Preparing for 2019 Open Enrollment
ACE TA Center
Timeline and key steps your program can take in the months leading up to Open Enrollment 2019.
Open Enrollment for 2019 Marketplace health coverage begins November 1 and ends December 15 in all states!
This resource provides a timeline, and describes key steps your program can take in the months leading up to Open Enrollment, to support efficient and successful enrollment of all eligible clients into plans that best meet their needs. For each step, this resource links to corresponding ACE TA Center tools to help you get started.
- Assess staff workload and develop a scheduling plan
- Conduct staff training and build enrollment staff capacity
- Build enrollment partnerships and educate community partners
- Evaluate and/or learn about available health plans
- Share key outreach and enrollment messages with clients
November 1-December 15
Open Enrollment can be a busy time for staff as they support clients’ enrollment in health coverage, while also staying on top of other ongoing tasks.
To help prepare staff for the 45-day Marketplace Open Enrollment period, and ensure your program has adequate personnel resources available to facilitate enrollments, programs should:
- Develop a work plan to identify, assign and accomplish activities to prepare for and conduct enrollment
- Evaluate staff capacity and assess how Open Enrollment-related tasks will change staff workload. Consider the impact on all tasks, including routine tasks, preparing for enrollment, and providing enrollment assistance services
- Set staff schedules for enrollment appointments, including during non-traditional work hours and when clients come in for other services
Will your staff be able to manage enrollment of all your eligible clients during the 45-day Open Enrollment period?
If not, now is the time to build relationships with community enrollment partners.
ACE tools to support planning for Open Enrollment:
- Account Tune-Ups: Getting Ready for Marketplace Open Enrollment
During Open Enrollment, staff will work directly with clients who may have questions and concerns about health insurance, plan options, and the enrollment process. It’s important to train staff members on these topics so they are prepared to educate clients and successfully facilitate enrollments.
- Train staff on health insurance enrollment basics. Focus on specific plan considerations for people living with HIV, such as medication access, provider continuity, and any premium or out-of-pocket cost assistance from the Ryan White HIV/AIDS Program, including ADAP.
- Consider getting staff members trained as Certified Application Counselors. Training is free of charge to participants!
- Train staff to conduct Account Tune-ups for all clients eligible for Marketplace coverage
ACE tools to support engaging and enrolling clients:
- Determining coverage eligibility
- Engaging clients in conversations about coverage and addressing their questions and concerns
- Choosing an affordable plan
- Tracking enrollment and renewals
- Enrolling diverse clients
Finding and educating enrollment partners in your community, or even within your larger organization or network, can help your program ensure that all eligible clients get enrolled into health plans that best meet their needs. Make sure enrollment assisters working with your clients are aware of the unique health coverage needs of people living with HIV (PLWH) and how RWHAP, including ADAP, can provide financial support for premiums, medications and co-pays.
- If needed, identify and establish partnerships with Navigators, Certified Application Counselors, and other enrollment assisters. Assisters may be found at partner organizations or within your health system.
- Make sure partners are aware of RWHAP, including the role of ADAP, in health coverage.
- Train your program staff to refer clients to these trusted partners before and during Open Enrollment.
ACE tools for enrollment assisters who are new to working with people living with HIV:
Clients have only 45 days to enroll in a health plan during Open Enrollment. Conduct Account Tune-Ups for all eligible clients in the months leading up to Open Enrollment, to make sure enrollment appointments are quick and efficient starting on November 1.
An Account Tune-Up includes making sure that clients understand the importance of health coverage, Marketplace accounts are up to date, no insurance payments are owed, and income taxes are filed to ensure future eligibility for Advance Premium Tax Credits. There are four main steps of an Account Tune-Up.
|1. Check paperwork, accounts, and payments.|
It’s important that clients’ insurance payments and Marketplace accounts are up-to-date.
|2. Review finances.|
A client’s income and tax filing history help determine eligibility for financial assistance through the Marketplace.
|3. Confirm enrollment in the Ryan White HIV/AIDS Program (RWHAP), including ADAP.|
Many RWHAP/ADAPs provide financial assistance to help eligible clients pay for their health coverage, but clients need to keep their paperwork up-to-date.
|4. Help clients prepare for enrollment and schedule enrollment appointments.|
Clients should understand their coverage options and be confident they are enrolling into a plan that best fits their health and financial needs.
Staff can conduct Account Tune-Ups with clients during:
- RWHAP/ADAP certification appointments
- Routine medical appointments
- Case management or benefits counseling activities
- Separate scheduled sessions
ACE tools to support Account Tune-Ups:
- Account Tune-Ups: Getting Ready for Marketplace Open Enrollment
It is important that staff to understand what plans are being offered in their area, so that they can help clients find a plan that best fits their financial and health needs. This will help clients avoid enrolling into a plan that does not provide the medical or prescription benefits they need -- even if its less expensive.
It’s also important to find out if the state RWHAP Part B/ADAP is reviewing and/or supporting particular plans, or if another local entity is assessing plans. Depending on staff capacity and experience with plan review, it may be helpful to engage community partners or third-parties to conduct this task.
For RWHAP recipients doing insurance purchasing:
Assess all plan options, including off-Marketplace plans
Consider locating a third-party to do a plan assessment once plan information becomes available
Train subrecipient staff on plan options as soon as they have been assessed
How RWHAP-funded direct service providers can prepare:
Check with ADAP and/or other RWHAP insurance purchasing programs to find out if they are assessing plans for people living with HIV, and when they will be ready to share this information.
Train program staff on plan options as soon as they have been assessed.
If assessments will not be complete until after November 1, schedule client enrollment appointments based on when you will have this information.
If no one is analyzing plans in your area, use existing plan assessment tools and templates.
ACE tools to support health plan selection:
ACE Health Care Plan Selection Worksheet
One of the most important steps to prepare clients for enrollment is educating them on the importance of health coverage, reminding them that financial assistance is often available to help pay for insurance, and connecting them with an enrollment assister who can help them find and enroll into a plan.
Staff can share these key messages with clients during RWHAP/ADAP certification appointments, routine medical appointments, and other case management or benefits counseling activities:
- RWHAP is not insurance! Health insurance covers care for all of your health needs, in addition to HIV care and medications.
- Someone can help you find and select a plan, fill out your application, and enroll.
- You should actively compare plans to avoid getting auto-enrolled into a plan that may not be the best option for your health needs.
- When you review plans, check for preferred HIV medications and providers. Cheaper plans aren’t always better plans!
- Avoid short term plans, particularly those that do not include coverage for Essential Health Benefits or protections for pre-existing conditions.
- In many places, the RWHAP, including ADAP, can help with insurance and medication costs depending on how much money you make.
ACE tools to communicate key enrollment messages to clients:
If you’ve followed all the above steps, your staff and clients should be well prepared to begin Open Enrollment on November 1! Remember that enrollment ends December 15 in all states this year.
During Open Enrollment:
- Revisit your staff schedule and ensure availability for enrollment appointments, including walk-ins.
- Continue promoting enrollment opportunities and scheduling appointments with clients.
- Be prepared to contact the Marketplace with enrollment questions or problems. Have customer service phone numbers handy.