Human Services (HHS) is establishing an SEP for uninsured and under-insured Americans to seek coverage through the FFE beginning February 15, 2021 and running through August 15, 2021.

 

 SEP Frequently Asked Questions

The SEP is from February 15, 2021, to August 15, 2021.

 

The SEP is available to eligible individuals and families in states with Marketplaces served by the Healthcare.gov platform, like Wisconsin, to enroll or change health insurance coverage for 2021. You can submit a new application or update an existing one.

Note: Network Health will participate in the Special Enrollment Period outside the Marketplace for those who wish to enroll directly with Network Health.

 

This SEP will generally take precedence over most other SEPs that you may be eligible for due to a qualifying life event such as loss of coverage or a move. If determined that you are eligible for a birth, adoption, or foster care/court order placement SEP, or any other SEP that provides a retroactive coverage date, you are to enroll under those other SEPs because the qualifying life event provides you with an earlier SEP effective date. If you qualify for retroactive date SEPs, you can choose from any plan available to you and will not be restricted based on plan category.

 

You can call Network Health Sales team at 844-635-1322. You can also work with a local independent agent. Finally, you can work visitHealthCare.gov or call the Marketplace Call Center at 1-800-318-2596 (TTY1-855-889-4325). Assistance is available in 150 languages.

 

Coverage will begin the first day of the month following the date of plan selection. For instance, if you choose a plan on March 15, your coverage will begin on April 1 and after you pay your first month’s premium.

 

The opportunity to apply for the SEP is by August 15. Then you have 30 days to submit your application to choose a plan. If you choose a plan after August 1, the coverage would start September 1.

 

The application does not include any new questions and you will not be required to provide any new information that is not otherwise required to determine your eligibility. You won’t need to provide any documentation of a qualifying event, like loss of a job or birth of a child, that is typically required for determining SEP eligibility.

 

No, you will not need to take further action at this time to resolve SEP verification issues. The Centers for Medicare and Medicaid (CMS) will resolve and will notify you of the results.

 

Yes, if you are making a change to your current application, you will need to go back through your application and make any changes needed in order to receive an updated eligibility result that provides the SEP before continuing on to enrollment.

This SEP DOES allow for prospects to move from one carrier to another.

 

Yes, current enrollees may change to any available plan in their area. There are no restrictions regarding metal levels of their current and/or future plans.

 

Yes.

 

Yes, potentially, as with any SEP enrollment. There is no change to premium payment policy during this SEP.

 

Network Health’s policy regarding premium payment will depend on when the member has selected the plan and the plan’s effective date. Here are some examples.

If a plan is selected before the effective month of coverage, the first premium payment is due by the 15th of the first coverage month. Ex: On April 15, I apply for coverage effective May 1, my premium is due by May 15.

If a plan is selected with an effective date in the same month of coverage, the first premium payment is due by the end of that same month. Ex: On April 15, I apply for coverage retro-effective April 1, my premium is due by April 30.

If a plan is selected with an effective date in the same month of coverage and, we’re into the next calendar month, the premium for the first and current month are due by the 15th of the current month. Ex: On May 2, I apply for coverage retroactive to April 1, and I have not yet paid my premium, the April and May premium are both due by May 15.

 

Yes, Individual 2021 Marketplace plan rates are set annually for the full plan year. Your age is usually taken into account in the rate determination process. If you’ve had a birthday since Open Enrollment and enroll in a new policy, you may have your premium rated to reflect the older age. Also, due to the changes from the American Rescue Plan Act, premiums may be lowered for you because of increased eligibility for financial assistance to help pay for Marketplace coverage.

 

Some enrollees may have filed a 2019 tax return and reconciled their APTC, but due to the IRS’ backlog of unprocessed returns, data indicating your filing and reconciliation is not yet available to the marketplace. You will need to attest on your application that you have filed and reconciled the APTC you received by checking the box “Yes, I reconciled premium tax credits for past years.” If you are receiving APTC and attest to filing and reconciling it on your application, you will remain eligible for APTC.

 

No. This process will work as it typically does. If information on your application does not match the Marketplace’s trusted data sources, or does not match a recently verified application, the inconsistency will need to be resolved within the usual timeframe. This means you will need to submit the approved documents to the Marketplace.

 

Yes. However, OCI is allowing each carrier to make this decision on their own.

 

If a member—on or off exchange—switches from one Network Health plan to another Network Health plan, their copayments and coinsurance already paid toward their deductible will move with them to the new plan selected. This is not the case if a new member has switched from another carrier to a Network Health plan.

 

Yes, the FPL for computing the APTC for a taxable year is the FPL that is in effect on the first day of the annual open enrollment period preceding that taxable year, thus the 2020 levels which were applicable during the 2021 open enrollment.

