Healthcare.gov is still our first choice for signing up for coverage through the Health Insurance Marketplace. It’s comprehensive, provides information in real time, and directly connects consumers with health plan options that apply tax subsidies and discounts for which they may qualify. When it’s working, it’s a great tool! Until Healthcare.gov is the reliable online Marketplace it was intended to be, however, MPCA enrollment staff encourages you to keep those paper applications on hand. The rest of this article outlines who should use the paper applications and provides guidance on how Certified Application Counselors (CACs) and Navigators can assist consumers in completing them.
Who Should Use Paper Applications?
Paper applications are a good option for people seeking health insurance coverage for themselves or family members IF they have had difficulty getting beyond the first steps with Healthcare.gov. If a person has created an account on Healthcare.gov but is unable to complete the identity verification step, CACs and Navigators should help them complete a paper application. If a person’s identity was verified by Healthcare.gov, help the individual call the Health Insurance Marketplace Call Center (1-800-318-2596), which can provide assistance through the rest of the application process.
Guidance for Completing a Paper Application
There are three paper Marketplace Consumer Applications available. You can access them and accompanying instructions here. Two of the applications are used to determine eligibility for low-cost or free coverage in the form of tax credits, cost sharing reductions, and Medicaid/MIChild eligibility:
- The Family Application is used by families even if some members of the household already have insurance
- The Individual Short Form is for single adults who aren’t offered health coverage from their employer, don’t have any dependents, and can’t be claimed as a dependent on someone else’s return
There is also an Individual without Financial Assistance Form for individuals and families to apply for health plans without getting help with costs.
Just like when enrolling online for coverage through Healthcare.gov, the paper application asks the applicant to provide information for everyone in his/her household, including those who don’t need coverage. This information is needed to determine the subsidy a family is eligible for as well as eligibility for Medicaid. If all household members aren’t included, the applicant may qualify for less because the household appears smaller.
The Family Application and Individual without Financial Assistance Form only provide space to include information for one or two additional household members. If an applicant needs to include information for more household members, make as many copies as needed of Step 2: Person 2 and complete.
Common Errors to Avoid When Completing a Paper Application
Now let’s review specific guidance for avoiding common errors made on the paper applications.
Answering tax filing questions
Step 2: Person 1 (page 2) of the Family Application asks questions about the applicant’s plans for filing taxes. Spouses should be listed as filing a joint tax return if they file jointly. If filing separately, answer “No” for #6. In Step 2: Person 2 (page 4), the spouse should be indicated as planning to separately file a federal income tax return.
Spouses are not claimed as tax dependents (there are rare IRS defined exceptions to this rule). Do not list spouses in Step 2: Person 1, #6b or Step 2: Person 2, #7b. Usually, children are tax dependents.
Previous versions of the paper applications included a statement in Step 5 (Family Application) and Step 4 (Individual Short Form and Individual with Financial Assistance Form) that read: “I confirm that no one applying for health insurance on this application is incarcerated (detained or jailed). If not, (name of person) is incarcerated.” The applicant should not sign the incarceration attestation! He/She should only print the name of the incarcerated person on the line.
This has caused so many errors that the current versions of all paper applications have been updated to read: “Is anyone applying for health insurance on this application incarcerated (detained or jailed)? Check YES or NO. If yes, write the name of the person incarcerated here: ________. Check here if this person is pending disposition of charges.” To fill this out correctly, most applicants will check the NO box.
Renewal of coverage
Step 5 (Family Application, page 7) and Step 4 (Individual Short Form, page 3): Renewal of coverage in future years provides six checkbox options for selecting automatic eligibility renewal options. One option MUST be selected for the application to be complete.
The applicant should always sign and date the application, unless an authorized representative has been designated. The current date should be included as the signing date. If the assister signs the application instead, the application is considered invalid, and a call must be made to correct the application.
The last page of each application consists of Appendix C: Assistance with completing this application. The first section allows the applicant to choose an “authorized representative” who can act on behalf of the applicant or enrollee in all matters with the Marketplace. Leave this section blank unless the applicant designates a family member or friend for this role. An assister is discouraged from being an authorized representative in the vast majority of situations, unless it is a service they’ve been providing in the past.
The bottom section of Appendix C is for application assisters: Certified Application Counselors (CACs), Navigators, agents, and brokers. The Marketplace does not allow partial information in this section, nor is it able to supply missing data. All of the following information MUST be provided by a Certified Application Counselor or Navigator to get credit for the assistance provided:
- Application start date
- Assister’s full name
- Organization name
- ID number
If a paper application is incomplete, especially if it is missing data that is important to eligibility, it is set aside for a follow-up phone call to capture the missing information. Because this slows down the processing time, it is important to complete the whole form before sending it in.
After an application has been completed, make a copy for the applicant, as the original application will not be returned. Some early versions of the paper application include a Washington, DC, mailing address. Make sure the applicant mails the completed application to:
Health Insurance Marketplace
Dept. of Health and Human Services
465 Industrial Blvd.
London, KY 40750-0001
What will happen once HHS receives the paper application? Staff at the eligibility support center in London, Kentucky, will scan the paper application and check for errors. The information is then input into the online system—yes, the same Healthcare.gov we use. Once submitted, an eligibility determination notice is mailed to the applicant, including directions for any next steps. If eligible for a qualified health plan, the applicant can then either contact the Marketplace Call Center or go to Healthcare.gov to compare and select a plan.
If you have any questions about the instructions in this article, please contact Julie Tatko, MPCA Program Coordinator, Outreach, Education & Enrollment.