Faq

(A) FAQs from those who already have a prior application and enrollment from last year. (#1 – #11)

ANSWER: Yes. If you have a prior or existing application and enrollment, all of the data inside your existing federal application has been saved in order to save you time. There’s no need to answer all of the questions. However, it is highly recommended that you update your federal application, particularly as it relates to household income information. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re- Enroll” icon to get started and then estimate your household income for the following year (in which your upcoming coverage will begin). You may not be able to estimate the exact same income that you will put in your actual application for market place plan, (there are easy estimating tools inside the application) but try to be as accurate as possible during the first opportunity to estimate your household income. The homepage of our website provides helpful guidance on what to do and what not to do when estimating household income. When you get inside your application for market place plan, you’ll know if you were not as thorough or accurate during the initial quote. The more you make, the more you’ll pay. Household income is hair trigger sensitive to your monthly payment so try to give yourself a good idea of what you’ll be paying from the get go.
ANSWER: Yes. However, the marketplace will have already re-created your application data so it won’t take long. Even if you think that your household income projection for the upcoming year hasn’t changed, what you don’t know is what you put down in the application before. If your estimated household income for the following year is different than it’s in your existing federal application, then you’re either paying too much (or too little) for your existing plan. You could choose another plan (from the same or different insurer) or keep the plan you have. Your own upcoming IRS Form 1095 A reflects the income you put in your application and not the income in your federal tax return. When you re-enroll in the healthcare marketplace through Georgia Health Insurance Marketplace, those 2 amounts should be similar. Otherwise there can be federal income tax consequences and reduced tax refunds. “Get a Quote & Enroll / Re-Enroll” to make sure you’re not paying too much (or too little). Either way, the consequences are compelling.
ANSWER: Yes. Even if you’re happy with your existing plan, that’s fine. Usually those who are happy with their existing plan never bother to see what other plans that same insurance company is offering for the following year. You may have a plan that was the company’s lowest priced silver plan before but they added a new one. Or, once again the household income estimating absolutely must be re-done or at least checked inside your existing federal application to make sure it’s accurate. Tax penalties via the IRS Form 1095A are always caused by not updating household income projections or by an original plan selection that was the least expensive but now is much less competitive. Your existing federal application data has been saved. It’s always recommended to go ahead and click the “Get A Quote & Enroll / Re-Enroll” to re-apply and then you can re- enroll and apply for market place plan even if you’re happy with your current plan. We want you to be satisfied with your plan, even if ends up being the same plan you had before. You’ll feel better knowing that your original decision was still a good one.
ANSWER: No, your insurance company doesn’t complete your enrollment, but you will end up being auto-re- enrolled by the federal government on December 16th, the day after Open Enrollment Period ends. The problem with that is that each year (on November 1) the rate increases for each insurance company for each of Georgia’s 159 counties becomes known and can be determined (based on your income). Finding out your new payment for the upcoming year in late December is not the time to make a change. Go to the Georgia Health Insurance Marketplace’s “Get A Quote & Enroll / Re-Enroll” icon between November 1 and December 15, and you won’t end up receiving any unwelcome surprises. It’s always best if you yourself complete your current market place plan enrollment. Auto-re-enrollment creates too many unwanted surprises.
ANSWER: Yes. The names of the plans may stay the same but quite often either the co-pays and/or the deductibles generally change as well. Every year, each private insurance company participating in the Affordable Care Act in Georgia conducts comprehensive actuarial studies to determine whether or not increases in co-pays and/or deductibles are warranted. Although they must follow federal guidelines, the pattern has been apparent since the initial 2013 ACA rollout. Generally speaking, co-pays and/or deductibles have increased every year. From November 1 through December 15, click the “Get A Quote & Enroll / Re- Enroll” icon at the Georgia Health Insurance Marketplace website to see if there have been changes to your current plan. At that time, you’ll have a better idea whether or not you want to enroll in a market place plan that may have lower co-pays and/or deductibles or re-enroll in the plan you already have using your updated following year household income estimate.
ANSWER: Yes. However, your rate could either go up or even go down. Each month, your chosen insurance company receives 2 payments on your behalf. The 1st is from the federal government in the form of your Advanced premium Tax Credit (APTC). The 2nd is from you. Depending on how your updated household income estimate relates to the new federal poverty level guidelines (100% -400% of the poverty level), that will determine how much the federal government will be paying on your behalf for the following year. Sometimes it’s more than last year and sometimes it’s less. Click the Georgia Health Insurance Marketplace “Get A Quote & Enroll / Re-Enroll” icon between November 1 and December 15 to re-enroll and enroll in the health insurance market place to see how your monthly rate will change for the upcoming calendar year. Please don’t wait until after December 16th.
ANSWER: No. federal applications don’t update themselves. Besides, the federal government only knows what you reported on your last tax return which will be a full 2 years older than the household income estimate they want. The rate you pay for coverage in 2020 (for example) is supposed to be based on your 2020 tax return that you will actually be filing in 2021. If you’re applying for 2020 Open Enrollment Period 11/1/2019- 12/15/2019, the last tax return you filed was in 2019 for your 2018 taxes. The whole premise of the health insurance market place is that you are paying a monthly rate that is commensurate with your income for the year you are being covered. In this example, your 2020 monthly payment is based on your estimated 2020 final household income. therefore, your 2020 household income must be an estimate. Click the Georgia Health Insurance Marketplace “Get A Quote & Enroll / Re-Enroll” icon to update your federal application or risk paying too much (or too little) for your plan.
ANSWER: No. Since you already have an existing prior application and/or enrollment, the bulk of your prior application has already been pre-populated. There are generic questions you’ll need to re-affirm but all of the names and dates of birth and social security numbers (last 4 digits only showing) and address and email and phone numbers and income sources and income amounts are already there. Updating your federal application for your healthcare marketplace plan enrollment should take you less than 5 minutes. However, don’t be hasty. Pay special attention to the income section for all family members, including those who may not have applied for coverage. Also know that when you “Get A Quote & Enroll / Re-Enroll” at the Georgia Health Insurance Marketplace website, your initial quote will change every time you change your estimated upcoming household income based on your tax household size. The confirmed amount will be what you put in your updated federal application inside our Enhanced Direct Enrollment quoting and enrollment platform.
ANSWER: Yes. Since the initial rollout of the Affordable care Act in Georgia in 2013, the menu of available plans has changed every year. Even in some of Georgia’s smallest counties where there has usually only been one available participating insurance company, plans can change or more often than not, the company will introduce a new silver plan with a lower deductible and lower copays or introduce a new bronze plan that includes co-pays (many bronze plans had PCP visits that were subject to the deductible). In the growing and highly competitive greater metropolitan Atlanta area (which could arguably include 10 counties), plans and prices and copays and deductibles change every year. Click the Georgia Health Insurance Marketplace “Get A Quote & Enroll / Re-Enroll” icon between 11/1-12/15 to see the changes in your Georgia county and in your zip code and then re-enroll or enroll in the market place.
ANSWER: No. Never. Georgia Health Insurance Marketplace is a consumer- friendly public site. Neither your name nor address nor phone number nor email address (or any other personally identifiable information) is ever shared with outside sources or outside agents. Our online Enhanced Direct Enrollment platform is designed for Georgia residents to “Get A Quote & Enroll / Re-Enroll” in the privacy of their own home or office and to not be worried about what happens after your phone number is included. All we do is Affordable Care Act enrollment for Georgia residents. Your quoting data and the personally identifiable information inside your health insurance market place enrollment always remains protected. No follow-up phone calls ever.
ANSWER: Yes. Almost definitely. Since 2013, Georgia Health Insurance Marketplace has helped tens of thousands of Georgia residents to “Get a Quote & Enroll / Re-Enroll” in Affordable Care Act plans. The changes in plan availability in both bronze and silver plans have changed dramatically over the years. Moreover, since the marketplace has gradually gained its own footing and equilibrium, there has been more intense competition and an increase in more intelligently priced plan availability. A market place application will not change itself and an outdated household income amount in an old application may have already meant that for the past 6-7 years, you’ve been paying more than you needed to. Your tax return and your application do not share information. If you haven’t updated your market place application, please do it now.

(B) FAQs from those wanting to know how to get an exact and accurate initial quote. (#12 – #22)

