computer-engineer-clipart-bRTdzpxi9Do you have questions about health insurance? It might seem overwhelming, but don’t worry, because there is plenty of help available! The Enrollment Period to buy health insurance on the Marketplace for 2016 is now closed. The third Open Enrollment Period (OE3) ended January 21, 2016.
You may still be able to get coverage for 2016. This is called a special enrollment period (SEP). Click on the “Special Enrollemnt Period” heading below to find out more about special enrollment periods. And remember, you can apply for TennCare and CoverKids year-round!

Here are some resources to get assistance completing the application:

    1. Enroll America’s connector tool: Find assisters in your region. Find events in your region. Find Marketplace information. Find enrollment information. Find details about discounts
    1. GetCoveredTenn website: www.getcoveredtenn.org: Find assisters in your region. Find events in your region. Find Marketplace information. Find enrollment information. Find details about discounts.
    1. GetCoveredTenn Hotline: 844-644-5443: Toll-free from anywhere in TN. Answered by trained volunteers. Consumers are referred to an organization that will assist with enrollment.
    1. Call the Marketplace at 1-800-318-2596. Have on hand the following:
        • Social Security numbers and the names on Social Security cards for each person in your family who is applying for coverage.
        • Documents that you are a legal immigrant.
        • Income information: either pay stubs or income tax information from 2015, if they expect similar earnings in 2016.
        • Employer’s name and address.
        • Information about insurance offered by your employer (even if you don’t have that insurance).
        • Documentation of any income that you can deduct from your taxes (student loans, veteran’s benefits, etc.).
        • Provider names and a list of prescription medicines for the household.

See more information below!

Special Enrollment Periods

Even though the Marketplace is closed, there are still some opportunities for folks to enroll in a qualified health plan (QHP). Certain life-changing events, such as marriage or birth, as well as events that lead to a loss of health coverage, can allow consumers to qualify for a SEP. SEPs allow consumers can enroll in coverage outside of open enrollment. Community Catalyst created a Fact Sheet on life-changing events. Check it out here!

This year, there are some new special enrollment periods. Read about other ways to get a SEP below.

Tax Penalty Special Enrollment Period

Centers for Medicare and Medicaid Services (CMS) announced a special enrollment period (SEP) for individuals and families in states which use the Federally-facilitated Marketplaces (FFM) who did not have health coverage in 2014 and have to pay a fine when they file their 2014 taxes. This SEP will allow individuals and families who didn’t know about or didn’t understand this new requirement to enroll in 2015 health insurance coverage through the FFM. For those who didn’t know about or didn’t understand the fee for not enrolling in coverage, CMS will provide an opportunity to purchase health insurance coverage from March 15 to April 30. If eligible consumers do not enroll in coverage for 2015 during this SEP, they may have to pay a fee when they file their 2015 income taxes.

Those eligible for this special enrollment period live in states with a Federally-facilitated Marketplace and:

  • Currently are not enrolled in coverage through the FFM for 2015,
  • Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
  • Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.

Consumers seeking to take advantage of the special enrollment period can find out if they are eligible by visiting https://www.healthcare.gov/get-coverage. If a consumer enrolls in coverage before the 15th of the month, coverage will be effective on the first day of the following month. Note that individuals taking advantage of the SEP will still owe a fee for the months they were uninsured and did not receive an exemption in 2015. The SEP is designed to allow such individuals the opportunity to get covered for the remainder of the year and avoid additional fees for 2015.

As of March 15, a new two-part question on the HealthCare.gov application allows consumers to take advantage of the Tax Penalty SEP by asking them to attest that they first became aware of (or understood the meaning of) the requirement to have health care coverage after the end of open enrollment. The Tax Penalty SEP application questions are shown in the screen shot below:

If a consumer selects “Yes” to both of these questions on the application, and is not currently enrolled in coverage, he or she will be able to qualify for a SEP, and then be able to select a plan. If assisters want ideas of how to find consumers who may be eligible for the Tax Penalty SEP, you can listen to this webinar on partnering with tax sites.

For more information, check out Enroll America’s resources here and here.

Note: This SEP does not apply to consumers who do not have to pay the penalty but are subject to reconciliation and have to repay premium tax credits (http://enrollmentloop.org/groups/new-sep-tax-season).

Other SEPS That Begin in Late April 2015

• Losing a dependent or dependent status (through legal separation, divorce or death)
• Being subject to a court order to provide health insurance, including child support orders
• Having income rise for consumers in Medicaid non-expansion states ineligible for advanced premium tax credits (APTC) solely due to income under 100% federal poverty level (FPL) which makes the consumers newly eligible for APTCs. Effective on April 28, 2015.

Consumers Who Don’t Receive Medicaid Denials Until After Open Enrollment May Be Eligible for a Special Enrollment Period

Like last year, consumers who apply for coverage through the Marketplace during Open Enrollment, and are found ineligible for TennCare (Medicaid) or CoverKids (the Children’s Health Insurance Program or CHIP), may be eligible for a special enrollment period (SEP) which will allow them to enroll in coverage on the Marketplace after the Open Enrollment Period has passed. This includes both:
• Consumers who applied for coverage at the FFM during Open Enrollment, were assessed eligible for Medicaid or CHIP, and were later determined ineligible for Medicaid or CHIP by their state Medicaid or CHIP agency.
• Consumers who applied at their state Medicaid or CHIP agency during Open Enrollment and were determined ineligible for Medicaid or CHIP by their state Medicaid or CHIP agency.