 

If you are enrolled in COBRA, you can drop COBRA and enroll in Marketplace coverage during the year if you qualify for a SEP. Because the 2021 SEP is available to all Marketplace-eligible consumers, if you have COBRA and are otherwise Marketplace-eligible, you may choose to enroll in a Marketplace plan during the period of time when you can access the SEP. You may also qualify for APTC if you terminate your COBRA coverage.

 

Yes, you can newly add a standalone dental plan (SADP) to your current Marketplace coverage or make a change to your current SADP. To do this, take the following steps.

  • Sign in and select your current application,
  • Select the option to report a life change,
  • Click the option for “change to my household’s income.”

If you do not need to update any information, you can step through the application, confirming pre-populated information, and then re-submit the application in order to newly select or change your current SADP. You should also re-select your current medical plan. Similarly, if you change your medical coverage, you should re-select your SADP if you don’t want to change it. If you are newly enrolling in Marketplace coverage through this SEP, you may also newly enroll in an SADP.

 

This SEP is available to all Marketplace-eligible consumers who are submitting a new application or updating an existing application, and for those with an offer of coverage through an employer, or through a family member’s employer. However, you won’t qualify for a premium tax credit or other savings if your offer of coverage through an employer is considered affordable and meets the minimum value standard, or if you are enrolled in the employer coverage. More information is available for those with an offer of coverage through an employer who are interested in changing to Marketplace coverage at www.healthcare.gov/have-job-based-coverage.

If you have an offer of coverage through an employer, you must include information about the offer when you submit a HealthCare.gov application, in order to receive an accurate eligibility determination.

 

Yes, this SEP is available to qualified individuals and their dependents, regardless of whether they have experienced another SEP triggering event such as newly gaining or becoming a dependent. If you have gained a new dependent within the past 60 days, you should update your applications to include this information to ensure you receive a correct eligibility determination, including an earlier SEP effective date, retroactive to the date of the event, if you are found eligible for a SEP due to a birth, adoption or foster care / court order placement.

If you have not newly gained a dependent within the last 60 days or experienced any other qualifying event, but want to add a current dependent to your coverage, you may also do so during the period of time of this SEP (through August 15). To add a dependent, as a current enrollee, you will need to return to your application, select the option to submit a change, add your dependent, and submit your application to receive an updated eligibility result. Once you update and re-submit your application, you can access the SEP and continue to enrollment.

 

No, an SEP is not available if you originally applied for coverage at your state Medicaid or CHIP agency during an SEP, including the 2021 SEP.

However, if you apply for coverage through the Marketplace during an SEP, and then are referred to your state Medicaid or CHIP agency, and are then are determined ineligible for Medicaid or CHIP by the state Medicaid or CHIP agency after the SEP has ended, you may qualify for an SEP to enroll in Marketplace coverage. Your coverage will take effect on the first of the month following plan selection, or you can call the Marketplace call center to request that your coverage start retroactive to when it would have started if you had been able to enroll in Marketplace coverage through your original SEP.

Note the rules regarding the SEP for those who have been denied Medicaid or CHIP eligibility outside of an enrollment period differ for the annual OEP (Open Enrollment Period). If you apply for coverage through the Marketplace or at your state Medicaid or CHIP agency during the annual OEP, and are determined ineligible for Medicaid or CHIP after the OEP has ended, you may qualify for an SEP.

 

If you are changing plans from an existing Marketplace plan, your current coverage will end based on the date your new plan will start. If you are enrolled in other types of coverage, such as coverage outside of the Exchange, you should apply for Marketplace coverage, select a plan, and then request to end your current (outside of the Marketplace) coverage based on when your new Marketplace coverage will start.

 

In order to use this SEP, if you are currently enrolled in a Marketplace plan, you will need to go through the application and make any changes if needed to your current information and submit the application in order to receive an updated eligibility result that provides the SEP before continuing on to enrollment. As noted, this SEP opportunity will not involve any new application questions or require you to provide any new information not otherwise required to determine eligibility and enroll in coverage.

To resubmit your application, if you are currently enrolled in Marketplace coverage, you should sign in and select your current application, select the option to report a life change, and then click the option for change to my household’s income. This will take you to the start of the application. If you do not need to update any information, you can go through the application, confirm the pre-populated information, and then re-submit the application in order to access the SEP. If you have experienced a change, you should make sure to include updated information to ensure you receive an updated eligibility determination.

 

If you update your application to reflect new information, then yes, you will need to re-select your current plan in order to apply your new, updated eligibility determination.

 

No, if you update your application to reflect current information such as a new address or household income change, and then you re-select the same plan, your deductible and other accumulator will not re-set.

You can find local help at Localhelp.healthcare.gov or by calling the Marketplace Call Center at 1-800-318-2596 (TTY 1-855-889-4325). Assistance is available in 150 languages.

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