ANSWER: Yes. Georgia Health Insurance Marketplace quoting algorithms are exactly the same as the federal government. By federal and state laws they must be. However, if in the initial “Get a Quote & Enroll / Re-Enroll” quoting platform you input your estimated household income at “X” and then in our Enhanced Direct Enrollment platform you put your estimated household income as “Y”, then your monthly rate will definitely be different. Moreover, if you change tour tax household size inside the enrollment or change an age of a family member, the final confirmed Advance Premium Tax Credit (monthly federal financial assistance) could also affect your monthly rate. When you complete your application for market place plan, your monthly payment is governed by federally controlled algorithms based primarily by the household income details and tax household size inside the federal Enhanced Direct Enrollment platform.
ANSWER: No. Annual estimated upcoming income from a JOB is based on gross earnings BEFORE taxes and other reductions are taken out of your paycheck. However, if you’re a 1099 contractor or similarly SELF- EMPLOYED, your estimated upcoming income from 1099 / self-employment income is based on upcoming estimated ANNUAL NET PROFIT. These totally contrasting forms of household income are totally different: JOB = Average pay period GROSS earnings x the # of pay periods per year (24x, 26x, 52x) = INCOME. However, 1099 / SELF-EMPLOYED average monthly NET PROFIT x 12 months = INCOME. We understand that for a 1099 contractor or self-employed household to estimate (for example) their upcoming 2020 household income during 11/1/2019-12/15/2019 Open Enrollment Period may be the same as asking someone to estimate next year’s weather patterns. It’s a challenge. Once inside the application, try to give an intelligent guess as to either your latest or your average monthly net profit. If you think maybe your upcoming year (2020) will be about the same as you 2018 tax return or your 2019 estimated final, then use that amount as a reasonable indicator. Regardless of a Georgia household income coming from a JOB or 1099 / SELF EMPLOYMENT, Georgia households BELOW 100% of the federal poverty level (based on family size) DO NOT receive monthly federal financial assistance. The most important thing to consider when enrolling in the healthcare marketplace is estimated upcoming household income. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to make sure your household qualifies for monthly federal assistance.
ANSWER: Yes. That’s federal law. Your “tax household’ is the total number of family members who are to be included in your federal tax return, regardless of how many will actually be applying for coverage. Ironically, as long as your estimated upcoming household income is between 100-400% of the federal poverty level, you may discover that enrolling 2 family members in a family of 3 might even be more affordable than only enrolling 1 family member. The reason for that is that each enrolling family member is assigned an advance premium tax credit (financial assistance) regardless of whether that family member has income or not. Tax household size is extremely important when you apply for market place plan. Use the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see how your monthly payment changes by including or excluding specific eligible family members. Family members on Medicaid (PeachCare for Kids) or those on Medicare or those already included in an “affordable” employee plan are NOT eligible for a plan. However, if they’re on your federal tax return, they are still part of your tax household and must be counted in your tax household size.
ANSWER: Yes. Private insurance companies offering Affordable Care Act plans have the right to raise a particular family member’s rate by as much as 50%. Although there is never a penalty for anyone ever having a pre-exiting condition, smokers are definitely charged more. When you go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon, there will be a space to the left of each enrolling individual that allows you to check as a tobacco user or not. Populate and then de-populate the smoking icon next to the applicable tobacco using enrolling family member and you’ll discover the direct effect that the enrolling smoking family member has on your overall household monthly rate. Please remember that market place plan enrollment “rate punishes” households who have enrollees who smoke or use tobacco.
ANSWER: No. However, if your household income (based on family size) is BELOW 247% of the federal poverty level (Family sizes of 1/2/3/4/5/6 below (approx. $31k / $42k / $53k / $64k / $75k / $86k) may be referred to Georgia Medicaid and be covered before, during and after the pregnancy for a limited time. Pregnant females in Georgia households ABOVE those income levels (based on family size) will NOT be referred to Georgia Medicaid. When you go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon, there will be a space to the left of each enrolling individual that allows you to check whether a female family member is pregnant (or not). As long as the tax household size and household income have been populated, you will be able to see whether or not the pregnant female will be referred to Georgia Medicaid or whether the pregnancy will instead be covered by the plan. Regardless, when pregnant females who apply and enroll in a market place plan will either be covered by the plan or by Georgia Medicaid
ANSWER: No. Never. Absolutely not. This question comes up very frequently and is therefore purposefully repeated in this particular FAQ section. Georgia Health Insurance Marketplace prides itself on being a consumer- friendly site. None of your personally identifiable information including your phone number and email address (or any other personally identifiable information) is ever shared with outside sources. Our online Enhanced Direct Enrollment platform is designed to allow you to “Get A Quote & Enroll / Re-Enroll” without becoming bombarded by unwanted phone calls or obnoxious email blasts. When you visit us to get a quote and enroll in the health insurance market place, your absolute privacy is never disturbed. No unwanted phone calls ever.
ANSWER: Yes. That is federal law when applying for an Affordable Care Act plan. The amount of your monthly federal assistance (also called an Advance Premium Tax Credit or APTC) is based on the upcoming tax return for the year in which you are seeking coverage. For example, if you are applying during 2020 Open Enrollment Period (11/1/2019-12/15/2019), your tax household size and estimated household income is based on the income by all family members for the calendar year 2020, for which you will file that household income in 2021 when your 2020 income tax is due. You may also find that perhaps (based on household size and household income, 2 enrolling family members may be disproportionately more affordable than only 1 enrolling family member. Each enrolling family member receives an applicable monthly subsidy, regardless of their individual income. Paying less for more family members is “sometimes” how the health insurance market place will work for some families. Those on Medicaid or Medicare or those who already have “affordable” employee insurance cannot be included however. Go to the Georgia Health Insurance Marketplace “Get A Quote & Enroll / Re- Enroll” icon to see if that phenomenon is applicable to your Georgia household.
ANSWER: No. Never. Although that family member may be included in the size of your tax household, their Supplemental Security Income (SSI) will NOT be included in your household income when it comes to computing your household income. Do NOT confuse regular Social Security Income or Social Security Disability Income (SSDI) with Supplemental Security Income (SSI). Supplemental Security Income is “almost” the ONLY income that is NOT included in household income when determining eligibility for healthcare marketplace plan enrollment. When you “Get A Quote & Enroll / Re-Enroll” NEVER include Supplemental Security Income (SSI) as part of your household income either in the quote or in the Enhanced Direct enrollment federal application.
ANSWER: Yes. Both. Even though the household’s federal tax return may show some of the Social Security income and / or some of the Social Security Disability Income (SSDI) as taxable and some as non-taxable, you still must include the full amount when you “Get A Quote & Enroll / Re-Enroll”. This will be reconciled to your advantage once you receive your IRS FORM 1095A and submit that form to your tax preparer. When you enroll in the market place, you must include ALL of the Social Security and / or all of the Social Security Disability Income regardless of how it is displayed on your federal tax return
ANSWER: If you are a 1099 contractor or self-employed your estimated upcoming income is determined by your annual net profit for the calendar year for which you are seeking coverage. 1099 / Self-employment estimated upcoming yearly income is based on the average monthly net profit times 12 months. Even though such a net profit estimate for the following year may be incredibly difficult for a1099 contractor or self-employed individual, it must be done, so give it your best estimate based on either your latest month’s net profit or your average month’s net profit. Once you are inside the Georgia Health Insurance Marketplace’s Enhanced Direct Enrollment platform, you will be asked about your net profit on a monthly basis and it will then be computed on an annual basis predicated on your monthly net profit answer. Just try to give an honest guess of either the latest or the average monthly net profit. If you think your upcoming calendar year (2020) will be similar to your 2018 tax return or maybe similar to your 2019 estimated final, then use that. Regardless of the amount being estimated for your upcoming 1099 / self-employment net profit, keep in mind that Georgia households who are estimating their household income to be BELOW 100% of the federal poverty level (based on family size) or ABOVE 400% of the poverty level (based on their family size) will NOT receive any monthly federal financial assistance. When beginning your health insurance market place enrollment, nothing is more important than your estimated upcoming household income. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to make sure your household qualifies for monthly federal assistance.
ANSWER: No. This was a very recent change in the IRS qualifications for household income for both a federal tax return as well as for income qualification for marketplace enrollment. However, alimony from a divorce finalized BEFORE 1/1/2019 DOES count as household income. It is always recommended that you consult a knowledgeable professional tax preparer for applicable alimony as income and alimony as a loss. A loss also enables a Georgia resident to lower their household income. Alimony income may or may not be income used in a market place application, but it depends on when the divorce was finalized.

(C) FAQs from those not knowing how to estimate household income for the next year. (#23 – #33)

