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2017 Marketplace Application Walkthrough

2017 Marketplace Application Walkthrough


>>Female Speaker:
We’re going to do an application walkthrough
for Healthcare.gov for a new consumer. Once a consumer actually
logs in, I identity proof this account first. If you ever have any
questions about identity proofing we have more
information available online where you can
follow up and read those power points to get more
information on that. But we’re going to start
with just a streamlined application walkthrough
for a family of three just to help get some
familiarity with how that works and flows for
consumers you might be sitting side —
with helping them with an application. So once a consumer logs
in, the first question they’re asked is where
do they want to go. Consumers that are in the
individual marketplace and don’t have an offer
of coverage from a small business employer
are going to click the big green button that
says “Start a New Application or Update An Existing One.” This is where pretty
much the majority of all consumers should be going
every time they log in. Since our current test
environment is set up for some 2017 testing I’m
going to actually run a 2016 application since it’s
not open enrollment yet. But this screen and the
customized content is dynamic based on this
scenario for all consumers, so you may see a version
of this for 2017 coverage. If this was open
enrollment I could start a new application here,
and select the state that the consumer has and
start an application. Since I’m going to walk
through a 2016 scenario, just for testing purposes
and to ensure we have all the right information in
our test environment, I’m actually going to exit out
of this screen in this bottom part of “Need
To Do Something Else”. If you happen to have a
current employee who’s looking to report a life
change for existing 2016 coverage or later in any
other future year, they need to report a life change and
you hit one of these guiding pages that’s working on
current applications or future year applications. You can always choose
this bottom option of “Need To Do
Something Else.” Go to “My Applications
And Coverage” and that’s actually where if a consumer
has other applications that hey may need to take
action on they can access them form this page. So since I’m going to start
a 2016 application, and I don’t have one yet, I’m
going to select 2016 as my year and then for the state
I’m going to be using Virginia for this test case. Our next page is just a
quick start application and a reminder of what
information consumers might need to have; things like
names of all their family members, birthdate,
income for your family, social security numbers
for anyone that has one, just as a reminder
before getting started. And since I already identity
proofed this account this is the next screen that comes
up after you complete that process that just informs
you that your identity has been verified. As an important reminder
that as we have consumers emails we will send them
periodic reminders from time to time with things
like important dates around open enrollment, if they
have any actions they need to follow up on, etcetera. Consumers can always opt out
of these from any email if they want to from the
unsubscribe footer. And then following on
this page is our privacy policy and information. There are two attestations
at the bottom that consumers need to agree to in
order to continue. And again if they ever have
any questions they can follow some of the learn
links here of learning more about their data or viewing
the privacy act statement. One of the other features
you’ll see periodically as we step through this
streamlined application is we have common terms and
definitions that consumers may not be as familiar with,
are shown with a dotted underline and when you over
hover them they pop up with a definition or
more information to help the consumer understand what
that might mean. So here is an example of
Special Enrollment Period where we hover over it and
it provides more information about a Special Enrollment
Period is really something that is outside of OE and
is really a way to gain coverage if they’ve had
a qualifying life event. So I’m going to go ahead
and start the application. The first thing we have are
a series of questions that help us figure out if the
consumer can go through the streamlined application
or would need to go through our classic application
that can handle some more complex household scenarios. For our scenario we’re going
to have a married couple that has one child. And we’re going to say
we’re applying for all three for coverage. If you happen to have
somebody who has coverage in the household but needs to
gain health insurance market place coverage for other
members of their household you would only highlight
the people in the household that actually need
marketplace coverage but you would still need to
include everybody that’s in the household on the application. That helps us make sure that
we’re making an accurate eligibility determination
for the consumer based on everybody that lives in the
household and the income that the family has. Next we have a couple
questions that are targeted per the scenario for a
particular household so this first set of questions are
pretty much for everyone. You, your spouse and your
one dependent and we’re pretty much just asking some
questions if everybody lives in the same household, if
they’re planning to file a joint tax return as
“married filing joint”, if they have any children
that live in the household that aren’t on their
tax return, if anyone is a full time student,
if anyone is pregnant or had a child in
the last sixty days. Then we have some other
questions that we’re asking about the same set of
consumers in the household but every time we have
one of these blocks of questions, you’ll see it may
