Open Enrollment for 2018 Marketplace Coverage is in Full Swing!

Open Enrollment for 2018 Marketplace Coverage is in Full Swing!

Monday, November 13, 2017
ACE TA Center

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Help your clients avoid these potential snags that could result in a delayed start to 2018 coverage, or disqualify them from receiving 2018 premium tax credits.

Check that clients have taken care of these tasks BEFORE they try to enroll.

1. Make sure clients have paid all past due premiums.

If your clients missed any 2017 premium payments, and want to enroll in the same plan or with the same insurer, they may have to pay these unpaid premiums before 2018 coverage can begin.

A few notes:

  • Insurers are not required to have this policy. Some may choose not to implement it.
  • In some cases, insurers may be willing to accept installment payments or partial payment.
  • Insurers must provide a written policy explaining how they will treat past due premiums.
If your client owes past-due premiums, talk with your state ADAP or local RWHAP insurance assistance program. These programs may be able to pay the client’s past-due premiums, as long as the premiums are for coverage that meets the cost-effectiveness and coverage requirements detailed in HRSA HAB Policy PCN 13-05, Clarifications Regarding Use of Ryan White HIV/AIDS Program Funds for Premium and Cost-Sharing Assistance for Private Health Insurance

2. Make sure clients have filed and reconciled their 2016 taxes.

Most people who get Marketplace health coverage qualify for premium tax credits to help pay for their premiums. For any client who received premium tax credits in 2016: If they did not file their 2016 taxes to show that they got the right amount of premium tax credit that year -- they will not be eligible for premium tax credits for 2018 coverage! 


 3. Ensure eligible clients are enrolled in ADAP or another RWHAP insurance assistance program to receive premium/cost-sharing assistance.

In most states, clients must be enrolled in ADAP in order to receive financial assistance for health insurance premiums and out of pocket costs. If your client is eligible for ADAP, and has not re-certified in the past six months, help them fill out the application form. This will ensure they are able to receive any premium and cost sharing assistance they may qualify for.
Note that some RWHAP Part A programs and other local recipients also provide premium and cost-sharing assistance. Check with your program director or contact your state ADAP coordinator for eligibility and plan details.
The Access, Care, and Engagement (ACE) TA Center aims to help Ryan White HIV/AIDS Program recipients and subrecipients support their clients, especially people of color, to navigate the health care environment through enrollment in health coverage and improved health literacy.