ANSWER: Per the chart on the Georgia Health Insurance Marketplace homepage and in our “Know More” section, the following income sources can be used to determine estimating upcoming annual household income for an application for market place plan: Annual job gross income before taxes or payroll deductions; Self-employment net profit; Real estate net profit; Social Security Income; Social Security Disability Income (SSDI); Retirement and / or pension income; Investment income; Capital gains; Other income including farm/fishing income, taxable scholarship income, prize award income, reportable gambling income, unemployment income and reportable cash support. Income deductions may include alimony, capital losses, business losses and student loan interest. Since you are to estimate your upcoming household income for the year for which you are seeking coverage, it is also vitally important that you be honest and at the same time be mindful of the applicable household incomes (based on tax household size) that would eliminate your ability to qualify for monthly federal financial assistance. Estimating upcoming household income for an application for market place plan is serious. To do it correctly, it requires a little effort on your part. For example, if you’re in 2020 Open Enrollment Period (11/1/2019-12/15/2019), you are trying to estimate your 2020 household income for the 2020 tax return that you won’t actually file until 2021. If during the course of 2020, you realize that your estimate may have been either high or low, you can always change the income on your original 2020 application for market place plan.
ANSWER: Both Supplemental Security Income (SSI) and alimony income derived from a divorce settlement finalized after 1/1/2019. Needless to say, it is both foolish and illegal to estimate an upcoming income source for which you have no intention of including on your upcoming federal and state tax returns. Your application for the healthcare marketplace should be taken seriously. Your federal eligibility letter (that you must download before you enroll in your selected plan) might ask you to provide a documented basis for the household income included in your application. Even though the documentation will be due 60-90 days or more later (after your plan enrollment), if you fail to reply for the documentation request, you will eventually lose your monthly financial assistance (Advanced Premium Tax Credit / APTC). Estimating upcoming household income for the healthcare marketplace is a serious but rewarding challenge. Don’t take it lightly.
ANSWER: Before you click our “Get a Quote & Enroll / Re-Enroll” icon, please understand that nothing is more important to your initial quote than the combination of your estimated upcoming household income AND your “tax household family size” (1/2/3/4/5/6). Your family size INCLUDES those family members NOT applying for coverage. When you apply for market place plan, the accuracy of your monthly financial federal assistance is key.
To qualify for monthly financial federal assistance (based on different “tax household family sizes” of 1/2/3/4/5/6) your household income must be MORE than100% of the federal poverty level and LESS than 400% of the federal poverty level.
What this means is that your “tax household family size” of 1/2/3/4/5/6 must have estimated upcoming annual household income of MORE than “approximately” $13k / $17k / $22k / $26k / $31k / $35k per year respectively and LESS than “approximately” $49k / $67k / $85k / $102k / $120k / $138k respectively. These income guidelines enable a broad spectrum of Georgia household incomes to apply for market place plan.
Every amount of estimated yearly household income OVER 100% of the federal poverty level means LESS monthly financial federal assistance. Every amount of estimated yearly household income UNDER 400% of the federal poverty level means MORE monthly financial federal assistance.
The MORE household income your tax household family earns, the MORE you’ll pay. The LESS household income your tax household family earns, the LESS you’ll pay. Any family tax household family size can buy a plan, even if your household is below 100% of the poverty level or above 400% of the poverty level. However, your household will not receive any monthly financial federal assistance.
To apply for market place plan, your annual household income(s) from part-time and/or full-time job(s) should be based on the gross income (before payroll deductions) of either your “latest” or “average” pay period (bi- weekly or weekly or 2x/month) gross income amount. If your “latest” pay period gross income amount is not a true representation, then use your “average” pay period amount.
If you have a part-time or full-time job, to apply for market place plan, multiply your current gross hourly wage X the latest or average number of hours per pay period that you work x the number of pay periods in a calendar year. Here are 3 examples based on being paid either bi-weekly or weekly or twice a month (not the same as bi-weekly). The above examples below are to help you put in your “initial” estimated 2020 household income when you go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon.
Example: $12/hr. x 60 avg hrs. every 2 weeks (bi-weekly $720) x 26 pay periods = $18720/yr.
Example: $12/hr. x 30 avg hrs. every week. (weekly $360) x 52 pay periods = $18,720/yr.
Example: $12/hr. x 65 avg hrs. twice a month (2x/month $780) x 24 pay periods = $18,720/yr.
Nobody likes math. We understand. However, when you apply for market place plan inside the Enhanced Direct Enrollment application, the annual computations will be done for you once you put in how much you make per pay period and how often you’re paid (26x, 52x, 24x).
ANSWER: Before you click our “Get a Quote & Enroll / Re-Enroll” icon, please understand that nothing is more important to your initial quote than the combination of your estimated upcoming household income AND your “tax household family size” (1/2/3/4/5/6). Your family size INCLUDES those family members NOT applying for coverage. This is critical to understanding market place plan enrollment
To qualify for monthly financial federal assistance (based on different “tax household family sizes” of 1/2/3/4/5/6) your household income must be MORE than 100% of the federal poverty level and LESS than 400% of the federal poverty level.
What this means is that your “tax household family size” of 1/2/3/4/5/6 must have estimated upcoming annual household income of MORE than “approximately” $13k / $17k / $22k / $26k / $31k / $35k per year respectively and LESS than “approximately” $49k / $67k / $85k / $102k / $120k / $138k respectively.
Every amount of estimated yearly household income OVER 100% of the federal poverty level means LESS monthly financial federal assistance when you have completed your market place plan enrollment. Every amount of estimated yearly household income UNDER 400% of the federal poverty level means MORE monthly financial federal assistance.
The MORE household income your tax household family earns, the MORE you’ll pay. The LESS household income your tax household family earns, the LESS you’ll pay. Any family tax household family size can buy a plan, even if your household is below 100% of the poverty level or above 400% of the poverty level. However, your household will not receive any monthly financial federal assistance.
If you have income from tips, your market place plan enrollment would include your annual income from (base hourly wage + your tips) or (tips only) probably comes from a job doing “something”, which means you either have a job or you’re an independent contractor. If your tips are included in your paycheck then use the same rationale as detailed above for someone having a job. If your tips are not included in your paycheck and you find yourself below 100% of the poverty level, then you will need to show tips perhaps under another category (such as other income) inside the actual application. It’s important to know that if you are applying for 2020 coverage (for example) and you include a certain amount of income for tips, then when you do your 2020 tax return (in 2021), those tips you showed in the application should also appear in that tax return.
ANSWER: Before you click our “Get a Quote & Enroll / Re-Enroll” icon, please understand that nothing is more important to your initial quote than the combination of your estimated upcoming household income AND your “tax household family size” (1/2/3/4/5/6). Your family size INCLUDES those family members NOT applying for coverage.
To enroll in a market place plan and qualify for monthly financial federal assistance (based on different “tax household family sizes” of 1/2/3/4/5/6) your household income must be MORE than 100% of the federal poverty level and LESS than 400% of the federal poverty level.
What this means is that your “tax household family size” of 1/2/3/4/5/6 must have estimated upcoming annual household income of MORE than “approximately” $13k / $17k / $22k / $26k / $31k / $35k per year respectively and LESS than “approximately” $49k / $67k / $85k / $102k / $120k / $138k respectively.
Every amount of estimated yearly household income OVER 100% of the federal poverty level means LESS monthly financial federal assistance. Every amount of estimated yearly household income UNDER 400% of the federal poverty level means MORE monthly financial federal assistance. When you enroll in a market place plan, your household’s estimated upcoming household income is hair trigger sensitive to the monthly payment you will make.
The MORE household income your tax household family earns, the MORE you’ll pay. The LESS household income your tax household family earns, the LESS you’ll pay. Any family tax household family size can buy a plan, even if your household is below 100% of the poverty level or above 400% of the poverty level. However, your household will not receive any monthly financial federal assistance.
If you are a 1099 worker or are self-employed, to enroll in a market place plan, the income you show (as a 1099 contractor or self-employed person) will be based on your latest or average monthly NET PROFIT x 12 months. This means your last month’s (or average) monthly GROSS INCOME minus work related expenses (possibly also including your health insurance payments) equals monthly NET PROFIT times 12 months.
However, some 1099 work or self-employed work can be seasonal or unpredictable. We understand. You could use your current year to date average monthly NET PROFIT as a reasonable estimate or at worst case, your net profit shown on your last tax return.
If after you enroll in a market place plan you are asked via your federal eligibility notice to document your net profit from 1099 work or self-employment, you will be given multiple choices of self-employment income verification. One form of acceptable verification is to search the web for a Schedule C (Form 1040) Profit or loss from Business Form and complete the first page based on your “last month’s” or “average month’s” NET PROFIT. At the upper right- hand corner of the blank form, put the month and year for the latest month and include your Gross Receipts (line 1) and Gross Income (line 7) MINUS Total Expenses (line 28 which is a total of applicable lines 8-27) to arrive at your NET PROFIT. Be sure to put your Application ID and name and social security number on the form and be sure to upload the form as soon as possible.
ANSWER: Before you click our “Get a Quote & Enroll / Re-Enroll” icon, please understand that nothing is more important to your initial quote than the combination of your estimated upcoming household income AND your “tax household family size” (1/2/3/4/5/6). Your family size INCLUDES those family members NOT applying for coverage.
To enroll in the health insurance market place and qualify for monthly financial federal assistance (based on different “tax household family sizes” of 1/2/3/4/5/6) your household income must be MORE than 100% of the federal poverty level and LESS than 400% of the federal poverty level.
What this means is that your “tax household family size” of 1/2/3/4/5/6 must have estimated upcoming annual household income of MORE than “approximately” $13k / $17k / $22k / $26k / $31k / $35k per year respectively and LESS than “approximately” $49k / $67k / $85k / $102k / $120k / $138k respectively.
Every amount of estimated yearly household income OVER 100% of the federal poverty level means LESS monthly financial federal assistance. Every amount of estimated yearly household income UNDER 400% of the federal poverty level means MORE monthly financial federal assistance. When you enroll in the health insurance market place, it’s all about numbers. It’s about the number of members in your tax household family and the estimated upcoming annual number representing your household income.
The MORE household income your tax household family earns, the MORE you’ll pay. The LESS household income your tax household family earns, the LESS you’ll pay. Any family tax household family size can buy a plan, even if your household is below 100% of the poverty level or above 400% of the poverty level. However, your household will not receive any monthly financial federal assistance.
If you have income from social security (whether it be taxable or non-taxable) you must include the full amount when you enroll in the health insurance market place. Look for the latest annual notice you would have received in the fall from the social security administration informing you of your new annual social security benefit amount. Simply multiply that amount times 12 months to arrive at your upcoming social security annual income.
ANSWER: Before you click our “Get a Quote & Enroll / Re-Enroll” icon, please understand that nothing is more important to your initial quote than the combination of your estimated upcoming household income AND your “tax household family size” (1/2/3/4/5/6). Your family size INCLUDES those family members NOT applying for coverage.
To qualify for the health insurance market place for monthly financial federal assistance (based on different “tax household family sizes” of 1/2/3/4/5/6) your household income must be MORE than 100% of the federal poverty level and LESS than 400% of the federal poverty level.
What this means is that your “tax household family size” of 1/2/3/4/5/6 must have estimated upcoming annual household income of MORE than “approximately” $13k / $17k / $22k / $26k / $31k / $35k per year respectively and LESS than “approximately” $49k / $67k / $85k / $102k / $120k / $138k respectively.
Every amount of estimated yearly household income OVER 100% of the federal poverty level means LESS monthly financial federal assistance. Every amount of estimated yearly household income UNDER 400% of the federal poverty level means MORE monthly financial federal assistance.
The MORE household income your tax household family earns, the MORE you’ll pay. The LESS household income your tax household family earns, the LESS you’ll pay. In the health insurance market place, almost any family tax household family size can buy a plan, even if your household is below 100% of the poverty level or above 400% of the poverty level. However, your household will not receive any monthly financial federal assistance. The unintended consequence of the Affordable Care Act is that in Georgia, those below 100% of the poverty level essentially are uninsurable because without any financial assistance, they can’t afford a plan.
If you have income from social security disability income (SSDI), this DOES count as income (whether it is taxable or non-taxable) you must include the full amount for the health insurance market place. Look for the latest annual notice you would have received in the fall from social security disability informing you of your new annual social security disability (SSDI) benefit amount. Simply multiply that amount times 12 months to arrive at your upcoming social security annual income.
ANSWER: Before you click our “Get a Quote & Enroll / Re-Enroll” icon, please understand that nothing is more important to your initial quote than the combination of your estimated upcoming household income AND your “tax household family size” (1/2/3/4/5/6). Your family size INCLUDES those family members NOT applying for coverage.
To complete a healthcare marketplace plan enrollment and qualify for monthly financial federal assistance (based on different “tax household family sizes” of 1/2/3/4/5/6) your household income must be MORE than 100% of the federal poverty level and LESS than 400% of the federal poverty level.
What this means is that your “tax household family size” of 1/2/3/4/5/6 must have estimated upcoming annual household income of MORE than “approximately” $13k / $17k / $22k / $26k / $31k / $35k per year respectively and LESS than “approximately” $49k / $67k / $85k / $102k / $120k / $138k respectively.
Theoretically, a healthcare market place plan enrollment is all about household income. Every amount of estimated yearly household income OVER 100% of the federal poverty level means LESS monthly financial federal assistance. Every amount of estimated yearly household income UNDER 400% of the federal poverty level means MORE monthly financial federal assistance.
The MORE household income your tax household family earns, the MORE you’ll pay. The LESS household income your tax household family earns, the LESS you’ll pay. Any family tax household family size can buy a plan, even if your household is below 100% of the poverty level or above 400% of the poverty level. However, your household will not receive any monthly financial federal assistance.
If you have income from a retirement plan or a pension, this DOES count as income when you complete your healthcare market place plan enrollment. Look for the latest notice you would have received from your retirement and/or pension plan and don’t necessarily assume that the amount you receive is the full amount. Your direct deposits may not tell the entire story. Multiply the correct amount by 12 (months) to determine your upcoming household income.
With a retirement plan or a pension, you can most likely use your current monthly (x12) or yearly retirement amount to project your upcoming household income. Updating your application is particularly meaningful for those who may have begun the retirement process lately and may no longer have other income. That’s a very good reason also to be sure to update your application for healthcare market place plan enrollment because your household income may have been higher before and applications don’t update themselves.
ANSWER: Before you click our “Get a Quote & Enroll / Re-Enroll” icon, please understand that nothing is more important to your initial quote than the combination of your estimated upcoming household income AND your “tax household family size” (1/2/3/4/5/6). Your family size INCLUDES those family members NOT applying for coverage.
To enroll in the market place and qualify for monthly financial federal assistance (based on different “tax household family sizes” of 1/2/3/4/5/6) your household income must be MORE than 100% of the federal poverty level and LESS than 400% of the federal poverty level.
What this means is that your “tax household family size” of 1/2/3/4/5/6 must have estimated upcoming annual household income of MORE than “approximately” $13k / $17k / $22k / $26k / $31k / $35k per year respectively and LESS than “approximately” $49k / $67k / $85k / $102k / $120k / $138k respectively.
Every amount of estimated yearly household income OVER 100% of the federal poverty level means LESS monthly financial federal assistance. Every amount of estimated yearly household income UNDER 400% of the federal poverty level means MORE monthly financial federal assistance.
The MORE household income your tax household family earns, the MORE you’ll pay. The LESS household income your tax household family earns, the LESS you’ll pay. Any family tax household family size can buy a plan, even if your household is below 100% of the poverty level or above 400% of the poverty level. However, your household will not receive any monthly financial federal assistance.
Estimating upcoming investment income and/or capital gains for the following year is difficult if not impossible. The best indicator might be that which was reported on you latest filed tax return or looking at your year to date and then projecting from there. When you enroll in the market place you can always update your application on your Dashboard anytime during the year or even make changes within the open enrollment period. Having investment income and/or capital gains in a prior application necessitates updating your application to enroll in the market place each and every year. You don’t want to end up getting a poorly calibrated IRS Form 1095A
ANSWER: Before you click our “Get a Quote & Enroll / Re-Enroll” icon, please understand that nothing is more important to your initial quote than the combination of your estimated upcoming household income AND your “tax household family size” (1/2/3/4/5/6). Your family size INCLUDES those family members NOT applying for coverage.
To complete your health insurance market place enrollment and qualify for monthly financial federal assistance (based on different “tax household family sizes” of 1/2/3/4/5/6) your household income must be MORE than 100% of the federal poverty level and LESS than 400% of the federal poverty level.
What this means is that your “tax household family size” of 1/2/3/4/5/6 must have estimated upcoming annual household income of MORE than “approximately” $13k / $17k / $22k / $26k / $31k / $35k per year respectively and LESS than “approximately” $49k / $67k / $85k / $102k / $120k / $138k respectively.
Every amount of estimated yearly household income OVER 100% of the federal poverty level means LESS monthly financial federal assistance. Every amount of estimated yearly household income UNDER 400% of the federal poverty level means MORE monthly financial federal assistance.
The MORE household income your tax household family earns, the MORE you’ll pay. The LESS household income your tax household family earns, the LESS you’ll pay. Any family tax household family size can buy a plan, even if your household is below 100% of the poverty level or above 400% of the poverty level. However, your household will not receive any monthly financial federal assistance.
If you have rental income, your health insurance market place enrollment will be based not on gross rental income but net income after expenses. Although you can always use the latest year’s tax return as a guide, you may be better off to look at the year to date gross income and expenses to see if there could be a reason to estimate the net income higher or lower than the prior or current year. Regardless, it’s always a good idea to re-enroll and update your application to see if the net rental amount you had in there should be updated anyway. Most Georgia residents forget exact amounts they may have put in after a period of time. Having rental income in a prior application necessitates updating your health insurance market place enrollment application each and every year. You don’t want to end up getting a poorly calibrated IRS Form 1095A because your net rental income changed.
ANSWER: Before you click our “Get a Quote & Enroll / Re-Enroll” icon, please understand that nothing is more important to your initial quote than the combination of your estimated upcoming household income AND your “tax household family size” (1/2/3/4/5/6). Your family size INCLUDES those family members NOT applying for coverage.
To complete your market place application and qualify for monthly financial federal assistance (based on different “tax household family sizes” of 1/2/3/4/5/6) your household income must be MORE than 100% of the federal poverty level and LESS than 400% of the federal poverty level.
What this means is that your “tax household family size” of 1/2/3/4/5/6 must have estimated upcoming annual household income of MORE than “approximately” $13k / $17k / $22k / $26k / $31k / $35k per year respectively and LESS than “approximately” $49k / $67k / $85k / $102k / $120k / $138k respectively.
Every amount of estimated yearly household income OVER 100% of the federal poverty level means LESS monthly financial federal assistance. Every amount of estimated yearly household income UNDER 400% of the federal poverty level means MORE monthly financial federal assistance.
The MORE household income your tax household family earns, the MORE you’ll pay. The LESS household income your tax household family earns, the LESS you’ll pay. Any family tax household family size can buy a plan, even if your household is below 100% of the poverty level or above 400% of the poverty level. However, your household will not receive any monthly financial federal assistance.
Using adjusted gross income from your latest tax return for a market place application that wants to know your upcoming income (for the year you are to be covered) has a number of inherent issues involved. First, you’re assuming that the sum total of lines 7 through 36 on your 1040 are going to be exactly as they were almost 2 years ago. Example, if you were to be completing your market place application in open enrollment period between 11/1/2019-12/15/2019, your last filed tax return would have been for 2018, even though you filed it in 2019. Furthermore, the marketplace wants to know what your household income will be in 2020, the year for which you will have upcoming coverage. The variation of data from a 2018 actual AGI and your final AGI 2020 AGI to be filed in 2021 for your 2020 tax return could be significant. It’s best to update your market place application each and every year, but you can always use the specific applicable line items as a guide. Just don’t run the risk of receiving a poorly calibrated IRS Form 1095A that you won’t receive until January or February of 2021, unless you can go ahead and download it from your Dashboard a few weeks prior to that.