After being determined ineligible for Medicaid or CHIP, consumers can come to the Marketplace by visiting www.healthcare.gov or by calling the Call Center (1-800-318-2596) to fill out or complete an application for coverage in a Qualified Health Plan (QHP). Consumers will need to indicate that they have been found ineligible for Medicaid or CHIP and that they applied for coverage during Open Enrollment (between November 15, 2014 and February 15, 2015).

Alternatively, after being determined ineligible for Medicaid or CHIP, most applications are transferred from the state Medicaid agency to the Marketplace. Once the Marketplace receives the application, it will notify the consumer, inviting consumer to come in and pick-up and complete a pre-populated application.

Upon completing their Marketplace application and being determined eligible for QHP coverage, consumers will be determined eligible for a SEP. Remember if you qualify for a SEP to change plans or enroll for the first time, you’ll have 60 days from your Medicaid or CHIP determination date to enroll.

More SEP Resources

Enrollment Numbers from 2014-2015 Open Enrollment

Since several of the Affordable Care Act’s coverage provisions took effect, about 16.4 million uninsured people have gained health insurance coverage. This includes 14.1 million adults who gained health insurance coverage since the beginning of the first Marketplace Open Enrollment in October 2013 through March 4, 2015, as well as 2.3 million young adults (aged 19-25) who gained health insurance coverage between 2010 and the start of Open Enrollment in October 2013 due to the ACA provision allowing young adults to remain on a parent’s plan until age 26. From the beginning of the first Marketplace Open Enrollment in October 2013 through March 4, 2015, the uninsured rate dropped from 20.3 percent to 13.2 percent – a 35 percent (or 7.1 percentage point) reduction. Click here to view the full report, click here to view the report’s technical appendix, and visit this page for infographics highlighting the report’s results.

Marketplace Numbers

The U.S. Department of Health and Human Services (HHS) announced a breakdown of the number of new and returning Marketplace enrollees. Of the total 8.8 million FFM enrollees, about half (53%) are new enrollees, while 47% of enrollees are renewing coverage. Of those renewing, about 53 percent took steps to actively renew their coverage.

On March 3, HHS released this Fact Sheet on the Affordable Care Act in Tennessee.

Affordable Care Act Sign Ups and Tax Credits in Tennessee

• At the end of Open Enrollment on February 15, 229,093 Tennessee consumers had selected a plan or were automatically re-enrolled in Marketplace coverage.

• 82 percent of Tennessee consumers who were signed up as of January 30 qualify for an average tax credit of $211 per month through the Marketplace.

• As of January 30, in the 37 States using the HealthCare.gov platform, the average advance premium tax credit covers about 72 percent (or $268) of the gross premium, and tax credits will reduce premium costs across the 37 States by over $1 billion a month.

The Affordable Care Act is Working in Tennessee

Over the past three months, consumers in Tennessee sent a clear message: The Affordable Care Act is working, and the quality health coverage offered through the Health Insurance Marketplace is an affordable product that consumers want.

In the final day of Open Enrollment, more new consumers signed up for health coverage than any other day this open enrollment or last. And it’s easy to understand why consumers were enthusiastic: 76 percent of Tennessee Marketplace enrollees as of December 2014 could have obtained coverage for $100 or less after any applicable tax credits in 2015.

Health insurers sent a message as well. They competed for consumers’ business. In Tennessee, consumers could choose from 5 issuers in the Marketplace in 2015 – up from 4 in 2014. Tennessee consumers could choose from an average of 71 health plans in their county for 2015 coverage – up from 48 in 2014.

We’ve achieved an historic reduction in the uninsured – the largest over any period since the early 1970s. Furthermore, in 2014, hospitals saved an estimated$5.7 billion in uncompensated care costs because of the Affordable Care Act, with states that have expanded Medicaid seeing about 74 percent of the total savings nationally, compared to states that have not expanded Medicaid.

Medicaid and Chip Enrollment Numbers

Approximately 11.2 Million Additional Individuals Enrolled in Medicaid as of January 2015.

The Medicaid and CHIP data released recently shows enrollment reaching approximately 11.2 million additional individuals as of January 2015 – a 19.3 percent increase over the average monthly enrollment for July through September of 2013, the pre-Marketplace open enrollment timeframe.

More OE2 Enrollment Numbers

This resource from the Kaiser Family Foundation lists the number of individuals who have selected a 2015 Marketplace plan and the estimated number of potential 2015 Marketplace enrollees by state, along with the “percentage of potential Marketplace population enrolled” in each state.

Marketplace Mistakes

Counting Dependent’s Social Security Income

CMS announced that the Marketplace is counting the Social Security income of dependents in the total household income, even in cases when the dependent’s income should not be counted. For more information, please read this “Assister and Advocate Alert.” File an appeal, if this happens to you!