apply to a different group of people that you told us
about in earlier questions. So these are just checking
to see if everybody is a U.S. citizen if they
can enter a social security numbers for everybody,
if they’re using different names. For ease and simplicity I’m
just going to go through this quick application pre
questions a little bit quickly just so we
can get into the meat of the application. And on the next screen,
this is our streamlined application, so it’s going
to pre-populate some of the information that
the consumer entered when they went through
identity proofing. If there happens to
be anything they need to change here, they can
go ahead and modify that. If the consumer is
interested in receiving emails when their notices
are available instead of receiving paper notices in
the mail they can check this first “go paperless”
get your notices by email instead of paper. This means that any time the
marketplace may send them a notice, such as if a
consumer has a data matching issue and we’re following up
on it, if they opt into this option we only make those
notices available online and we’ll send them an email
when they’re available. If consumers prefer to
receive that kind of communication just by mail,
then don’t check the box. Also its important for
assisters and navigators or any other agent and broker
entities on this next question “Another
Person is Helping Me Complete My Application”
to check this box. This is actually where you
would actually enter in all of your assister information
to make sure that you’re tagged on the application,
it helps us for tracking purposes as well and helps
consumers enters that information so that we kind
of know who helped them with the application. You’ll also see little
question marks here on certain questions that
provide more help on a particular question
or particular item. So you can always hover
over these little questions and question marks and
figure out if there’s anything else that you may
need to understand. And sometimes we provide
links to longer help articles if more information
might be needed. I’m going to uncheck this
since I’m walking through this as a consumer and
I’m going to go ahead and enter in my
home address. So our consumer scenario
is in Chester, Virginia and when we get to the end
with the county it’ll be preselected when the
consumer picks their zip code. Sometimes some zip codes
cross-counties so it may actually prompt you to
select a particular county. You’ll also see sometimes
this “Did You Mean” and it will have an
address correction here. When you see this it’s a
good idea to update your address. This helps us make sure
that we’re aligning to the correct county and zip
code and USPS database, which actually helps makes
sure everything lines up correctly in our
enrollment data. And consumers that may have
a different mailing address than their permanent address
can say no here and enter in a different one. I’m going to go ahead
say yes for simplicity. This information “Check
In/Update” is prepopulated again from
identity proofing. Normally you would have
a consumer that needs to change their date of birth,
I’m doing this because we have different test data
in our system for testing identity proofing versus
application data. So normally you would have
a consumer that doesn’t need to do this but I
have to change it just for our walkthrough. For consumers that have
social security numbers, it’s important to enter
it, it helps us with their eligibility determination
to make it more accurate and helps us verify
their information. There also is an optional
race/ethnicity question, consumers can answer it
if they want to but they don’t have to. So for speed of walking
through the application I’m going to skip those
but that’s totally at the option of
the consumer. Underneath each person
there’s a question “Are You Applying For
Coverage For Yourself?” This is where the
consumer should identify for each person on
their application if they actually need
marketplace coverage. Again if there’s anybody in
the household who doesn’t need marketplace coverage
they still need to be included on the app but you
would answer no to this question if somebody didn’t
need marketplace coverage because they may have only
self-coverage through a job ad other people
may not be eligible for the self-coverage. I’m going to go ahead and
enter in our consumer’s spouse and child
dependent information. And again this should
be information that the consumer comes in to their
session with you when you happen to be helping
them walk through their application. And I’m going to add their
dependent child real quick. And once we have this
done — this is just the demographic information —
consumers will have the opportunity at the end to
review this and make sure everything’s accurate and
make sure they don’t’ have any typos as they’re going
through their application. On the next screen
we’re asking for income information
for the household. So you’ll see a set for each
person in the household. So for John Carson I’m going
to add a job — there are lots of types of income so
make sure as you’re talking to the consumer they kind
of review the list and make sure they’re not missing any
other kind of information. We’re just doing to have
some simple local jobs at local Store A and the
employer phone number is important. So the employer
information here that we ask is important that the
consumer has it as complete as they can get it. It helps us verify
information sometimes; for things like if the
consumer might have an offer of coverage it
helps us actually contact that employer and make
sure that that coverage isn’t affordable. So we do use this
information periodically throughout the year. If a consumer has any
deductions, its important to review this information
with them — so you can hover over the deductions
highlighted text and see more information or learn
more details if you need more help with the