(D) FAQs from those who have 19-25-year-old dependents on their federal tax return. (#34 – #44)

ANSWER: Yes. There are many advantages to doing this. Your unemployed 19-25- year-old will add an additional amount of financial assistance without adding any income to your household. Just make sure that he/she is to be shown on your upcoming tax return and that he/she is not filing a tax return on his/her own. This will add an additional amount of month. Requesting coverage for an unemployed 19-25- year-old in your application for market place plan will almost always actually lower the monthly payment for your plan, even though you’d be adding another family member. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon and see the difference. Don’t forget to include him/her in your tax household family size in both instances. With him/her covered and without him/her covered. The savings with him/her included may surprise you, but always check before you begin your application for market place plan.
ANSWER: That depends. If he/she has been filing his or her own tax return and he or she is still single and making over approximately $13,000 per year, then probably not. If he or she is single and they are projected to make less than $12,490, then they will not be able to qualify for own plan. In Georgia, in order for a single person 19 or over to qualify for the healthcare marketplace, they must have an estimated income of over 100% of the federal poverty level. Your dependent child may need to be on your plan in order for them to qualify. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon for yourself and see the difference. Don’t forget to include him/her in your tax household family size in both instances. With him/her covered and without him/her covered. Change the household income each time to include his/her income or not include it. The additional amount with him/her included in your plan may not be as much as you think. The healthcare marketplace quoting algorithms may be to your advantage or disadvantage depending on his/her income.
ANSWER: Probably so. It depends of course on what “very little money” means. If it’s not that much, it will probably help you or at least not increase your plan cost that much. Including him/her when you apply for market place plan will mean that you are adding another financial assistance subsidy source (your 19-25- year old dependent) without adding that much more income to your estimated yearly household income. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon for yourself and see the difference. Don’t forget to include him/her in your tax household family size in both instances. With him/her covered and without him/her covered. Change the household income each time to include his/her income. The additional amount with him/her included in your plan may not be as much as you think. But remember, in Georgia, a single person who will be filing his/her own tax return MUST be above 100% of the federal poverty level and for a single person that means (for now), above $12,490. If your child is below that amount, you probably need to include him/her when you apply for market place plan.
ANSWER: Yes. You can add your newly turned 19- year-old to your plan during both Open Enrollment Period (11/1-12/15) and during Special Enrollment Period (12/16-10/31). However, don’t wait too long to include him/her in your own market place enrollment. You can add him/her within 60 days BEFORE he/she turns 19 or within 90 days AFTER he/she turns 19 or no later than 12/31 of the year he/she turned 19. However, usually the marketplace may want to see proof of your 19- year-old being dropped from Georgia Medicaid / PeachCare for Kids. This requested documentation will only happen though if your market place plan enrollment (adding him/her) happens during Special Enrollment Period (12/16-10/31). In that case the marketplace usually gives you 60-90 days to upload his/her loss of coverage documentation (losing Medicaid), which can be easily done in your Dashboard. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see how this affects your own plan.
ANSWER: Yes. Whether your 26-year-old is on a plan with you and/or your spouse’s employer or if your 26-year-old is on your own individual and family marketplace plan, the 26- year- old will lose eligibility for both and will need to enroll in a market place plan for himself/herself. This can be done 60 days before or 60 days after or absolutely no later than the final day of the calendar year (12/31) that he/she turned 26. However, usually the marketplace may want to see proof of your 26- year-old’s proof of prior insurance (meaning proof that he/she was on a Qualified Health Plan either with your employer or with the marketplace). This requested documentation will only happen though if he/she decides to enroll in a market place plan during Special Enrollment Period (12/16-10/31). In that case the marketplace usually gives you 60- 90 days to upload his/her loss of coverage documentation (losing coverage on your plan), which can be easily done in your Dashboard. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see how this affects both his/her future plan and your own if you already have a marketplace plan.
ANSWER: No. If your 19-25-year-old files his/her own tax return with his/her own household income, then he/she becomes his/her own taxable household and cannot be a dependent on your tax return. That is one of the initial qualifying questions on our Enhanced Direct Enrollment application. “Will you be filing a tax return?” and “Are you a dependent on anyone else’s tax return?” When you enroll in the health insurance market place, the answers to these 2 questions are very important. If his/her income is BELOW 100% of the federal poverty level (currently $12,490), then you may want to plan on including him/her on your own upcoming tax return and have him/her not file on his/her own. However, that is a situation you must discuss in depth with your 19-25- year-old-dependent. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see how this affects both you and your plan and your 19-25- year-old.
ANSWER: The absolute last day that your 19-25-year-old dependent MUST leave your employer or individual family plan is the last day of the calendar year (12/31) in which he/she turned 26. This policy may vary with different employer plans (as long as they are Qualified Health Plans), but it is the absolute final date if your 19- 25-year-old is currently in a health insurance market place plan. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see how this affects both you and your plan and your newly turned 26-year old’s new plan as well. Remember, that if he/she is single, then their own estimated upcoming household income must be above 100% of the federal poverty level if they require financial assistance. If their own income will be below that amount, then they will not qualify for financial assistance but they can buy a plan (which you might end up paying for yourself on your 26-year-olds behalf).
ANSWER: Yes. Unless you want to assist him or her with the federal application yourself. Filing your own federal income tax return for your own household gives each applicable tax filer the ability to qualify for their own healthcare marketplace plan enrollment. Once again, depending on your 19-25-year-old’s household income (based on the tax household family size of their own young household), that will determine to what extent he/she receives monthly financial federal assistance. However, they can enroll with or without any financial help. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see how much they might expect to pay based on their estimated upcoming household income.
ANSWER: Yes and No. Assuming that he/she got married and there is now estimated upcoming household income between them that is MORE than 100% of the poverty level for a family of 2 ($16,910) then he or she or them together should definitely (using their own income estimates) enroll in the market place on their own. If your 19-25-year-old was on your plan, the marriage qualifies them for special Enrollment Period (12/16-10/31) as long as their marriage happened in the last 60 days. If on the other hand their combined estimated upcoming household income is less than 100% of the poverty level for a family of 2 ($16,910), then they will not be able to qualify for financial assistance and you “could’ elect to add them to your own “tax household family size” and see how that affects your own marketplace plan. Whichever the decision, it would be best for you (and for them) to go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re- Enroll” icon to see how much they might expect to pay based on their estimated upcoming household income (or even yours) however you/they decide to enroll in the market place.
ANSWER: Yes. As long as you expect for them him or her to be still included as a dependent child in your upcoming federal tax return for the year in which he or she expects to have coverage, then they can be included in your health insurance market place enrollment also. If you have not included him or her in your plan before, please go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see how much you might expect to pay based on your new tax household family size (to include them) and see how your household’s estimated upcoming household income affects your own health insurance market place enrollment.
ANSWER: Yes. Unless the child of your 19-25-year-old-dependent is expected to be on someone else’s upcoming federal tax return for the year in which your 19-25-year-old dependent would be covered as well. The newborn or the child 0-18 would be counted as a family member in the market place application if they were not on anyone else’s federal tax return, but that would not necessarily mean that the 0-18- year-old-child would also be included for coverage if the expanded “tax household family size” (Including you, your spouse, your other siblings, your 19-25 year old and the 0-18 year old child of your 19-25 year old dependent) were below 247% of the federal poverty level. In that case, the child would definitely be included in your new market place application as a family member, but would not necessarily qualify for a marketplace plan. Family sizes of 1/2/3/4/5/6 with estimated upcoming annual household incomes of “approximately” less than $31k / $41k / $52k / $63k / $74k / $85k with dependent children (or grandchildren) would mean that those 0-18-year-olds would probably qualify for PeachCare for Kids (Georgia Medicaid). Before beginning your market place application, go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see how much including that child in your tax household family size affects your own new family size and your new rate, whether the 0-18 year-old child is approved for marketplace coverage or not. You should also visit our graph on our homepage that discusses the inclusion or exclusion of 0-18 year old dependents as it relates to the particulars of a market place application for a family with any 0-18 year old dependent. It’s an important section and explains the options you have in this situation.

