MARKETPLACE PLANS
Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar
Please read the information below before you GET A QUOTE & ENROLL / RE-ENROLL
If you already have Marketplace Insurance you can update your Marketplace application here in order to:
Avoid a tax penalty (inaccurate IRS Form 1095A) due to outdated income in prior Health Insurance Marketplace Enrollment
Avoid paying too much (or too little) because your income may have changed since your last Marketplace Plan Enrollment
Avoid paying too much due to Automatic Re-Enrollment (12/16/2019). Your company (and others) have new plan options
The Georgia Health Insurance Marketplace goal is for Georgia households to know the informed way to:
1. Get a Marketplace Quote that will qualify your household for maximum allowable financial assistance
2. Choose among Marketplace Insurance Plans that are affordable and make sense for your household
3. Enroll or Re-Enroll using the Health Insurance Marketplace Enhanced Direct Enrollment platform
4. Get Marketplace Plan Enrollment confirmation and easily create your own Marketplace Dashboard
An important explanation of each of the (1,2,3,4 above) is thoroughly explained below
BEFORE you Apply for Marketplace Plan please be aware of these two very important facts
Estimated Household Income (based on family size 1 2 3 4 5 6) is the most important factor affecting your rate
Yearly income is to be based on estimated household income for the calendar year of your upcoming coverage
1. Get a Marketplace Quote that will qualify your household for maximum allowable financial assistance
To GET A QUOTE there are 4 questions: (1) Zip code (2) Who needs health coverage? (3) How many people are in your tax household? (4) Estimated yearly household income before taxes/payroll deductions
(1) Zip Code: Type in your GA zip code. You might have to select a county if your zip is in multiple counties
(2) Who needs health coverage?
- Type in the age and gender for each family member needing coverage
- Add spouse and dependents (ages 0-18 and/or ages 19-25) if they qualify for coverage
- A 19-25 yr old dependent with NO INCOME will actually LOWER your quote
- A 19-25 yr old dependent with income MORE THAN $12,491 will RAISE your quote
- If 19-25 yr old dependent earns $12,491+/yr, they should apply alone & file their own tax return
(3) How many people are in your tax household? (how many family members will be on your tax return)
- INCLUDES household members who WILL BE needing health coverage
- INCLUDES household members who WILL NOT BE needing health coverage
- INCLUDES household members who WILL BE in your upcoming tax return
- The TOTAL # of household members determines your family SIZE 1 2 3 4 5 6
- Each family SIZE 1 2 3 4 5 6 has different household income parameters
- Your family SIZE 1 2 3 4 5 6 and household income DICTATES your monthly payment
- Before beginning your application for Marketplace Plan, please have all names, dates of birth and social security numbers for ALL members of your tax household (even if they NOT needing coverage)
For EACH family member needing coverage, there are ALSO 3 additional questions:
- Tobacco use? You will pay significantly more for an enrolling family member who uses tobacco
- Are you pregnant? You will not be denied if pregnant. Pregnancy is included in all plans
- Is a family member eligible for OTHER coverage?
