The Assister Bulletin is a technical assistance resource funded under a grant from the  Health Resources Services Administration (HRSA), 
Bureau of Primary Health Care
for Florida Assisters  on the Health Insurance Marketplace.



~ February 23, 2018 ~

OPEN ENROLLMENT IS OVER.
FOCUS ON SEPs, APPEALS & EXEMPTIONS! 
   
 
LUNCH & LEARN CONFERENCE CALL
 
 
Date   
Friday, March 23rd 2018
Time   
12:30-1:30 PM
 
   
From your computer, tablet or smartphone:   
 
Or, you can dial +1 (872) 240-3311 

Access Code: 307-260-925  
 
       
The Committee on Veterans' Affairs is scheduled to hold a previously planned hearing at 8 a.m. Its chairman, Rep. Phil Roe (R-Tenn.), intends to "address" the issue in his opening statement, his staff said. The hearing follows a damning report issued Wednesday from VA's inspector general, Michael J. Missal. Shulkin is challenging the findings as "unfair."  Washington Post

Idaho is going rogue on Obamacare. The Republican-led state has a maverick plan to flout the federal health care law, letting insurers sell "Idaho Freedom" plans that don't meet Obamacare coverage rules and patient protections. And the brazen move - Gov. Butch Otter is plowing ahead on his own, without seeking federal waivers or permission - poses a test for the Trump administration.  Politico

The top federal health official on Wednesday said he will uphold ObamaCare as long as it remains the law. In response to a question about a controversial plan in Idaho to allow insurers to sell plans that don't meet ObamaCare requirements, Department of Health and Human Services Secretary Alex Azar told a congressional panel that he has a responsibility to enforce the law.  The Hill

The House is set to approve a bill Thursday that advocates for the disabled fear would weaken the Americans With Disabilities Act by removing incentives for business owners to comply with the 27-year-old law mandating equal access to public accommodations. But proponents of the bill, which has the backing of House Republican leaders and a handful of Democrats, say it would stem a tide of " drive-by lawsuits" brought by predatory lawyers seeking to collect payouts from noncompliant business owners without actually improving access for those with disabilities. The ADA Education and Reform Act would require those who sue businesses in federal court to first deliver a specific written notice to that business detailing the illegal barrier to access, and then give that business 60 days to come up with a plan to address the complaints and an additional 120 days to take action.
Washington Post

The health-care industry is in the throes of a major shake-up. That creates a situation in which companies face a greater risk by standing pat than possibly overpaying for an acquisition. Amazon, Berkshire Hathaway and JPMorgan Chase announced last month that they would start their own nonprofit company aimed at lowering medical costs for their employees. Separately, The Wall Street Journal reported that Amazon has designs on expanding its hospital-supplier business.  Wall Street Journal

Businesses are pushing back on the Internal Revenue Service's decision to begin enforcing the Affordable Care Act's employer insurance mandate, challenging penalties that run into the millions and asserting the agency is wrong to impose the fines. The ACA imposes a penalty on employers with more than 50 workers who don't provide qualifying coverage to employees, but the fines weren't initially enforced. In November, the IRS said it would begin assessing penalties, starting with companies that failed to comply in 2015, when parts of the employer mandate first kicked in.
Wall Street Journal

Wisconsin's Scott Walker, one of the nation's most militantly anti-Obamacare governors, is making strengthening the health care law a key plank of his reelection platform as Republicans fret over potential losses in November. Walker wants to prop up his Obamacare market with a $200 million program that would compensate health insurers for high-cost patients so they don't hike premiums for everyone. He also would enshrine Obamacare protections for people with pre-existing conditions. Politico 
 