(E) FAQs from those not understanding how monthly federal financial assistance works. (#45 – #55)

ANSWER: Any tax household family member in your upcoming tax return for the year in which you will be covered (2020 upcoming coverage means the 2020 tax return that won’t be filed until 2021), MUST be included in your application for market place plan, whether they are to be included for coverage or not. This is a federal regulation as part of the Affordable Care Act. If you do not include them (as a family member) even though they are not seeking coverage, it would mean that you were not answering the questions honestly and forthrightly in your own application for market place plan. Please go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see how much your own monthly financial assistance is that includes all of the applicable tax household family members not looking to be covered. You might even find that it even makes sense to include them for coverage anyway, but that is your decision and yours alone to make.
ANSWER: Any and all tax household family member incomes (except SSI) included in your upcoming tax return for the year in which you will be covered (2020 upcoming coverage means the 2020 tax return that won’t be filed until 2021), MUST have included in your own request to apply for healthcare marketplace coverage the incomes of all tax household family members, whether they are to be included for coverage or not. This is a federal regulation as part of the Affordable Care Act. If you do not include their incomes as part of your tax household income, even though they are not seeking coverage, it would mean that you were not answering the questions honestly and forthrightly in your own healthcare marketplace application. Please go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see how much your own monthly financial assistance is that includes income from all tax household family members not looking to be covered. You might even find that it even makes sense to include them for coverage anyway, but necessarily. Remember that your monthly financial federal assistance is based on your tax household family size as well as the income of all tax household family members in your tax return. The healthcare marketplace is based on household income, not individual income of isolated tax household members.
ANSWER: Your upcoming household income is used because the Affordable Care Act adheres to the principle that the amount you pay after monthly financial federal assistance should be commensurate with your income for the year for which you are requesting coverage. When you apply for market place plan during (for example) 2020 Open Enrollment Period (11/1/2019-12/15/2019) using prior income has no bearing on your monthly payment unless your prior income is exactly the same as your 2020 tax return which won’t be filed until 2021.If your 2020 income ends up being different than your 2018 or 2019 income, then there may be an issue with your IRS Form 1095A. We completely understand that the notion of ‘estimating” your upcoming household income can be difficult. We didn’t determine the federal regulations though. Please understand that when you apply for market place plan, you need to try to follow the guidelines as best you can. Just read the tutorial on our homepage and go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to get started.
ANSWER: Tax household family size is almost as important as household income. The state of Georgia is a federally facilitated marketplace state. That means that there is no expanded Medicaid for those over 18 in tax household families that are below 100% of the federal poverty. Georgia state exchange health plan enrollment requires that for any family member to receive monthly financial federal assistance through market place plan enrollment, they must be a tax household family member in a family that is ABOVE 100% of the federal poverty level. 100% of the federal poverty level for family sizes of 1/2/3/4/5/6 is approximately $13k / $17k / $22k / $26k / $31k / $35k. One of the many unintended consequences of the Affordable Care Act for Georgia state exchange health plans is that (for example) a lower income single mom with one (0-18yr. old) unemployed dependent must make more than $16,910 to qualify for monthly financial federal assistance and a lower income single mom with two (0-18yr.old) unemployed dependents must make more than $21,330 to qualify for monthly financial federal assistance. Without an income contributing spouse, market place plan enrollment can be very challenging, particularly in Georgia’s rural southeast, southcentral and southwest counties and often in the huge Atlanta metropolitan area as well. We sincerely wish this was not the situation. However, the rate quoting algorithm in the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon must follow both federal and state rate quoting guidelines for market place plan enrollment.
ANSWER: The good news is that it won’t affect the applicable internal rates of other non-smoking applying family members. The bad news is that the applicable internal rate of the smoking family member can mean an increase of as much as 50% when that smoker is part of an applying tax household. Before you enroll in a market place plan, you will first go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re- Enroll” icon. You will be able to see your household rate that includes a smoker applying for coverage. To see what smoking is costing your households plan, switch off the tobacco usage next to his applicable age and gender and you’ll be able to see how much that tobacco use is affecting the monthly rate when you and your enrolling and smoking family member enroll in a market place plan.
ANSWER: No. Count that SSI family member as part of the tax household family size but do NOT include their Supplemental Security Income (SSI) as part of your estimated upcoming annual household income amount. When you enroll in the health insurance market place, household income from SSI is not recognized as part of household income so don’t include it anywhere. However, just because that family member receiving Supplemental Security Income (SSI) needs to be part of your tax household family size, that does not mean that they cannot apply for health coverage. As long as the tax household income is above 100% of the federal poverty level for your applicable family size, your SSI family member can enroll in the health insurance marketplace, unless they are already on Medicare or Medicaid. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to get started and do not include that SSI income there or inside the Enhanced Direct Enrollment federal application.
ANSWER: When you qualify for financial assistance, the amount is determined primarily by the combination of your tax household family size and your estimated upcoming yearly income for the period in which you will have coverage. Once you enroll in the health insurance market place, the Department of Health & Human Services notifies your selected participating private insurance company that they will be paying the confirmed amount of monthly financial federal assistance (your Advanced Premium Tax Credit / APTC) on your behalf each and every month. However, just because the government is paying doesn’t mean that you don’t have to pay as well in order to maintain your health insurance market place enrollment (unless you have a $0 payment). You will be eventually cancelled within a reasonable amount of time if you fail to make your own payment. Once cancelled due to non-payment of your portion of the payment, you will not be able to enroll in the health insurance market place until the next Open Enrollment Period (OEP 11/1-12/15) and then only for a next January start date. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon and you will see the amount of your financial assistance based on the household income and tax household family size you submit.
ANSWER: Yes, if you fall behind in your payments or don’t respond to a documentation request with a generous deadline. We see it happen all too often and the reason is always due to irresponsibility or unintentional negligence on the part of the individual or household applying. Anyone (regardless of income category) can easily get their healthcare marketplace plan enrollment cancelled and thereby lose monthly financial federal assistance if they fail to make their portion of their monthly payments on a reasonably regular basis. Another way is failing to respond within the 60-90-day deadline when the applicant’s initial eligibility notice requests that the Georgia resident upload specified documentation that may be asked for immediately after the initial healthcare marketplace plan enrollment. If the applicant does not respond to the documentation request until after the generous deadline has already passed, the monthly financial federal assistance will cease and the participating private insurance company will ask that the next payment be the full amount, including the lost monthly financial federal assistance amount. This usually ends up in a cancellation because the Georgia resident is unable to pay the full amount without the help of the previously paid financial federal assistance payment. Losing your healthcare marketplace plan enrollment cannot be “fixed” in most situations. Instead, the Georgia resident must wait until the next Open Enrollment Period (11/1-12/15) in order to apply for a January start date for the following year. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see how much your monthly financial federal assistance will be. It may be a welcome sight, but if it goes unappreciated, the consequences can be dire. Healthcare marketplace plan enrollment can be a privilege. Don’t treat it as a right by ignoring premium due dates and document uploading due dates.
ANSWER: Your monthly financial federal assistance is also called your Advance Premium Tax Credit. This is a long four-word identification for APTC. This is primarily computed based on your unique combination of tax household family size and estimated upcoming household income. When you enroll in the market place, it is determined how much financial help you will need in order to make your monthly payment. That amount is based on a set of algorithms as a result of the information you put in your initial quote and what information you put in during the Enhanced Direct Enrollment application. Before you enroll in the market place, you will see that amount right after you Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon and input your initial data. The screen will identify your APTC as “savings”. If you maintain the same household income when you go into your application, that “savings” will be exactly the same except that it will be identified in your federal eligibility notice as an Advance Premium Tax Credit or APTC. When you enroll in the market place and you become eligible for a tax credit, you may want to take advantage of it if it helps make you plan have a monthly payment that you can afford.
ANSWER: We understand. First of all, if a Georgia household does not qualify for financial assistance because their household income (based on family size) is below 100% of the federal poverty level, then they will not qualify for health insurance market place enrollment unless they pay an amount which would be completely unaffordable as it relates to their household income. This is a sad situation because that lower income Georgia household is not at fault. It is equally understandable if a higher income household above 100% of the poverty level but barely below 400% of the poverty level for their family size of 1/2/3/4/5/6 with a household income of at or slightly less than $50k / $68k / $85k / $102k / $120k / $138k respectively also cannot afford health insurance market place enrollment. The lower income Georgia family below 100% of the poverty level has no choice. The upper income family at least has more of a choice. They can choose the absolute lowest priced bronze plan and at least they will know that they are in a plan that ignores the presence of pre-exiting conditions, allows unlimited hospitalization and more importantly limits their medical liability (whatever the expense) to the deductible, which is the major part of their out of pocket maximum. Which would you rather have? A huge 6-7 figure unexpected hospital bill (without health insurance market place enrollment) that could possibly lead to bankruptcy? Or a huge 6-7 figure unexpected hospital bill where your maximum liability would be about $8,000? For higher income Georgia households, there is a choice and it’s a fairly compelling reason for health insurance market place enrollment. There are no other plans other than affordable Care Act plans that fully include (without exception) pre-existing conditions and no limit on hospital costs. The most stunning fact is that since the beginning of applicable record keeping, over 40% of personal bankruptcies are caused by unexpected and expensive major medical issues and hospitalization. Moreover, a recent study indicated that the state of Georgia has some of the highest hospital rates in the country. That too is a fact. It’s a grim alternative and is fairly compelling rationale as to why anyone who can afford (or try to afford) a health insurance market place enrollment should probably make every effort to do so. Finally, we completely understand the notion that the Affordable Care Act makes it difficult for middle and upper middle-class families. Is a family of 3 making $85,000 a wealthy family? No. it’s just a matter of priorities. Go the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon and input your initial data. There may be a plan available that you can afford.
ANSWER: Yes. Even though your non-taxable social security income is not part of your adjusted gross income, you must still include the full amount. Also, some Georgia residents whose sole income is social security are under the false impression that they need not file a tax return even if they have a market place application. This is totally false and can be dangerous. Be sure to file an annual federal tax return for the year you are receiving marketplace coverage and be sure to include all social security estimated income (taxable and non-taxable) in your market place application. If you fail to file a tax return for the year in which you had coverage, you will be denied any form of monthly financial federal assistance for the following calendar year when you attempt to complete that market place application for the following year. Don’t put yourself in that kind of dangerous situation unless you’re not worried about going without an Affordable Care Act qualified health plan (including pre-existing conditions accepted and unlimited hospitalization) for a full calendar year.