- DO check if family member is enrolled in Medicare / Medicaid / CHIPS / PeachCare for Kids
- If you’re already enrolled in a plan at your job (and it’s NOT affordable), you could maybe NOT check
(4) Estimate your yearly household income (BEFORE taxes and payroll deductions). NOT take-home-pay
- Household income by family size 1 2 3 4 5 6 affects your monthly payment more than everything else
- Household income comes from ALL family members INCLUDING those NOT needing coverage
- Household income comes from ALL family members who WILL be included in your upcoming tax return
- Don’t worry! If you’re MATH challenged, there’s more help inside the quoting tool and below as well
BEFORE you Apply for Marketplace Plan please be aware of these two very important facts
Estimated Household Income (based on family size 1 2 3 4 5 6) is the most important factor affecting your rate
Yearly income is to be based on estimated household income for the calendar year of your upcoming coverage
YEARLY HOUSEHOLD INCOME SOURCES FOR GEORGIA HOUSEHOLDS
Yearly income is to be based on estimated household income for the calendar year of your upcoming coverage
2019 SEP (Special Enrollment Period) NOW through October 31, 2019
2020 OEP (Open Enrollment Period) November 1, 2019 through December 15, 2019
2020 SEP (Special Enrollment Period) December 16, 2019 through October 31, 2020
Household income (based on family size 1 2 3 4 5 6 ) MUST be MORE (NOT less) than 100% of the poverty level
Georgia Household Incomes: weekly pay period, bi-weekly pay period, monthly income, yearly income
Georgia Household Incomes (by Family Size 1 2 3 4 5 6 ) that WILL QUALIFY for financial assistance
Georgia Yearly Household Incomes that WILL QUALIFY for FINANCIAL ASSISTANCE
The HIGHER your household income, the LOWER your Financial Assistance (STILL OKAY, LOWER, NONE)
The LOWER your household income, the HIGHER your Financial Assistance (HIGHEST, STILL HIGH, GOOD)
Georgia Household Incomes that WILL QUALIFY for LOWER CO-PAYS / DEDUCTIBLE (CSR)
The HIGHER your household income, the HIGHER your co-pays and annual deductible (Cost Sharing Reduction)
The LOWER your household income, the LOWER your co-pays and annual deductible (Cost Sharing Reduction)
Cost Sharing Reduction = LOWER COSTS for: Dr Visits, Hospital Visits, Prescriptions, Co-Pays and Deductible
Cost Sharing Reduction (CSR) is ONLY available in Marketplace SILVER Plans
PLEASE READ THIS If you have children ages 0-18 in your household (who will be on your upcoming tax return)
Georgia children 0-18 already enrolled in PeachCare for Kids will NOT qualify for Marketplace Plan
If you have children aged 0-18 and your household income is LESS than these below, go to www.gateway.ga.gov
(Children 0-18 in households with income LESS than these below, go to www.gateway.ga.gov)
NOTE: Our 6 year experience has been that if your household income is LESS than those in the chart above and you try to enroll your children in a Marketplace Plan, your children will be “referred” (very very slowly) by the Marketplace to PeachCare for Kids and you might end up waiting months (not days or weeks) to hear from Peachcare for Kids. If you instead apply your children NOW at www.gateway.ga.gov , the response will be faster. In the unlikely event they are then denied by Peachcare for Kids, your children 0-18 can be quickly enrolled in your Marketplace plan if you keep the denial documentation and contact us (within 60 days of the denial). We will then quickly enroll them in your Marketplace plan.
Make your best estimate of yearly household income so you qualify for maximum allowable financial assistance Don’t worry if you’re “MATH challenged”. When you actually apply for Marketplace Plan, it will be easier
EACH separate income for each family member will be asked when you’re applying for Marketplace Plan
(1) INCOME from ALL family members including those family members NOT enrolling in Marketplace Plan
(2) INCOME from ALL family members who WILL be included in your household’s tax return filing
(3) INCOME is asked for CURRENT periods, NOT last year’s income unless it’s about the same as last year
(4) JOB: If paid by the hour, multiply your hourly wage x the AVG. number of hours per pay period
(5) JOB: How often are you paid? (weekly 52x/yr) (bi-weekly 26x/yr) (2x/month 24x/yr) (Math done for you)
(6) JOB: Income from full-time/part-time jobs based on GROSS income, not take-home pay after deductions
(7) SELF-EMPLOYED/1099. What is your average/latest monthly NET PROFIT? (Yearly math done for you)
(8) SELF-EMPLOYED/1099 projections are hard. If prior month or year is a good indicator, use that
(9) If you’ve read all of the above, you’re likely to qualify for maximum allowable financial assistance
IMPORTANT
In Georgia, in order to qualify for financial assistance for State Exchange Health Plan Enrollment your household income (based on family size 1 2 3 4 5 6) must be MORE (NOT less) than 100% of the federal poverty level (PVL)
2. Choose among Marketplace Insurance Plans that are affordable and make sense for your household
AFTER answering the 4 questions, you’ll see your initial Marketplace eligibility results and plan menu
You’ll see your household’s SAVINGS and whether or not you qualify for CSR (lower co-pays/deductible)
SAVINGS: This is how much the Marketplace will pay the insurance company for your chosen plan
SAVINGS: This is reflected in your monthly payment for all Marketplace Plans, (Bronze, Silver, Gold)
CSR: This is Cost Sharing Reduction: the LOWERING of co-pays and deductible on SILVER plans only
CSR: This means lower co-pays, deductible and lower costs for: Dr Visits, Hospital Visits, Prescriptions, etc.