Form 1095-A Issues

HHS announced recently that they have encountered an issue with about 20% of Form 1095-As generated by the Marketplace. The forms with an error list the 2015 second lowest cost silver plan (SLCSP) instead of the 2014 SLCSP. Using the wrong SLCSP to calculate the consumer’s PTC would result in an incorrect PTC amount and could affect the consumer’s need to repay or get a refund.

Consumers can check and see if their 1095-A form was correct by calling the Marketplace or by logging in to their healthcare.gov account (select the 2014 application, select “tax forms” from the menu on the left hand side of the screen, view or download Form 1095-A, and a red box will be present on the “tax forms” page stating if the consumer has an inaccurate 1095-A).

Corrected 1095-A forms will be sent out in early March. Consumers who have already filed their taxes can submit an amended return once they receive the corrected 1095-A. Consumers can file an amendment with their corrected 1095-A form at VITA sites for free. VITA sites in your area can be found by calling 2-1-1.

New: The IRS released a statement at the end of February that consumers who have already filed their taxes and had a mistake on their 1095-A form do not need to send in an amended return once they receive their corrected 1095-A and any penalties that could be applied for not amending the tax return will be forgiven. However, the IRS statement further states that “some individuals may choose to file amended returns. A tax filer is likely to benefit from amending if the 2015 monthly premium for his or her second lowest cost Silver plan (benchmark plan) is less than the 2014 premium.” Consumers can look up the 2014 second lowest cost silver plan here.

More information can be found here. The FAQs include information for consumers who received a Form 1095-A with the incorrect SLCSP and already filed their taxes prior to Feb. 25, how consumers will know if their 1095-A is affected, and what consumers should do if they are affected and have not yet filed their taxes.

Tax Time

Exemptions from the Individual Mandate

While a variety of exemptions from the requirement to have health insurance are available, many consumers still do not know which exemptions they may qualify for, or they may not understand that there is a fee for those who can afford health insurance but choose not to buy it. Assisters can use the Exemptions Screener Tool to help consumers figure out which exemptions from the shared responsibility payment may apply to them, if any, as well as step-by-step instructions on how to apply for each exemption through the Marketplace or on their tax return.

There are some exemptions that are special for 2014. Two exemptions are unique for 2014 because they are available to consumers who:

  • had a 3 month or longer gap in coverage at the beginning of 2014 despite enrolling or being treated as enrolling in coverage during open enrollment (OE1), or
  • were eligible for but did not enroll in employer coverage with a coverage year that started in 2013 and ended in 2014.

Other exemptions are special because the IRS is allowing eligible consumers to get them directly on their taxes for 2014. These include:

  • exemptions for consumers enrolled in limited-benefit Medicaid and TRICARE programs that are not MEC, and
  • exemptions for consumers who were in the Medicaid gap.


Georgetown Center for Children and Families created a FAQ for immigrant families who might have questions about new tax filing rules created by the ACA.

King v. Burwell

On March 4, the Supreme Court heard oral arguments for the much anticipated King v. Burwell case, a case that threatens to eliminate tax credits for 200,000 Tennesseans and 6 million people nationally in states that do not have a state-based Marketplace, which is approximately three dozen states.


A core goal of the ACA is to provide affordable healthcare to people living in the United States. To ensure affordability, the ACA includes premium tax credits for consumers with incomes between 100% and 400% FPL (and lawfully present immigrants 0% – 400% FPL). The issue under debate is if consumers in all states can access premium tax credits. While the broad context of the ACA does not differentiate between premium tax credits in the Federally-facilitated Marketplace (FFM) and State-based Marketplaces (SBM), there is text in the ACA that refers to tax credits provided to consumers in marketplaces “established by the State.” Since some states did not establish their own marketplace and use the FFM, the Supreme Court will decide if tax credits can be provided to consumers who receive coverage through the FFM.

What Happens Next?

A decision is expected at the end of June or in early July. The most important thing to know is that consumers’ tax credits will not be affected right now.


TJC attorney Chris Coleman hosted a conference call on Friday, March 6. Click on this link to download the recording of that call. Please note that the recording began 10 minutes before the call actually started, so skip forward 10 minutes to begin listening to the call.

There has been a lot of news coverage of the case this week and there are many resources available to help advocates communicate about the case to their supporters and stakeholders.

  • HHS created a Fact Sheet that outlines the impact of King v. Burwell on FFM states, like Tennessee.
  • The Commonwealth Fund has a series of issue briefs about how subsidy shutdowns could affect consumers, health insurers, health care providers, andstates. Each comes with a summary infographic.
  • The Commonwealth Fund also has an interactive map of the potential impact of a subsidy shutdown on each state.
  • Community Catalyst mapped the potential impact by congressional district.
  • The Urban Institute has put together a report about the implications of King v. Burwell on uninsured rates, changes in types of coverage, and costs of insurance.
  • In the Loop compiled answers to common questions that may be asked by consumers. Click here for the full post and the talking points.
  • Go here for a great summary of the case in plain English