Marketplace Appeals Length and Proving Income
Ads by +HealthNetwork
You can appeal any HealthCare.Gov or state Marketplace decision in regards to coverage or cost. Typically the process will take 90 days at most.
Questions
Women Paying More Than Men on Group Plan?
Grandfathered employer group plans established before March 23, 2010 can discriminate prices based on gender and don’t have to follow the ACA’s rules.
Do All Plans Offer Cost Sharing Reduction Subsidies?
All Silver plans offered on the Health Insurance Marketplace offer cost sharing reduction subsidy options. The amount of reduction you qualify for is based on your projected income.
Question about Notice 2015-17? When Does Excise Tax Kick In?
If you are reimbursing an employee for individual Marketplace coverage you don’t have to apply for the exemption for this until after June 30, 2015.
Can I Switch Plans If Someone Losses Eligiabilty?
If you are on a family plan and someone loses eligibility for the plan, you get a 60 day special enrollment window to switch to an individual plan.
Temporary Coverage That Counts As Minimum Essential Coverage?
If you need temporary coverage, but want minimum essential coverage that can protect you from the fee, go with a Marketplace plan.
Are Gender Ratings Illegal Under the ACA?
Gender ratings (charging women more than men or vice versa for health coverage) are illegal under the ACA, but some plans are grandfathered in and can charge more based on gender and discriminate based on health.
Can I Change My Health Insurance Plan Mid-Year?
You cannot change your health plan outside of open enrollment unless you qualify for special enrollment. Typically once you enroll in a plan you’ll need to keep it
If I Return to the US as Expat Will I Have Coverage?
When you return to the US as an expat you can either enroll in a health plan through the Marketplace via special enrollment, or if applicable take employer coverage.
Timeframe for ObamaCare Application?
In most cases the application process for ObamaCare’s Marketplace is immediate. In some cases the application could take verification
Plan Doesn’t Offer Dental, How Can I Get Dental?
All plans that offer coverage to children must offer pediatric dental, but not adult. If your plan doesn’t offer dental you can get it as a standalone plan during open enrollment.
Can Medicare Policies Deny Preexisting Conditions?
Under the ACA neither Original Medicare or Supplemental Medicare (like Medigap) can deny coverage for preexisting conditions.
ObamaCare Tax Credits Getting Married or Divorced?
Getting married or divorced can affect tax credits based on filing status. Use Premium Tax Credit Form 8962 alternative calculation for year of marriage. This can help you adjust tax credits and ensure you avoid repaying extra credits or missing out on claiming additional ones.
How to Switch to Marketplace Coverage After Employer Coverage?
If you are losing employer coverage you can switch to Marketplace coverage by enrolling in the Marketplace no less than 15 days before employer coverage ends.
Can I Waive Employer Insurance if I Have Coverage?
Under the employer mandate no employer can force an employee to accept coverage, an employer may have to offer, but the employee can always decline.
How Long Do I Have to Get Coverage After 26th Birthday?
You have 60 days from the day you turn 26 to get your own health insurance plan, enroll before your birthday for coverage that starts when the old plan ends.
Who Owes Penalty if Only Spouse Has Income?
The penalty for not having coverage is based on your “tax family” and “coverage family”. Those who file together must all have coverage, get exemptions, or pay the fee based on household income.
Why Did ObamaCare Eliminate Composite Rating?
Under ObamaCare HHS eliminated composite ratings which allowed group plans to charge uniform premiums and now must use individual rates or state specific versions.
Does an Employer Have to Offer Coverage if I Have Coverage?
A qualifying employer must offer health coverage regardless of what other coverage options an employee has.
How Long Can Employees Go Without Coverage?
Employers can have a 90 waiting period for new hires, but if they are required to provide coverage must provide it every month or pay a monthly fee.
Grandfathered Group Plan Denying Well-Woman Visits?
I am a teacher in SC with health insurance through the state’s health plan under Blue Cross Blue Shield. This insurance does not cover an annual gynecological visit nor birth control pills. I have contacted my insurer to ask why they don’t have to cover this under the Affordable Care Act and they said they… Read More
Do Untaxable Disability Wages Impact Tax Credits?
ObamaCare’s tax credits are based on annual household income (filers MAGI plus dependents AGI). MAGI includes non-taxable disability payments.
What Do I Do If I Didn’t Get My Insurance Card Yet?
If you enrolled in a plan and paid your premium, but don’t have your insurance card yet, you can call your insurer and collect the information you need.
Medicaid and children being raised by family (but not the parents)?
If these children are your legal dependents, you should list them as such on your marketplace application. If you were already covered by Medicaid, this should extend to your children. They also might be covered by CHIP.
What do I do if my Income is Lowered?
You can (and should) report any income changes over the course of the year by logging into your state or federal marketplace account. Doing so will automatically update the cost-assistance that you are eligble for.