On October 27, the Internal Revenue Service released a number of inflation-adjusted thresholds for 2017. For calendar year 2017, the dollar individual responsibility penalty for failure to have minimum essential coverage or to claim an exemption from the requirement remains $695 per adult, and half this amount for children, up to a maximum of $6,085 per family. Taxpayers are alternatively subject to a penalty of 2.5 percent of their modified adjusted gross income above the filing limit up to the cost of a 60 percent actuarial value policy if that amount is greater than the dollar value penalty.
When families file their taxes, if their advance premium tax credits exceed the premium tax credits that they were actually due, the caps on the amounts they must repay remain the same in 2017 as they were for 2016: $300 for unmarried individuals (other than surviving spouses or heads of households) with incomes under 200 percent of the federal poverty level (FPL); $750 for those with incomes 200 to 300 percent of the FPL; and $1,275 for those with incomes at least 300 percent but less than 400 percent of FPL. For all other taxpayers (including married individuals), the cap on repayment obligations remains $600 for those with incomes less than 200 percent of FPL, $1,500 for those with incomes between 200 and 300 percent of FPL; and $2,550 for those with incomes at least 300 percent but less than 400 percent of FPL. Individuals with incomes above 400 percent of FPL must repay all advance premium tax credits.
For individuals to qualify for tax subsidies for health savings accounts (HSAs) for 2017 they must be enrolled in high-deductible health plans with deductibles of at least $2,250 but not more than $3,350, and out-of-pocket limits not exceeding $4,500. Family high-deductible health plans must have deductibles of at least $4,500 but not more than $6,750 with out-of-pocket limits not exceeding $8,250. Standardized plans will be available through the marketplaces that qualify for HSA eligibility.
Information For Agents And Brokers
On October 26, the Centers for Medicare and Medicaid Services released at its REGTAP.info website (registration required) a 127 slide primer for the 2017 open enrollment period for agents and brokers participating in HealthCare.gov. The slides cover ten topics:
- Agent/Broker registration reminders and tips,
- An overview of open enrollment,
- Annual redetermination and auto-re-enrollment updates,
- Helping consumers with Data Matching Issues (DMIs),
- New call center resources for agents/brokers,
- Marketplace call center tips,
- Working with navigators and other non-agent/broker assisters,
- An overview of pathways to assist consumers enrolling in coverage through the individual marketplace,
- A step-by-step review of the individual marketplace online application, and
- The Small Business Health Options Program (SHOP) marketplace highlights.
The slides are not formal guidance and most of the information they contain has been released earlier. A number of topics, however, are described with particular clarity, including overviews of the 2017 open enrollment process and of the 2017 annual redetermination and auto-reenrollment process. There is a description of how HealthCare.gov will deal with people who received premium tax credits in 2014 and 2015 and failed to file or reconcile their taxes for those years.
The slides include flow charts clearly contrasting the direct enrollment process—through which the applicant applies using a web-broker or insurer's website that connects with Healthcare.gov—and the marketplace enrollment path, in which the entire enrollment process takes place on the HealthCare.gov website with agent or broker assistance. The slides also walk step by step through the process of applying for assistance online for a new enrollee and a returning enrollee showing each of the screens the applicant would see in the process.
The slides describe a number of marketplace features new for 2017. Features of particular interest to brokers and agents include:
- Lists of agents and brokers who have completed necessary training and been registered to serve marketplace clients and agents and brokers whose registration has been terminated which will be updated as frequently as daily;
- Enhanced agent and broker locator tools on HealthCare.gov which allow consumers to shop for registered agents and brokers based on location and hours of operation;
- A new agent/broker call support center;
- New capacity that allows agents and brokers as well as consumers to use mobile devices to apply and enroll through HealthCare.gov; and,
- Enhancements to the direct enrollment process.
The slides describe the individual shared responsibility requirement for 2017; they note that consumers can use the Internal Revenue Service's "Am I required to make an Individual Shared Responsibility Payment?" tool to determine if they are eligible for an exemption.
As noted earlier, CMS will suggest an alternate plan for individuals who lose coverage because the insurer through which they were covered for 2016 has ceased marketplace participation for 2017. Enrollees who lose coverage are eligible for a "loss of minimum essential coverage" special enrollment period, which means that they will have 60 days from the day they lose coverage, December 31, 2016, to apply for 2017 coverage, a month beyond the normal open enrollment period.
Beginning in 2017, the marketplace is offering a special direct call line for agents and brokers: 855-788-6275. This number is only accessible to agents and brokers who are registered with HealthCare.gov and who enter their national producer number (NPN). It is available 24/7 for password resets for consumer accounts, non-standard special enrollment periods, and other consumer eligibility and enrollment issues. The marketplace also offers an agent/broker email help desk at, open Monday to Friday, 8 am to 8 pm ET, for other issues like identity proofing problems, policy questions, or web-broker inquiries.
An agent/broker call line, 855-267-1515, and email help desk is available Monday to Saturday, 8 am to 10 pm. ET, for agent/broker registration issues and specific enrollment and eligibility policy questions related to the individual marketplace. The web-broker email help desk is available from 9 to 5 ET Monday to Friday.
The slides also describe when and how brokers and agents can use the general marketplace call center to provide consumer assistance. Consumers have to contact the marketplace call center and provide an agent/broker's name and NPN before the agent/broker can access the consumer's information, but thereafter the agent/broker can contact the call center on the consumer's behalf and participate in three-way calls with the consumer and call center. Contact with the call center is appropriate for resolving complex situations or technical difficulties, but not for simply entering information for an application.
The SHOP Agent/broker portal allows agents and brokers to complete proposals for their clients, enroll and track employee participation, modify a client's account, and monitor a client's payment history 24/7. The SHOP call center, 800-706-7893, is available for SHOP issues, Monday to Friday, 9 to 7 ET.
New features in the SHOP marketplace for 2017 include:
- An automatically created profile of registered agents and brokers searchable by employers at HealthCare.gov;
- A standard address format for entering employer and employee addresses;
- Premium breakdowns by employees and dependents, which are available to authorized users (previously premium amounts were only listed as total and employee amounts);
- Employee choice of different metal levels within insurance companies (available in 21 states);
- Plan quality ratings in pilot states (Virginia and Wisconsin); and,
- Reports for agents and brokers through the SHOP agent/broker portal on employer payment delinquencies and marketplace payments to insurance companies by employer to allow tracking of commissions.
REGTAP.info continues to be an invaluable source of information for anyone tracking the ACA. It is incomprehensible to me why it is only available to registered users (although anyone can register) or why it has absurdly tight security requirements (passwords must be changed frequently and after three tries at entering a password a user is locked out).
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2e1RzTi
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