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Webinar Q&A: Basics of Health Coverage: Enrollment Tools and Resources for New Program Staff

August 23, 2017

ACE TA Center

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The following questions and answers came from the August 23, 2017 ACE TA Center webinar, Basics of Health Coverage: Enrollment Tools and Resources for New Program Staff.

Questions

  1. Last year, Marketplace consumers were auto-enrolled into their same plans December 15th. Do you know when auto-enrollment will take place this year?
  2. When will the Certified Application Counselor training be available?
  3. Does an individual have to retake the Certified Application Counselor training if they were certified last year?
  4. Is there a deadline by which 2018 Marketplace plans must be released?
  5. Can an individual create a Marketplace account on healthcare.gov before open enrollment begins?
  6. What insurance is available for a reasonable amount for an individual that makes 35,000 a year?
  7. What if a client is self-employed?
  8. Does the Medicare part D open enrollment happen at the same time as Affordable Care Act (Marketplace) and Medicaid enrollment?
  9. What coverage options does a client have if they are not legal residents, but do hold a legal state identification card?
  10. I live in Virginia and our state did not expand Medicaid. Will ADAP pay the premium for clients who enroll into a Marketplace plan? If so, will they pay the premium for people who are not HIV positive but are unemployable? 
  11. Does ADAP only provide financial assistance for medications?
  12. What's the difference between Part A and B in Ryan White Program?

Answers

  1. Last year, Marketplace consumers were auto-enrolled into their same plans December 15th. Do you know when auto-enrollment will take place this year?
    Auto-enrollment will take place on December 15th, the same date as last year. A major difference this year is that open enrollment also ends on December 15th, so clients will not have the opportunity to select a different plan after being auto-enrolled. For this reason, it’s especially important to encourage clients to proactively compare plans and select one that will best meet their healthcare needs. 

    Also: as in all previous years, the Marketplace will send a letter to all individuals enrolled into a Marketplace plan ahead of open enrollment. This letter will include information about their anticipated premium payment for 2018. It’s important to encourage clients to open and review all pieces of mail they receive, or review the mail with their case manager ahead of open enrollment. 
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  2. When will the Certified Application Counselor training be available? 

    The Certified Application Counselor training is available now and you can apply today for free. You can access the training through the CMS Enterprise Portal by logging in or registering as a new user at https://portal.cms.gov/wps/portal/unauthportal/registration. Existing users can login at: https://portal.cms.gov.

    To become a Certified Application Counselor, you must volunteer or work for a community health center or other health care provider, hospital, non-federal governmental or non-profit social service agency in a state with a Federally-facilitated Marketplace or a State Partnership Marketplace that has been designated as a Certified Application Counselor organization. You can visit https://marketplace.cms.gov/technical-assistance-resources/assister-programs/cac.html to learn more about the process of applying for and receiving the designation of a CAC organization. 
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  3. Does an individual have to retake the Certified Application Counselor training if they were certified last year? 

    Certified Application Counselors must complete a recertification training each year. You can access the training at: https://portal.cms.gov

    We encourage CACs to complete their recertification training prior to the beginning of Open Enrollment, even if their certificate hasn’t expired. This will ensure they have received the most current training and are ready to provide enrollment assistance to consumers. 
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  4. Is there a deadline by which 2018 Marketplace plans must be released?
    Marketplace plans will be released no later than November 1st, however some states may release plan information before then. We encourage you to monitor your state’s healthcare exchange website, as well as the website of your state’s Department of Insurance. In addition, we recommend being in touch with your state’s ADAP program to learn if they will recommend particular plans for clients or if they plan to provide financial help for specific plan. You can find the contact information for your state’s ADAP director here: https://www.nastad.org/resource/part-b-coordinator-directory 
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  5. Can an individual create a Marketplace account on healthcare.gov before open enrollment begins?
    Yes! Individuals can create a Marketplace account at any time throughout the year. People may find it helpful to create Marketplace accounts before open enrollment begins so they are able to quickly access the Marketplace website and begin shopping for plans as soon details are released.  
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  6. What insurance is available for a reasonable amount for an individual that makes 35,000 a year?
    Information about 2018 Marketplace health plans has not been released yet. To prepare for open-enrollment and plan comparison, we encourage you to visit healthcare.gov now and set up an account. This will allow you to easily sign into the Marketplace and begin comparing plans as soon as they are released. Also, be sure to check with your state’s ADAP program to find out if they recommend and/or provide financial assistance for particular plans, for eligible individuals.

    Also, remember that federal financial assistance is available to individuals in all states who are between 100% and 400% of the federal poverty line. Individuals will be able to calculate the exact costs for a health plan on the Marketplace website before enrolling.
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  7. What if a client is self-employed?
    Clients who are self-employed and lawfully present in the U.S. can enroll into a health plan through the Marketplace. They are eligible to receive financial assistance if their income is between 100% and 400% of the federal poverty line and if they meet. Self-employed clients may also qualify for Medicaid if they reside in a Medicaid expansion state. 
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  8. Does the Medicare part D open enrollment happen at the same time as Affordable Care Act (Marketplace) and Medicaid enrollment?
    No, the enrollment periods are not the same, as these are three different programs: 

    Medicare Part D, also called the “Medicare prescription drug benefit” is designed to help with the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries. Medicare open enrollment occurs between October 15th and December 7th each year.

    Medicaid is the single largest source of health coverage in the United States for low-income adults, children pregnant women, elderly adults and people with disabilities. There is no open-enrollment period for Medicaid, which means you can apply for and enroll at any time of the year.

    Health coverage through the Marketplace: The Affordable Care Act established the Marketplace - an online service that helps people shop for and enroll in affordable health insurance. Open enrollment for the Marketplace runs from November 1, 2017 to December 15, 2017, however outside the open enrollment period you can enroll in a plan if you qualify for a Special Enrollment Period. You can learn more about access to health insurance through Marketplace coverage at www.healthcare.gov.
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  9. What coverage options does a client have if they are not legal residents, but do hold a legal state identification card?
    The coverage options available to your client depends on that individual’s federal legal status. We encourage you to review resources available through the ACE TA Center including the eligibility decision tree and the immigration fact sheet.
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  10. I live in Virginia and our state did not expand Medicaid. Will ADAP pay the premium for clients who enroll into a Marketplace plan? If so, will they pay the premium for people who are not HIV positive but are unemployable? 
    In many states, individuals may be eligible for premium payment assistance through the state ADAP program. We encourage you to contact your state ADAP coordinator to learn more about financial assistance opportunities available in your area. You can find the contact information for your state’s ADAP director here: https://www.nastad.org/resource/part-b-coordinator-directory
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  11. Does ADAP only provide financial assistance for medications? 
    In many states, ADAP provides financial assistance for premium payments and out of pocket costs, in addition to medication costs. We encourage you to visit your state ADAP website, or contact your ADAP director to learn more about the financial assistance available in your area. 
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  12. What's the difference between Part A and B in Ryan White Program?
    The Ryan White HIV/AIDS Program is divided into five Parts, A through F:

    Part A provides grant funding for medical and support services to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs). EMAs and TGAs are population centers that are the most severely affected by the HIV/AIDS epidemic.

    Part B provides grant funding to states and territories to improve the quality, availability, and organization of HIV health care and support services. In addition, Part B also includes grants for ADAP, the AIDS Drug Assistance Program.

    For more information about how the Ryan White HIV/AIDS Program is structured, including descriptions of Parts C, D and F, please visit the HRSA/HAB website: https://hab.hrsa.gov/about-ryan-white-hivaids-program/about-ryan-white-hivaids-program

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