Insurance Exchanges

Due to technical issues in establishing automated eligibility and enrollment functionality, Marketplaces have had difficulty in providing timely eligibility determinations to applicants and enrolling qualified individuals in Qualified Health Plans (QHPs) during the open enrollment period for the 2014 coverage year. Such a circumstance may be considered an exceptional circumstance for individuals who were unable to enroll in a QHP through the Marketplace due to these issues. This bulletin provides guidance on the availability of advance payments of the premium tax credit and cost-sharing reductions on a retroactive basis to an issuer, and clarifies the attendant responsibilities of the QHP issuer in this circumstance.

SHADAC’s Marketplace Enrollment Reports provide monthly updates of Marketplace enrollment by state using data included on the Assistant Secretary for Planning and Evaluation (ASPE) Marketplace enrollment reports. SHADAC focuses its reports on states running their own State-Based Marketplace and includes a map displaying which states are operating State-based; Federal-State Partnerships; and Federally-facilitated Marketplaces. This resource is updated regularly as additional state and ASPE enrollment reports are published and made available.

The National Health Council and its patient advocacy members have created this web tool where people can enter their unique health needs – the number of doctor visits, specialist visits, hospitalizations, and specific medications (both generic and brand name) – to learn how the different metal plans in their state’s Marketplace can affect their out-of-pocket costs. The tool generates a personalized report that a patient can print off or e-mail, and the report helps the person focus in on the metal plan level that more appropriately meets his or her needs.

Early evidence from across the nation suggests that consumer assisters are playing a vital role in helping people enroll in the new coverage options made possible by the Affordable Care Act. The State Health Reform Assistance Network has engaged with a number of states to develop easy to understand materials to educate consumer assisters about various issues that may confuse consumers and the assisters trying to help them during the eligibility determination and enrollment process. The following resource guides, prepared by Manatt Health Solutions, were developed to help consumer assisters answer some of the most common eligibility and enrollment questions: Minimum Essential Coverage; Household Composition Eligibility Rules; MAGI Household Income Eligibility Rules; and Immigrant Eligibility.

This is the fourth in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace. This brief includes data for states that are implementing their own Marketplaces, and states with Marketplaces that are supported by or fully run by the Department of Health and Human Services. This brief also includes updated data on the characteristics of persons who have selected a Marketplace plan (by gender, age, and financial assistance status), and of the plans that they have selected (by metal level); along with additional data on the characteristics of people who have selected plans in the FFM and the plans they have selected.