consumer for what they may have to deduct. If they have nay then you’d
say yes and then you’d add a deduction and again there
are types just like income. For our scenario
I’m going to say no. The last question
here for each person is the yearly income. This is calculated based on
the information the consumer entered up here when they
added an income source. For consumers that don’t
have a steady month to month income — so we basically
take the income divided it out by 12 months and
then roll it up to get a year estimate. If that’s no a good estimate
then they should say no here and tell us what they think
a better estimate is. This is more important for
consumers that might have self-employment and job
based coverage that comes in terms of projects and
different contacts and they might have a different
estimate for the year than the current ones that
they have for this month. I’m going to add another
job for John’s spouse Suzanne who works at
Local Company B. And similarly I’m going to
enter an employer phone number for her employer and
it’s a good idea to add the street address but for
speed of walking through this I’m going to
skip it for now. But normally for consumers
you’d want to make sure that you include this. And this is really — we’re
looking for the HR benefits address not necessarily
where the consumer actually goes to work everyday. I’m going to say Suzanne
does not have any deductions; yes her
current yearly income is what we typed
in earlier. Their child Anna, doesn’t
have any income so I’m not going to add a source and
I’m going to say based on what we entered we expect
her income to be zero for next year and
that’s correct. The next questions are
additional ones that help us figure out if somebody
in the household might be eligible for Medicaid
or CHIP for non-income based reasons. So most of the information
on the application will help us figure out if anybody
in the household might be eligible for Medicaid or
CHIP based on their income. But there are other ways to
qualify for Medicaid that are not income based and so
answering these questions helps us determine if we
might need to recommend that the consumer apply for
Medicaid or CHIP coverage directly with the state for
non-income based reasons. In our scenario I’m going
to say no, but just as a reminder again there are
those hover question marks so if you or consumer
questions about what we’re really asking here and how
to answer the question don’t forget you can always
hover over those question marks on each one. The next set of questions,
are about whether anybody has other coverage and
then we’ll get down to the questions
about life changes. If there’s somebody in the
household that has other coverage you would answer
“Yes they’re currently enrolled in other
health coverage”. When you answer yes it’ll
pull down a list with kinds of coverage so things like
Medicaid, CHIP, Medicare, Tri-Care, VA Health Care
Program, Peace Core or others. So if the have — somebody
could have already marketplace coverage
or anything else they check the other box. For our scenario we
don’t have anybody that currently has coverage;
our whole household needs marketplace coverage. If you have a child that’s
on the application that has a parent living outside
the home it’s important to answer this question. Lastly for consumers that
may be coming after having applied for Medicaid or CHIP
benefits from their state, this is the question we
ask to figure out If they are coming over because
they were denied. That actually helps us
determine whether they’re eligible for a special
enrollment period, when it’s outside of open
enrollment, in order to enroll in marketplace coverage
if they were recently denied Medicaid or CHIP. In our scenario we don’t
have anybody but I just wanted to make sure we
point out that question. The next section of
questions about life changes, are all questions
that are generally speaking qualifying life events
that may grant a special enrollment period depending
on when the event occurred. And again, just as a
reminder, you can hover over these underlined
words to get some more information about some of
the different questions and what they mean. Two that are particular
to point out with the qualifying health coverage
and then making sure that when answering the “move”
question down at the bottom, did anyone change their
primary place of living. It’s important to hover
over this with consumers and make sure that
they’re answering this from a permanent
move perspective. So did they really
move to a new home? It’s not temporary, if
they’re a student moving to or from the place they
actually attend school, if it’s a seasonal worker
who is moving somewhere that they both live and work,
or consumers that might be moving to or from
transitional housing. For our scenario, since
we’re in 2016, I’m going to report that John Carson is
losing coverage at the end of this month so that we can
open an SAP and I can walk through the enrollment
experience later with folks. For the renewal of coverage,
this actually checks tax data for consumers year
after year to check income and then also helps us
ensure that if they don’t actively enroll in coverage
in a future year by December 15th for January 1 of the
following year, that we’ll be able to automatically
re-enroll them; with financial assistance still. If a consumer disagrees they
have the option to change the amount of time if they
don’t want to allow five years, if they want to do
something shorter than that they can change that. The impact here is for
consumers that either disagree and either don’t
renew or choose a shorter number of periods that we’re
allowed to check that data. It actually means that in
future years if they don’t actively come in and update
their application for future year coverage before
December 15th and we automatically enroll them. It means that we would
automatically be enrolling them without any financial