ALL Marketplace Plans must have the same essential health benefits. Benefits are dictated by federal law
ALL Marketplace Plans cover “Pre-Existing Conditions” without penalty. There is no medical underwriting.
Plan Details show plan costs, doctor visits, free preventive care, prescription coverage, labs/imaging, hospital/emergency, mental health/substance abuse, pregnancy/birth coverage and much more
All Federal Health Insurance Exchange Plans have 3 metal tiers (Bronze/Silver/Gold). Silver is often the best.
The major rate difference between (Bronze, Silver, Gold) plans is generally driven by the deductible
Many benefits are not subject to a deductible: free physicals, free preventive testing, Dr & Drug co-pays, etc.
A deductible usually becomes relevant with hospitalization or a costly medical procedure
A common myth is that you must pay the deductible before your benefits become available. That’s false
(That would be like assuming that your car insurance doesn’t begin until after you’ve wrecked your car)
Since the beginning of record-keeping, over 40% of consumer bankruptcies are caused by hospital bills
A Marketplace plan with unlimited hospital benefits is one of your primary defenses against bankruptcy
When you enroll in the Federal Health Insurance Marketplace, hospitalization (without a ceiling) is important
Another common myth is that Doctors are associated with only 1 particular insurance company.
For instance, many Doctors may accept Marketplace plans through both Ambetter and Anthem/Blue Cross
It’s also a myth that “doctors who accept one company are better than doctors who accept another company”
Dental plan selection is optional. However, you MUST have a Marketplace health plan to add a Dental plan
Click Add to cart next to your initially selected plan. You’ll then Start application for your Marketplace Plan
3. Enroll or Re-Enroll using the Health Insurance Marketplace Enhanced Direct Enrollment platform
After clicking Add to cart, you’ll Start application. This confirms eligibility and allows you to enroll in a plan
(1) There is a Privacy Statement from HealthSherpa, the Marketplace’s Enhanced Direct Enrollment Platform
HealthSherpa works directly with the Health Insurance Marketplace to help you enroll in a Marketplace plan
(2) You’ll be asked to verify your identity. This is required, even if you have a prior Marketplace application
The Health Insurance Marketplace needs this for your own protection as well as to help determine eligibility
There are short verification questions that will appear after you’ve filled in your personal information
(If you have a prior year application, we’ll pre-fill your information to save you time. Update it if changes)
(3) Before beginning your application for Marketplace Plan, please have all names, dates of birth and social security
numbers for ALL members of your tax household (even if they NOT needing coverage)
(4) When you enroll in a Marketplace Plan with Enhanced Direct Enrollment, it should be an easy 10-15 minutes
(5) When you’ve finished your application, click the Download Letter icon at the bottom of your screen.
The Letter includes your confirmed eligibility results based on information you provided in your application
(6) The Letter is also emailed/mailed from the Marketplace and will also be in your HealthSherpa Dashboard
(7) Click Download Letter You MUST do this in order to enroll in your plan. The Letter includes:
(a) Your monthly/yearly federal financial assistance (APTC: Advance Premium Tax Credit)
(b) The yearly household income that you yourself submitted in your Marketplace application.