(F) FAQs from those not understanding how medical cost sharing reductions (CSR) work. (#56 – #66)

ANSWER: No. They are completely different and many Georgia residents qualify for both. However, both Cost Sharing Reduction (CSR) and “financial help” (monthly financial federal assistance or “savings” or Advanced Premium Tax Credits or APTC) offer very significant additional benefits if you qualify for them in your application for market place plan. Cost Sharing Reduction (CSR) means that the federal government also authorizes Georgia private insurance companies participating in Georgia state exchange health plans to actually reduce the co-pays, deductibles, and total out-of-pocket maximums for Georgia households who successfully complete an application for market place plan and are between 100% of the federal poverty level and 250% of the federal poverty level. Cost Sharing Reduction (CSR) is available to those tax household Georgia families. This applies to Georgia households with tax household family sizes of 1/2/3/4/5/6 (or more) who have household incomes ABOVE 100% of the federal poverty and BELOW 250% of the federal poverty level. Tax household family sizes of 1/2/3/4/5/6 with estimated upcoming household incomes of LESS than “approximately” $31k / $42k / $53k / $64k / $75k / $86k, qualify for Cost Sharing Reduction (CSR) when they successfully complete their application for market place plan and select a silver plan from any of the private health insurance companies in Georgia participating in Georgia state exchange health plans through the Affordable Care Act. Go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon and input your tax household family size and estimated upcoming household income to see if your Georgia household qualifies. There is also a more detailed breakdown of Cost Sharing Reduction (CSR) on the homepage of our website. Those tax household family sizes who are above the 250% and below 400% of the federal poverty level may still choose a silver plan with monthly financial federal assistance. However, the Cost sharing reduction (CSR) benefit will not be included. Families above 400% of the federal poverty level may also choose a silver plan as well.
ANSWER: Yes. Cost Sharing Reduction (CSR) is only available on silver plans. Although monthly financial federal assistance is included on all bronze, silver and gold plans, the healthcare marketplace does not include Cost Sharing Reduction (CSR) on any plans except for silver plans. Bronze plans are always the lowest monthly cost plans regardless of the amount of monthly financial federal assistance. However, many lower and middle-income Georgia tax household family sizes might find that silver plans with Cost Sharing Reductions (lower co-pays and deductibles) are not that much more than higher deductible bronze plans. Conversely, higher income tax household families in the healthcare marketplace may find that the deductible on their “non- CSR” silver plans are not that much lower than the less costly bronze plans. In either case, go to the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to see which bronze, silver or gold plan makes sense for your Georgia household.
ANSWER: No. However, depending on your tax household family size and estimated upcoming household income, there are 3 distinct levels of Cost Sharing Reduction (CSR) based on tax household size and income. When certain Georgia tax households apply for market place plan and choose a silver plan, this is how it works. The lowest copays/deductibles are for tax household family sizes at 100%-149% of the federal poverty level. This means tax household sizes of 1/2/3/4/5/6 with incomes less than $18k / $25k / $31k / $38k / $45k / 51k. The 2nd lowest copays/deductibles are for tax household family sizes at 150%-199% of the fed poverty level. This means tax household sizes of 1/2/3/4/5/6 with incomes less than $24k / $33k / $42k / $51k / $60k. The 3rd lowest copays/deductibles are for tax household family sizes at 200%-249% of the fed poverty level. This means tax household sizes of 1/2/3/4/5/6 with incomes less than $31k / $42k / $53k / $64k / $75k / $86k.
ANSWER: It will be based primarily on several things: The combination of (a) your tax household family size, (b) your estimated upcoming household income for the year you will have coverage, (c) the family members seeking coverage and (d) the ages of those seeking coverage. The 3 different levels of cost sharing reduction are primarily based on tax household family size and household income though. Once you’ve actually completed your market place plan enrollment, your ability to be qualified for lower co-pays and deductibles (and the revised amounts of co-pays and deductibles) will be shown on your health insurance marketplace eligibility letter, which you must download (or just click) in order to actually finally enroll in your chosen plan.
ANSWER: First, you’ll have an exact idea right after you get a quote after filling out the basic data: zip code, tax household family size, household income and which family members are enrolling. This will be confirmed to you immediately even before you begin you have even start marketplace application. However, if you enroll in a market place plan and input different tax household family size and different household income than you did in your original quoting data, your qualification for cost sharing reduction might change. The income questions in the application for marketplace plan will make it easy to compute upcoming yearly household income. Once you’ve input how much you are paid (not take-home pay) per pay period and how often you are paid (weekly bi-weekly, twice a month, etc.), your estimated upcoming yearly income will be automatically computed for you on both an individual family member basis as well as on a total household basis.
ANSWER: Yes, of course. Anyone can enroll in a marketplace silver plan regardless of their income, even if you are above 400% of the federal poverty level. Cost Sharing Reduction (CSR) is just an added benefit for those below 250% of the federal poverty level (tax household sizes of 1/2/3/4/5/6 with incomes less than $31k / $42k / $53k / $64k / $75k / $86k). However, before you enroll in the health insurance market place, you should also look at marketplace bronze plans that may offer similar deductible amounts at a lower monthly payment. The higher your household income, the less contrast there is between silver and bronze plans
ANSWER: The primary reason is that the marketplace household income algorithms are constructed in such a way that lower income households should have access to lower copays and deductibles. Different household income amounts should receive different amounts of reductions of their copays and deductibles. For a clearer understanding of where your estimated upcoming yearly household income would appear (100%-149% of the poverty level); (150%-199% of the poverty level); (200%-249% of the poverty level), go to our home page and see the income chart by family size 1/2/3/4/5/6 for “incomes that WILL qualify for lower co-pays and deductibles”. These are the household incomes by family size that the health insurance market place uses based on the 2020 federal poverty levels. Also, please note that any household must be ABOVE 100% of the federal poverty level for their 1/2/3/4/5/6 family size. Each family size has a higher household income level.
ANSWER: The “benchmark” plan for all marketplace enrollments is based on “the 2nd lowest priced silver plan”. That is viewed as the “norm”. Any household size 1/2/3/4/5/6 that is between 100% and 250% of the federal poverty level will see that bronze plans are lower priced plans (with higher deductibles) than silver plans and that gold plans are higher priced plans (with lower deductibles).The silver plans with Cost Sharing Reductions (CSR) become the happy medium for Georgia households with estimated upcoming annual household incomes between 100%-250% of the poverty level. This makes their healthcare marketplace plan enrollment more affordable and the copays and deductibles more acceptable.
ANSWER: Yes. Enrollment is done on a household basis, meaning those who are in your “tax household’ family members in your tax household means family members who will appear in the upcoming tax return for the calendar year for which you will be receiving health coverage. In other words, if you are seeking coverage for 2020, your 2020 income tax return will be filed in 2021 and the same members in that tax return should also be included in your application, whether they are actually applying for coverage or not. You can have a tax household family size of 3 with only 2 members seeking coverage when you enroll in the market place, however you are still a tax household family size of 3.
ANSWER: No. Each private insurance company participating in the marketplace in Georgia offers different bronze, silver and gold plans. Each “metal” category for each company may have different variations of the combination of co-pays and deductibles. However, by federal law, all marketplace plans (whether bronze, silver or gold) must include the 10 basic health benefits including a no charge annual physical. These 10 essential health benefits include: hospitalization, emergency services, laboratory services, prescription drugs, preventive and wellness services, chronic disease management, ambulatory out-patient services, pediatric services, pregnancy / maternity / prenatal / post-natal services / newborn care, rehabilitative & habilitative services and devices, mental health and substance use disorder services, and more. By its very nature, health insurance marketplace enrollment guarantees every enrollee that they will be covered by any and all pre- exiting conditions and they will have access to the same benefits regardless of the plan they choose. The pricing is generally based on the deductible. The lower the deductible, the higher the price (with the possible exception of those who qualify for CSR). The higher the deductible, the lower the price.
ANSWER: Yes. That is highly recommended. If you estimate your upcoming yearly income for the calendar year for which you will be covered, during the initial “getting a quote” stage, the quoting system will show you whether or not you qualify for lower copays and lower deductibles through Cost Sharing Reduction (CSR). If you do a “sloppy” household income estimate when you get a quote, you have no way of knowing if your final quote after your market place application has been completed will be the same as when you did your estimate initially. The application itself makes it hard to make mistakes. Questions for each “enrolling or not enrolling” family member include: income source; how often are you paid; how much are you paid (not take-home- pay) are fairly direct questions. Taking the time on your own to estimate yearly income before you start your application, will almost definitely assure you of no surprises. Input 3 different household incomes and you’ll end up with 3 different monthly payments. It’s a tax household family size and household income algorithm that will change with every estimated upcoming household income amount.

