Whether you plan to enroll in the Health Insurance Marketplace on your own or through the assistance of a trained Navigator or Certified Application Counselor (CAC), I have five tips for you to consider before you begin the process. These are tips I gleaned from a supplemental training for North Carolina Navigators, and they will help you be prepared to make the best possible health insurance decision for you and your family.
1. As you prepare to either meet with a Navigator or CAC or complete the application by yourself, you will need the following specific information within reach:
- Social security numbers or document numbers for legal immigrants
- Employer and income information for every member of your household (for example, pay stubs and W-2 forms).
- Policy numbers for current health insurance plans covering members of your household
- A completed Employer Coverage Tool – a form which helps you determine if you have access to affordable employer-based coverage
- Previous year’s tax return (recommended by the training)
2. The application and/or the Navigator will ask for you to think about all of your income. For the purposes of determining eligibility for the Advanced Premium Tax Credit (the subsidy that will save you money on your health insurance premiums), income is defined as:
- Wages, salaries, and tips
- Net income from any self-employment or business
- Unemployment compensation
- Social Security payments including disability (with the exception of SSI)
- Other taxable income, such as retirement income, investment income, pension income, rental income, prizes, awards, and gambling winnings
3. When you are comparing the plans available to you on the Marketplace, consider what your priorities for health insurance are for you or your family members. Some questions to consider might be:
- What cost will my budget allow?
- What is more important to me, low monthly premiums or low cost-sharing?
- Do I have specific providers I would like to continue to see?
- What health care services am I and my family most in need of?
- What prescription drugs do I need covered?
The answers to these questions, and others you may consider, will influence the type of health insurance plan you may choose for yourself or your family.
4. The Advanced Premium Tax Credit (APTC) is determined from a projection of your anticipated income for 2014. Try to be as accurate as you can when listing your projected income in order to avoid discrepancies. The IRS will determine the actual amount of your APTC when you file your taxes in 2015, and if they find that your income was more than you projected, you may be required to pay a portion of the credit back. On the other hand, if your income was less than you projected, you may receive a refund. See Tip 2 for a list of types of income the IRS would like reported.
5. To protect privacy and the personal information of clients, Navigators and CACs are not allowed to retain any of your contact information or other personally identifiable information. If you meet with a Navigator or CAC, be sure to leave with your online account information (username and password) for the Marketplace and contact information for the enrollment assister in case you need further assistance.
If you heed these five enrollment tips, you should be well-prepared to engage with the Health Insurance Marketplace and find an affordable health plan that suits your family. Happy shopping!