Marketplace Jeopardy

DMI (Data Matching Issues)

100

This issue occurs when the Marketplace cannot verify information on your application with government records.

What is a data matching issue

200

What could happen if the member can't resolve a DMI with the Marketplace?

- Lose tax credit

- Lose coverage

- Change in Coverage (NA/AN usually)

300

Your client calls in to add their baby to their plan. They don't have the SSN yet. How long do you have to enter the social on the application? 

90 days

400

List 3 documents you could upload/send to prove a "loss of coverage"? 

- COBRA offer

- Letter from Insurance Carrier

- Letter from Employer

500

List 3 documents you could upload/send to confirm the SSN? 

• Social Security card
• 1040 Tax Return (federal or state versions acceptable)
• W2 and/or 1099s (includes 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099S, 1099INT)
• W4 Withholding Allowance Certificate (federal or state versions acceptable)
• 1095 (includes 1095A, 1095B, 1095C)
• Pay stub documentation
• Social Security Administration documentation (includes 4029)
• Military record
• U.S. Military ID card
• Military dependent’s ID card
• Unemployment Benefits (Unemployment Benefits Letter)
• Court Order Granting a Name Change, that must have your original first and last name, new first and last name, and SSN
• Divorce decree

 

Life Events

100

This type of event can make you eligible for a Special Enrollment Period outside Open Enrollment.

What is a qualifying life event?

200

After experiencing a qualifying life event, you generally have this amount of time to enroll in a Marketplace plan.

What is 60 days

300

This is the amount of time a person can enroll on the MP if they lost Medicaid/CHIP coverage or were found ineligible AFTER applying for life event. 

What is 90 days

400

Jeff moves from Las Vegas to Salt Lake. He finds a lump on his neck and would like to check it out. He calls you today for coverage. He has not had insurance for the past 6 years. Can you enroll him on the Marketplace?

No, he has no life event. 

 

He could apply for a STP or Fixed Indemnity Plan but his preexisting condition will not be covered. 

500

Jeff moves from Las Vegas to Salt Lake. He finds a lump on his neck and would like to check it out. He calls you today for coverage. He had insurance at his job in Vegas. Can you enroll him on the Marketplace?

Yes, as long as that coverage has ended within the past 60 days or it is set to end soon. 

Income

100

What is the name for the income that the Marketplace uses to determine savings eligibility? 

"Your subsidy is based off your ..." 

Modified Adjusted Gross Income

or

Adjusted Gross Income

200

These household members’ incomes must usually be included when applying for Marketplace savings.

Any household member included in your tax household. 

Self, Spouse, Kids

300

If your income changes during the year, you should do this to avoid owing money back at tax time.

Update the Marketplace application. 

(If it was wrong for 10 months you will still owe back for those months you were incorrect.) 

400

Are unemployment wages counted towards the AGI when calculating income? 

What is....yes 

500

When calculating income do we calculate what they have made thus far or for the entire year? 

Calculate the entire year. 

Employer Coverage

100

When helping a client decide if their employer plan is affordable do you calculate the income from that employer or the income for the entire household? 

Entire Household

200

If employer coverage is considered affordable and meets minimum value, you generally cannot receive these through the Marketplace.

What are premium tax credits or Marketplace subsidies?

300

If the employer coverage is affordable for the employee but not their family what should you do? 

Have the employee enroll on her work insurance and the rest of the family can enroll on the MP and receive a tax credit. 

400

This is the percentage of your income the government considers “affordable” for employer-sponsored health coverage.

What is 9.96%

500

If I am offered affordable/minimum value coverage through my employer can I still enroll in a plan on the Marketplace? (be careful)

Yes, you can enroll in a plan at FULL cost.