assistance that they may have had, because we can’t
make that determination without having some kind
of income information for the consumer. And then lastly, before we
have our review application, is our Tax Filer
Attestation question. This is important
particularly to review with current enrollees or
enrollees that may have had marketplace coverage
in the past, even if they don’t currently. As we know, some consumers
move in and out of marketplace as they may have
job based coverage or may be eligible for Medicaid or
CHIP and then may become uneligible based on income
changes and job changes that they have
throughout the year. So if a consumer had prior
marketplace coverage its important to review this
question and ensure if they did file their taxes and
reconcile any premium tax credits that they received
in the past, they should check the box to say
“yes” they reconciled; if they didn’t then
don’t check the box. We also check this
information against the IRS data. Since this is a new consumer
— ooh I missed a question. So this is actually a
good example of an error. If you happen to miss
a question when you hit submit it’ll scroll
back up and add in red “This is a Required
Question”. So I accidentally missed
answering this, but this is actually helpful to
demonstrate what happens if you happen to miss
one before you submit. We make sure that all
the required questions are answered before we
continue onto the next step. On the last page before
we get to our application results is a summary of
all the information the consumer entered. It’s a good idea at this
point in time to just check and make sure there
aren’t any typos in names and addresses, phone numbers,
email addresses, birthdates, and the last four digits of
the social security numbers. If consumers see something
that they need to edit, they can use the edit
button on any one of these sections and go back
into that section. When you do, you’ll drop
back into that particular section but then continue
through the application to the rest of the
sections before you get back to this page. But again, it’s a summary
of all the questions the consumer has answered
at this point in time. At the very bottom,
we have a couple “Agree and Confirm”
attestation questions and statements. And then at the very
end we have our “Sign and Submit” to make the consumer is
signing under penalty of perjury and that
everything they’ve provided is true and accurate to the
best of their knowledge. So I’m going to go ahead
and electronically sign and that is the end of the
our current application filling out for a
streamlined application. On the next page we’ll see
eligibility results and I’ll point out a couple of things
and that will wrap up our application walkthrough. So right at the end of
submit we’ll see a checkbox when it’s coming through. And on our eligibility
results there are three sections that are
important to know. The first one has summary
of their eligibility information; consumers
with the same eligibility will be grouped together. If we had, for example,
if Anna Carson in the household, was actually
eligible for CHIP instead of for tax credits; Anna
would be on a separate row and she would have a separate
statement over hear that would happen to say “for
children’s health program”. Or might be with the
state branded CHIP name if it happens to be something
other than children’s health insurance program. But this whole family is all
grouped together, so they’re all eligible for marketplace
health plans, they’re eligible for an advanced
premium tax credit of $625 per month as the maximum
for their tax household they can use to reduce
their premiums. They’re also eligible for
cost-sharing reductions or CSR, if they enroll
in Silver plans. This helps reduce their out
of pocket costs that they pay as the marketplace
then actually shares some of the cost burden with the
insurance companies and that actually means that the
consumer pays less out of their own pocket if they
enroll in a Silver plan. The second step is they’re
viewing their detail eligibility results. This is access their
actual eligibility results PDF notice. The other thing that’s
important to pay attention to in this box is there’s
sometimes dynamic text in here based on a
consumer scenario. For example, since we’re
outside of open enrollment and based on what our
scenario walkthrough included, was an event
that actually did grant a special enrollment period. There’s a statement here
that says they’re eligible for a special enrollment
period but they may need to send more information. So they’ll actually need
to review with their eligibility determination
notice PDF and see if they need to send in
any other information. If any of the consumers were
— had a data matching issue — there would also be an
additional red statement up here in step one
that says you would need to send in documents,
this eligibility is temporary for the
next couple of months. So be looking for
consumers that might have that red text that this
is temporary and you need to submit
more documents. That’ll tell you that
the consumer has a data matching issue. And then more information
is available in the PDF. When you download the PDF
notice, this is savable and printable and the
consumer can always come back into their
account and open it up and read it at a
later point in time. This is actually a
required download before consumers can
continue to enrollment. We want to make sure
that there’s important information in their
full eligibility and determination before they
go on to picking a plan. And that wraps up our
eligibility results and our application
walkthrough.

Comments (3)

  1. ok steps 3 never shows

  2. Hello I need help please how can I update my payment method in my marketplace account

  3. molina healthcare is a scam they will take your money do nothing for u and never give your money back

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