(H) FAQs from those wanting to know the benefits of creating their own Dashboard. (#78 – #88)

ANSWER: Creating your own Dashboard is completely optional. However, if you do choose to create your own Dashboard, you will find it to be extraordinarily helpful. Here’s how you do it: Your initial confirmation screen will invite you to create your own Dashboard. Your pre-populated username will be the same email address you used in your marketplace application and all you’ll have to do will be to create your own 6+ digit password. You’ll enter your dashboard and will immediately see a wealth of information about your completed application, enrollment and selected plan. Once you’ve completed your application for market place plan, you will also be receiving several confirming emails both from the marketplace as well as from Health Sherpa, the only Enhanced Direct Enrollment platform that works in conjunction with the marketplace. An important email will come from no_reply@healthsherpa.com and the subject will be; Action required . This may be letting you know how you can make your initial payment (your insurance company’s payment phone number is included) and it may also remind you that you may have documents to upload based on a request from the marketplace. The easiest and fastest way to upload any requested documents is to do it through your own Dashboard. The documents will be transmitted directly to the marketplace in real time.
ANSWER: Yes, definitely. Once you’ve clicked “Enroll in this plan”, you may decide at a later date (but within the allowable time-frame to change plans. You can change plans during Open Enrollment Period (OEP 11/1- 12/15) and within the allowable time frame once your healthcare marketplace application is done by clicking our “Get a Quote & Enroll / Re-Enroll” icon and starting again. However, the best way (and fastest way) is to “sign in” to your Dashboard and then select “Change Plans” and then “Enroll in this Plan”. If you enroll in a different plan, the confirmation process will repeat itself as it did when you selected your original plan.
ANSWER: Yes. Your Dashboard enables you to both view your existing marketplace application and to make changes or update your application. Next to each and every marketplace application section (primary contact information, household members, household income, household deductions, income summary, basic household questions and additional questions), there is the opportunity to edit any applicable section you need after you apply for market place plan. It is particularly important that you make any household income changes as soon as possible within the allowable time frame during Open Enrollment Period (OEP 11/1-12/15)
ANSWER: Yes. Just as the initial menu of plans enabled you to see all of your plan details including plan summary, doctor visits, Emergency / Surgery, diagnostics, labs, imaging, diagnostics, prescription drugs, mental health benefits, official documents including summary of benefits, drug formulary, provider list and much more, your Dashboard also has your own plan details available to you after your market place plan enrollment.
ANSWER: Yes. Your marketplace eligibility notice (Letter) is extraordinarily important. In order to enroll in your plan, you would have already had to either download your eligibility letter or view it. That important letter is included in your Dashboard in the Application history section and under the word “Documents”. Just click the “Eligibility’ icon and you will see the complete letter which includes “Enrolling family member(s)”; “Results”; “Next steps” and so much more. When you enroll in a market place plan, you cannot complete the process unless you download or view this Eligibility letter so it’s very helpful that it’s also maintained in your Dashboard for easy reference.
ANSWER: Yes. Your own application and application history inside your Dashboard includes your chosen and confirmed health insurance company, the name of your plan, your effective date, your subsidy (monthly financial federal assistance), your net premium (monthly payment after your subsidy), your Eligibility Notice (letter), your FFM ID # (your application ID Number, and your submission date of application to the health insurance market place.
ANSWER: Yes. Using your Dashboard is the best and fastest way to upload requested documents (only if requested in your Eligibility Notice). These documents might include income verification, immigration status, or other documents requested during Open Enrollment Period (OEP11/1-12/15) and/or proof of relocation, proof of loss of prior coverage, proof of marriage or divorce, etc. during Special Enrollment (SEP 12/16-10/31). Uploading requested documents and meeting the 60-day deadline (sometimes less per your Eligibility Notice instructions) is one of the most important responsibility you have if the health insurance market place has requested verification documents from you. Your Dashboard will show that your documents have been uploaded and will later show that the verification has been completed. If this is not done in a timely manner, you could lose your monthly financial federal assistance (Subsidy/ Advance Premium Tax Credit). This would mean that you would be responsible for the entire payment if the deadline is missed. Responding to documentation requests and uploading them in a timely manner in your Dashboard is a vital responsibility.
ANSWER: Yes. Your application history includes everything including the name of your insurance company, your plan name, marketplace plan effective date, your monthly subsidy amount (savings / Advanced Premium Tax Credit), your net monthly premium (monthly payment after APTC), applicable documents including original Eligibility Notice (letter), FFM ID # (Federal Marketplace Application ID number) and the date the application for your healthcare marketplace plan enrollment was submitted.
ANSWER: No. Creating your own Dashboard is not required. However, creating your own Dashboard is so easy. After you enroll, you will see a confirmation screen that will invite you to create a Dashboard. Your easy to remember user-name will be the email address you had in your marketplace application. All you have to do is to create your own 6+ digit password. You’ll also have another opportunity to create your own Dashboard by opening an important email from no_reply@healthsherpa.com with the subject: Action required. Either way you use to create your own Dashboard, once you enroll in the market place, you’ll find that having your own Dashboard is extraordinarily helpful as well as user friendly.
ANSWER: Yes. As you may know, your IRS Form 1095A is mailed to Georgia residents every calendar year (usually between late January through mid-March). The IRS Form 1095A is essentially a financial summary of the marketplace plan you were enrolled in for the prior year. For example, if you had a plan during 2020, your 1095A form would be mailed to you in the early part of 2021. The form is pre-populated specifically for you and shows the months in which you were enrolled. Each month has columns indicating the cost you would have paid for the 2nd lowest priced silver plan, the amount you paid for your plan, the Advanced Premium Tax Credit (monthly financial federal assistance / APTC) you had, and a reconciliation column. In order for you to file your federal tax return (in this example for the tax year 2020, to be filed in 2021), you MUST have this form so that it can be converted (by you or your tax preparer or professional) into IRS Form 8962. If you fail to include this in your 2020 tax return filed in 2021(for example), you run the risk of not being qualified for monthly financial assistance for health insurance market place enrollment for the next Open Enrollment Period (in this case 2021 OEP 11/1/2020-12/15/2020). To easiest way to avoid future mail delivery issues of your 2020 IRS 1095 Form is to “Get a Quote & Enroll / Re-Enroll” at Georgia Health Insurance Marketplace either during 2020 Open Enrollment Period (11/1/2019-12/15/2019) or (if applicable) during 2020 Special Enrollment Period (12/16/2019-10/31/2010) and create your Dashboard. Your own IRS Form 1095A
ANSWER: Yes. That is an option. If your initial payment is made through your Dashboard, it is immediately transmitted in real time to your chosen insurance company. If you choose instead to pay your insurance company directly, your confirmation screen will provide you with the phone number for the company’s payment line. Ongoing payments (after your initial payment) must always go through your chosen insurance company directly. Your Dashboard only accepts the initial payment after your market place application. Your Dashboard cannot accept ongoing future payments and not ongoing future payments.

(I) FAQs from those with requests for documentation included in their eligibility notice. (#89 – #99)