The family Nikolas Cruz lived with didn't notice anything terribly strange about the young man's behavior the morning of the massacre at a Parkland, Florida, high school, the family's attorney said Thursday. The only thing abnormal was that he didn't get up for his adult GED class. Normally, the father would take him to class on the way to work, but when they tried to wake Cruz up Wednesday, he said something like, "It's Valentine's Day. I don't go to school on Valentine's Day," according to the lawyer."They just blew it off," attorney Jim Lewis said. "This is some 19-year-old that didn't want to get up and go to school that day, and (they) left it at that."The family took Cruz in last year after his adoptive mother died. Cruz was depressed, Lewis said. The family's son knew Cruz, so they opened their home, got him into a GED class and helped him get a job at a Dollar Tree store, the lawyer said. CNN

Students who survived the Florida school shooting prepared to flood the Capitol Wednesday pushing to ban the assault-style rifle used to kill 17 people, vowing to make changes in the November election if they can't persuade lawmakers to change laws before their legislative session ends. About 100 Marjory Stoneman Douglas High School students arrived at a Tallahassee high school to extended applause late Tuesday after a 400-mile trip on three buses. They told the 500 students and parents waiting for them that they are fighting to protect all students. AP

President Trump said on Thursday that he would make school safety a top priority when he meets with the nation's governors later this month, following one of the deadliest school shootings in modern American history. In the address to the nation, he also said he planned to visit the grieving South Florida community where a gunman killed 17 students and adults at a local high school. But he pointedly avoided any mention of gun control.
"We are here for you - whatever you need, whatever we can do, to ease your pain," Mr. Trump said, calling the deaths at Marjory Stoneman Douglas High School in Parkland a "scene of terrible violence, hatred and evil.New York Times

   
Consumers must use Form 1095-A to complete Form 8962 when they file their 2017 taxes. These forms allow consumers to reconcile the total APTC they received during 2017 with the amount of premium tax credit (PTC) for which they are eligible based on their final 2017 income and household information.

Consumers who have health coverage through the Marketplace and receive a Form 1095-A might also receive a Form 1095-B (Non-Marketplace MEC) or Form 1095-C (SHOP & Job-based Coverage), if they or members of their household had coverage in 2017 through other plans outside of the Marketplace, like Medicaid, CHIP or private health insurance.
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For the upcoming 2018 filing season, the IRS will not accept electronically filed tax returns where the taxpayer does not address the health coverage requirements of the Affordable Care Act. The IRS will not accept the electronic tax return until the taxpayer indicates whether they had coverage, had an exemption or will make a shared responsibility payment. In addition, returns filed on paper that do not address the health coverage requirements may be suspended pending the receipt of additional information and any refunds may be delayed. 
 


How Do You Solve a Problem Like Maria?
 
Individuals affected by the 2017 hurricanes in Puerto Rico and the U.S. Virgin Islands who relocated to a state that uses the Federal Health Insurance Exchange, but were unable to enroll during the 2018 Annual Open Enrollment Period or any other special enrollment period, are eligible for an exceptional circumstance special enrollment period to enroll in 2018 Exchange coverage. Individuals in this situation may request this special enrollment period through March 31, 2018. These individuals should contact the Exchange Call Center at 1-800-318-2596 to request enrollment using this special enrollment period.
  For details on Marketplace SEPs, click here.
   
I ndividuals affected by the 2017 hurricanes in Puerto Rico and the U.S. Virgin Islands to enroll, dis-enroll or switch Medicare health or prescription drug plans through March 31, 2018. This special enrollment period can be used even if the beneficiary made a choice during Medicare's fall open enrollment period. The special enrollment period can also be used for those who left Puerto Rico and would like to enroll in a local Medicare Advantage or Medicare prescription drug plan that would better meet their healthcare needs. Beneficiaries who change their permanent residence, rather than temporarily relocate, and no longer reside in their plan service area, are eligible to join a Medicare Advantage or prescription drug plan offered in the new area in which they reside through the existing residence change special enrollment period. Individuals who were displaced and return to Puerto Rico or the U.S. Virgin Islands are also eligible for the residence change special enrollment period. Individuals in these situations may contact 1-800-MEDICARE to request enrollment using this special enrollment opportunity.  
 For details on Medicare SEPs, click here. 
 