(c) If you qualified for lower co-pays and deductible available in a SILVER Plan (with CSR)
(d) Your next steps, including choosing a plan, which you’ll do next when you click Enroll in this Plan
(e) It’s possible the Marketplace will ask you to send documentation within 60-90 days (This is common)
(f) The Letter is emailed to you from the Marketplace and will also be in your HealthSherpa Dashboard
(8) Click Enroll in this plan This is the same plan you originally selected prior to beginning your application.
(9) After clicking Enroll in this plan, a Marketplace confirmation screen from HealthSherpa will appear.
4. Get Marketplace Plan Enrollment confirmation and easily create your own Marketplace Dashboard
(1) Your Marketplace Plan Enrollment confirmation screen from HealthSherpa includes the following:
- The amount of your 1st payment (premium) is based on the answers to the questions in your application
The Georgia Health Insurance Marketplace quoting algorithm is exactly the same as the Federal Marketplace
If the payment now shown is different from the original quote, it’s because your application had a different income
If you want to change plans within the enrollment window, you can do that inside your HealthSherpa Dashboard - The pre-populated USERNAME for your HealthSherpa Dashboard is the same email address you used
inside your Marketplace application. To create your dashboard, you only need to create a PASSWORD
Create a PASSWORD of 6 digits or more and you will immediately go to your HealthSherpa Dashboard - Confirmation of your insurance company plan and the company’s phone number to call to make your payment
You also have the option to pay via your HealthSherpa Dashboard or wait to get an invoice from your company
Making a payment via your HealthSherpa Dashboard is NOT required to set up your HealthSherpa Dashboard
Your 2nd payment is always made directly through your insurance company, not via HealthSherpa - It will advise you to “Check for any required follow-ups” in your Letter (Your Marketplace Eligibility Notice)
Your Letter is also mailed to you directly at your home/mailing address (or emailed if you chose to go paperless)
(2) You’ll also then immediately receive an email from “no_reply@healthsherpa.com”. The subject of the email will be: “Action required: Next steps to finalize your health insurance enrollment”
- This email will advise you to make your payment by the due date and to make your payment either by:
calling your chosen health insurance company (their phone number will be in the email itself)
or by making your initial payment inside your HealthSherpa Dashboard - The email also lets you know that you can Upload now > any documents (usually due in 60-90 days) that may
have been requested of you by the Marketplace in your Letter (Eligibility Notice from the Marketplace) - Once you’ve entered your HealthSherpa Dashboard you can upload documents next to the Verify icon
(3) Another opportunity to create your HealthSherpa Dashboard is to just click “Dashboard”
(or any other live icon) displayed inside your “no_reply@healthsherpa.com” email with the subject of
“Action required: Next steps to finalize your health insurance enrollment”. To create your Dashboard:
You’ll be assigned a pre-populated USERNAME which is the email address you used in your application
Create a PASSWORD of 6+digits or more and you’ll immediately go to your HealthSherpa Dashboard
Be sure to bookmark your Dashboard page, you’ll find it invaluable throughout the year and at tax time too
(4) Your Dashboard gives you valuable information about your Federal Marketplace Enrollment
- Pay your initial payment (optional), which will be transmitted directly to your chosen insurance company
- Change Plans Change your originally selected plan (should you choose) within the allowable timeframe
- Download your Letter (your Health Insurance Marketplace Eligibility Notice from London, Kentucky)
- Verify You can upload Marketplace Eligibility Documents (if requested in your Eligibility Notice)
- View application View your Marketplace Application, information submitted and your application ID #
- Report changes to your Marketplace Application (income, employment source, address, phone, etc.)
- View Application History : Effective date, Subsidy amount, payment, documents, FFM ID, Submit date
- View Plan Details : Plan summary, Dr. visits, Emergency/Surgery, Pregnancy, Diagnostics/Labs/Imaging
- Download your own pre-populated IRS Form 1095A for the upcoming year for your upcoming tax return
- And much more, all in one very accessible place, your very own Marketplace HealthSherpa Dashboard
Consumer Text Line 404.951.7600