ANSWER: That’s difficult to answer. Generally speaking, during Open Enrollment Period (OEP 11/1-12/15) the percentage is very low. During Special Enrollment Period (SEP 12/16-10/31), the percentage is relatively high. In either event, if you do get a request for documentation that appears inside your Eligibility notice (letter), it always allows you a reasonable period of time to respond after you have completed your application for market place plan.
ANSWER: It depends on when you are applying. If applying during Open Enrollment Period (OEP 11/1-12/15), most of the request for documentation will be about household income (including income from tax household family members applying and those not applying). If you are applying during Special Enrollment Period (SEP 12/16-10/31), you will almost always receive a request for documentation inside your Eligibility Notice (Letter). The documentation request would be based on the qualifying life event that would have made you eligible for Special Enrollment in the healthcare marketplace in the first place. These include: (a) Loss of health coverage in the past 60 days: Send documentation proving that within the last 60 days that you were insured for at least 1 of those prior 60 days. (b) Loss of health coverage anticipated within the next 60 days: Send documentation proving that sometime within the next 60 days that you will be losing health coverage. (c) Moving from another state into the state of Georgia. Send documentation proving your move. The Eligibility Notice will provide you with a number of examples to use in order to prove your move. If you did move from another state, you must have had qualifying coverage in your prior state of residence including Medicaid or marketplace coverage through state exchange health plan enrollment in your prior state of residency.
ANSWER: Your plan will start as long as you have made your initial payment (either through your Dashboard or through your chosen health insurance company directly) BEFORE the effective date (start date) of your plan. Your enrollment in a marketplace plan is never considered complete until you have made your initial payment. Generally speaking, during Open Enrollment Period (OEP 11/1-12/15), your plan would begin before the due date of your documentation. However, if you miss your due date, you may discover that your monthly payment has been increased because the federal government then decided not to pay your monthly financial federal assistance (APTC) on your behalf. Don’t let this happen. Generally speaking, during Special Enrollment Period (SEP 12/16-10/31), you should respond to the request for documentation IMMEDIATELY rather than wait for the due date of your documentation. When you apply for market place plan during Special Enrollment Period, your eligibility and start date may be delayed until the marketplace has received and processed your uploaded qualifying life even documentation.
ANSWER: That depends. First of all, look at your Eligibility Notice (letter) and the due date may be different based on the type of documentation requested. Generally speaking, requested documentation pertaining to household income verification could be anywhere from 30-60 days depending on the date of your market place plan enrollment and your start date. A documentation request for something other than income verification may involve a more protracted due date like 60-90 days. Whatever the due date, it is never in your best interest to procrastinate. Verification takes time once you have uploaded your verification documents. If your market place plan enrollment is being done during Special Enrollment Period (SEP 12/16-10/31) you should make every effort to upload your documentation as soon as possible. Delaying your response until even before the due date might mean that your conformation won’t be effective until after your start date and you will still be required to pay for the full month.
ANSWER: You will have 3 choices of ways to respond to a documentation request from your Eligibility Notice (Letter). (1) You can upload your requested document(s) inside your Dashboard after clicking the “Verify” icon located in the upper section of your dashboard page. If you choose this method and do it successfully, it will immediately show on your screen the date you uploaded it and later that it was completed and received. (2) You can upload your requested documents per the upload instructions indicated in the Eligibility Notice (letter) from the health insurance marketplace. (3) If you are challenged by the process of uploading anything at all, you have a final alternative which means mailing your documents. It is highly recommended that you never mail documents through regular first-class mail. The least expensive way to mail documents (and still have a tracking number) is to mail them Priority Mail through the U.S. Post Office. The postage cost will only be about $7.35+ and you can later go the USPS website to track delivery so that you will have confirmation that your documents arrived. Whenever you send any documentation in the mail to the marketplace, please be sure to include all name(s), date(s) of birth of all applying tax household family members and ALWAYS include the Application ID Number that was in your Eligibility Notice (Letter) from the health insurance marketplace as well as the “bar code page” included in the Eligibility Notice (Letter). Your Application ID is also located in your Dashboard near the bottom of your screen and it is identified as your FFM (Federally Facilitated Marketplace) ID. If you choose to send your requested documentation via Priority Mail, address your envelope to: Health Insurance Marketplace; ATTN: Coverage Processing; 465 Industrial Boulevard, London, Kentucky 40750- 0001. When you enroll in a market place plan and receive a request for documentation, mailing in your documents (even via Priority Mail) means that the response will NOT be as fast had you uploaded them instead.
ANSWER: You do not need to send any documentation if your Eligibility Notice (letter) does not ask for them. If there is a request for income verification and your household income comes from a part-time or full-time job, then the best document is either your latest paystub or your latest “average” paystub (of your latest paystub was either irregularly low or high). Since most employees have direct deposit, the “paystub” would be inside your employee online pay account. Print it out, create a pdf file and upload it either to your Dashboard or you may follow the uploading instructions on your Eligibility Notice (Letter). Your Eligibility Notice will also have a due date. Do not ignore that. After you enroll in the health insurance market place, your monthly financial federal assistance will begin with the month of your effective date. Ignore the deadline for submitting any requested income verification and your financial assistance will cease. Procrastination is not worth it. Finally, the amount you put as your average/latest pay period earnings (gross earnings, not take-home pay), should resemble the documentation you send in. Sometimes it’s best to look at your pay period gross pay BEFORE you “Get a Quote & Enroll /Re-Enroll.
ANSWER: This is by far the most difficult documentation because many self-employed and/or 1099 workers have irregular income at irregular times. We understand. The most important thing to know is that your income is based on NET PROFIT, not gross income. Net profit minus applicable expenses equals net profit. Most Georgia residents in this category have a pretty good ide what their “average” monthly net profit has been recently and that may be the best way to project upcoming average monthly net profit. It’s always a good idea to try to determine this amount BEFORE you “Get a Quote & Enroll /Re-Enroll”. The question on the application will be asking about your ‘latest’ month’s net profit. If that was an irregular month (either too high or too low), then give it a more average amount. When it comes to documentation, you will be given a laundry list of acceptable examples. You could always create a “last month’s” net profit by completing an “originally blank” new IRS Profit and Loss Form for the latest month. Put the applicable month and year in the upper right-hand corner (to replace the date on the form) and fill it in using a prior tax return as a guide. Remember, you are doing it for a month, not for a year. The health insurance market place may have a higher propensity for requesting income documentation from those who are either self-employed or 1099 contractors, so try to be as honest and reasonable as you can when you submit your documentation.
ANSWER: First, do NOT use copies of checking account statements to show proof of social security or social security disability income, unless you actually have to. It is always best to make a copy of the latest annual letter you received from the Social Security Administration. Since Open Enrollment period (OEP 11/1-12/15) is about the same time-frame in which these letters arrive from the SSA, using the latest letter or even last year’s letter is usually acceptable since the average increase from one year to the next is usually insignificant (1%-3% increase).If you had a job prior to going on social security, please do not include income from that job if you will not be employed during the time of your upcoming calendar year coverage. Healthcare marketplace plan enrollment is about estimating upcoming household income and not prior year income.
ANSWER: Enrollment during Special Enrollment Period (SEP 12/16-10/31) must be based on a specific Qualifying Life Event and the qualifying life event must have either happened in the last 60 days or (in limited cases) is anticipated to happen in the next 60 days. Loss of health insurance coverage is the only life event that can be considered valid both for the “past 60 days” and the “next 60 days”. Other life events include moving into the state of Georgia from another state in the past 60 days or getting married/divorced in the past 60 days. When you enroll in the market place during Special Enrollment Period, the likelihood of needing to submit documentation is high because your very enrollment is predicated on one specific event which is not necessarily assumed to be the case until documentation is submitted.
ANSWER: That depends on the life event you are attesting that you qualify for. If you lost health insurance coverage in the last 60 days (and had it for at least one day in the last 60 days) or you anticipate that you will lose health coverage in the next 60 days, you will need to provide proof of that coverage and/or proof of loss of that coverage. If in the last 60 days you moved from outside the state of Georgia (and you had prior coverage) to the state of Georgia you would need to provide some documentation that you recently moved (newly signed lease, mortgage, new driver’s license, new utility bill, new checking account, etc.) Whatever the case, a health insurance market place enrollment during Special enrollment Period (SEP 12/16-10/31) means that you will almost always be required to upload supporting documentation that verifies your rationale for special enrollment.
ANSWER: No. Not if you respond immediately. Due to the health insurance marketplace having experienced issues with consumers not always being forthright about special enrollment qualifying life events, it is highly likely that your enrollment will not be transmitted to your chosen health insurance company and plan until your qualifying life event has been verified. Prior to submitting a market place application, try to have your documentation ready so that you are able to upload it almost immediately after completing your application. We don’t want to say that it’s like being “guilty until proven innocent” but prior years have indicated that far too many Georgia residents are unaware that Open Enrollment Period (OEP 11/1-12/15) is the best time to apply unless you really do have a verifiable qualifying life event.

(J) FAQs from those wanting to know about 12/16 – 10/31 Special Enrollment Period (SEP). (#100 – #110)

ANSWER: No. There is a huge difference between Open Enrollment Period (OEP 11/1-12/15) and Special Enrollment Period (SEP 12/16-10/31). Once you’ve missed OEP, your only alternative is to have a Qualifying Life Event in order to successfully submit an application for market place plan. Qualifications include loss of health coverage in the past 60 days or future 60 days, moving to Georgia in the past 60 days, moving from one Georgia county to another county (with coverage already), getting married, getting divorced, having a child, adopting a child, having a change in immigration status and many more. In almost every case, Special Enrollment means that you may need to have already had health coverage at least 1 day in the past 60 days but you are seeking new coverage based on your qualifying life event. Almost anyone can enroll during Open Enrollment Period. Special Enrollment period is much more restrictive.
ANSWER: The most important document is the one that is listed on your Eligibility Notice (Letter). However, in almost every case, it’s important that most all Georgia residents who apply to the marketplace during SEP, have proof that for at least one day in the last 60 days that they had qualifying coverage in the healthcare marketplace. This can include any of the following: marketplace coverage from another state, Medicaid coverage from another state, Georgia Medicaid coverage dropped due to end of pregnancy or a child who just turned 18, loss of employee insurance, etc. Of all the categories, those may be the most important ones. Remember, you apply and enroll first, and then you upload your documents proving your loss of coverage.
ANSWER: There’s a different example for each situation. If you had a loss of health coverage from an employer, then you should supply one of the following (1) On your (former) employer’s letterhead, a notice detailing when your coverage did end or when it will end. (2) On your (former) insurance company’s letterhead or with a notice from them indicating when your coverage ended or when it will end. If your health coverage was lost for another reason (other than non-payment, which is not a qualifying reason) then you will need to supply documentation from the prior insurer. This includes 19- year- old Georgia dependents who just became ineligible for PeachCare for Kids due to recently turning 19. If you apply for market place plan during Special Enrollment Period (SEP 12/16-10/31), its always best to be prepared to upload your documentation as soon as you can. Most any special enrollment will usually require validation of the qualifying life event.
ANSWER: No. If your enrollment was completed prior to the 15th of the month it would start on the 1st day of the following month. If your enrollment was completed after the 15th of the month, it will start the 1st day of the next following month. In either case, a market place plan enrollment start date may be held up pending receipt of any request for documentation or verification detailed in your Eligibility Notice. This is not the case for Open Enrollment Period (OEP 11/1-12/15). A plan enrollment during OEP may indeed start prior to receipt of any verification, but still you must honor the deadline.
ANSWER: There are many. Loss of health coverage in the last 60 days or anticipated loss in the following 60 days. Loss of coverage can include an employee plan, being dropped from a family plan due to turning 26, being dropped from PeachCare for Kids (Georgia Medicaid) due to turning 19. It can also include in the past 60 days moving to Georgia from another state or even sometimes moving from one Georgia county to another Georgia county (if your current plan is not available in your new county. It can also include (in the past 60 days), getting married or getting a divorce, or having a child or adopting a child. In every case however, you must have had an existing plan before the qualifying life event before you can enroll in a market place plan during Special Enrollment period (SEP 12/16-10/31)
ANSWER: If your tax household family size has in the last 60 days increased or decreased due to marriage, divorce, adoption, birth, death, or due to someone in the tax household family moving (for example) to employee insurance. Before you enroll in the health insurance market place during SEP, try to have your qualifying life event documentation or verification ready if it is requested on your Eligibility Notice (Letter) and always be mindful of the 60 day period whereby the event must have happened 60 days prior to the date you are reporting the actual household change.
ANSWER: There are 3. Again, all must have occurred within the prior 60 days of your enrollment. (1) Moving from a foreign country (and already have naturalized citizenship or citizenship) into the state of Georgia (No prior insurance required). (2) Moving from another state into Georgia and had some form of creditable health insurance coverage in your prior state. (3) Moving from one Georgia county to another and your plan you had in the prior county is unavailable in your new Georgia county. With the exception of moving from another country in the past 60 days, you will generally always need to show verification of a change in residence or relocation if requested on your Eligibility Notice (letter) from the health insurance market place.
ANSWER: Yes. As long as you will be losing it within the next 60 days from the date of your enrollment application. Sometimes reporting a future loss of coverage will be problematic because the insurance company may not attest that you will lose coverage until you let them know and request a letter or notice from them. In the case of an employer, you could simply have your human resources manager to type a letter on the company letterhead. In the case of moving from another state, you may have to let the other insurer know that you will be (for example) moving to Georgia and you need for them to know that in order for them to supply verification of your future loss of coverage. However, be careful to avoid cancelling prior coverage before you know that your healthcare marketplace plan enrollment has been fully completed
ANSWER: Generally, the answer is yes. Since Special Enrollment Period (SEP 12/16-10/31) is more restrictive than Open Enrollment Period (OEP 11/1-12/15) and you need to have a qualifying life event (loss of coverage, relocation, denied Medicare, change in immigration status, marriage, new-born, etc.), you will usually need to provide verification if you want to enroll in the market place during special enrollment period. The most important thing is to provide proof that the event occurred within the last 60 days (sometimes the next 60 days) and that you had coverage at least one day of that last 60 days.
ANSWER: No, hardly ever. However, if there was a really unusual circumstance, you might be able to try instead to be proactive and appeal the situation with the marketplace. Maintaining your health insurance market place enrollment is a responsibility and all you have to do to remain in your plan is to make sure that you continue to make your premium payment on time. Try not to fall outside the 30-day grace period. If you do get cancelled due to non-payment, you will be unable to enroll again until the following Open Enrollment Period (OEP 11/1-12/15)
ANSWER: Yes. Definitely. The information from your application and enrollment in another state will not transfer into a market place application for the state of Georgia. It’s also important to know that you must have moved to Georgia within the past 60 days and you must have had coverage in either a marketplace plan from another state or a Medicaid plan from another state. Do not cancel your prior coverage in that other state’s plan until you have confirmed coverage in Georgia. This means that you should make sure any verification documentation submissions you have done have been approved.