 
 
A consumer could end their coverage by cancelling if the consumer's start date has not passed or the consumer has not made their first month's premium. When coverage is cancelled, there is no advance notice required; but the cancellation must be done prior to the policy start date . A consumer would proceed with terminating coverage if the consumer has enrolled and paid at least one month's premium or her coverage has been effectuated. The Marketplace requires 14 days' notice before terminating coverage. For details, click here.

The Trump administration took another swipe at the Affordable Care Act on Tuesday, proposing new rules that would make it much easier for consumers to buy less expensive health insurance policies that do not comply with coverage requirements of the law. Under current rules, such "short-term, limited-duration insurance" cannot last for more than three months. Under the proposal, the limit would be 364 days.New York Times 

Insurers will again be able to sell short-term health insurance good for up to 12 months under a proposed rule released Tuesday by the Trump administration that could further roil the marketplace. "We want to open up affordable alternatives to unaffordable Affordable Care Act policies," said Health and Human Services Secretary Alex Azar. "This is one step in the direction of providing Americans health insurance options that are more affordable and more suitable to individual and family circumstances."
  KHN

        
NACHC/UnidosUS held a webinar on February 13th about Outreach & Enrollment for Puerto Rico and the Virgin Islands. It is the first of a series of targeted webinars over the next several months. The webinar provided information on the unique challenges facing patients impacted by the devastating hurricanes in 2017, as well as effective strategies for health centers and other partners to serve these populations. Please be on the lookout for additional dates and times for future webinars in this series on the NACHC Events page. And please watch the NACHC Outreach and Enabling Services page for updated resources and a link to the recording with the speakers' presentations.
Special thanks to the Robert Wood Johnson Foundation and Community Catalyst for supporting this project.

This is a reminder to please join CBPP for their upcoming Health Reform: Beyond the Basics webinar on the Marketplace appeals process next Wednesday, February 28 at 2:30 pm ET (11:30 am PT). The webinar will be presented by the National Health Law Program (NHeLP) and will detail what decisions can be appealed, how to file an appeal, and ways to expedite the appeal process. To register, click here. 
  
 
PRETTY PLEASE!
 
Use the correct & complete CAC & NAV # on all applications!
***13 characters (FLCAC or FLNAV + A/B/C/D + 2 digit contract # + 5 digit CAC or NAV # ***
*** CAC or NAV # is issued by your employer***
 

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I just received a call from a female consumer. She was fined $695 for not having insurance in 2017. The accountant told her that if she purchased health insurance by March 2018, she would be reimbursed for the 2017 penalty.
That does not sound correct to me. Open Enrollment was over on December 15, 2017 unless she applied for an extension to December 31st because of Hurricane Irma or until March 31st if she relocated from PR/USVI to Florida. In any case, there is no way that she can purchase insurance by March 2018 and avoid the penalty for not having insurance all of 2017.

If a veteran has no insurance, but is eligible to get healthcare at a VA facility, then that veteran would NOT be eligible to use the Marketplace, correct?
Both VA health insurance and Marketplace health insurance is taxpayer-funded and it is illegal to have both at the same time and take APTCs for the Marketplace plan.

I am also a VITA volunteer and have a case I have never experienced before. My consumer's annual household income for a family of 5 went from $9K to $24K but she is being denied an exemption. I don't get it.
Neither do I except that exemptions aren't automatic. You have never actually seen her prior income tax returns or know how she reported that a household of 5 had an income of only $9K. When a decision by the Marketplace is incorrect, you can file an appeal. Even one that is expedited!  If denied the exemption at the beginning of 2017, that's what you might choose to do. However, this decision to deny an exemption (from the penalty) is made by the IRS. You can  click here for information on the IRS appeal process.   

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