Supplement Healthcare Coverage Application

Transcription

1 Page 1 Supplement Healthcare Coverage Application About the Healthcare Coverage Application Starting October 1, 2013, you can apply for health coverage through the new Health Insurance Marketplace. Coverage begins as soon as January 1, The Marketplace is designed to help you find health coverage that fits your budget and meets your needs. Through a streamlined application process, you ll find out if you can get savings that you can use right away to help you pay your premium amount for private health coverage. You can also find out if you qualify for free or low-cost coverage through Medicaid or the Children s Health Insurance Program (CHIP). For your convenience, there are different ways to apply to the Marketplace. The fastest way is to apply online at HealthCare.gov. If you apply online, you ll also get your eligibility results right away. - CMS Product No The Benefit Bank online service offers the ability to complete the paper version of the Application for Health Coverage & Help Paying Costs. This enables you to help your clients in obtaining healthcare coverage. Clients who are interested in medical help should always use QuickCheck for guidance on which application to complete. The enhanced QuickCheck helps guide OBB clients to the appropriate healthcare coverage program, as well as continuing to provide a rough assessment for multiple other benefits and tax credits. Your QuickCheck results will be critically important when completing the Healthcare Coverage Application as application submission depends upon the program for which your client is applying. Clients applying for Medicaid programs must send their applications to their County Department of Job and Family Services (CDJFS) and those applying for Marketplace coverage should apply directly through the Marketplace online, by phone, or with the assistance of a Navigator or Certified Application Counselor. To find an in-person assister, visit OhioForHealth.org. Before you begin, it may help to have this information ready: Social Security numbers (SSNs) Document numbers for eligible immigrants who want health coverage Birth dates Paystubs, W-2 forms, or other information about your family s income Policy/member numbers for any current health coverage Information about any health coverage from a job that s available to you or your family, even if you are not covered by that plan

2 Page 2 Medicaid Coverage Healthy Start and Healthy Families (Medicaid) This is a health care program that offers free health coverage to families, children (up to age 19) and pregnant women. Coverage includes: Doctor visits, hospital care, pregnancy related services, prescriptions, vision, dental, substance abuse, mental health services, and much more to help families stay strong and healthy. Eligibility Be a United States Citizen or meet Medicaid citizenship requirements. The immigration rules are complex but programmed into The Benefit Bank Have or get a Social Security number Be an Ohio resident Children (up to age 19) in families with income up to 206% of the federal poverty level Pregnant women in families with income up to 200% of the federal poverty level Families with income up to 138% of the federal poverty level and a child younger than age 19 Application Submission This application should be printed and mailed/handdelivered to your local County Department of Job and Family Services office. Find your county office here: Clients can also apply through the Ohio Benefits portal: Next Steps Shortly after you enroll in Medicaid, you may get a letter asking you to choose a Medicaid Managed Care plan. The best way to enroll in Managed Care is online through the Consumer Hotline: Medicaid for Adults This is a health care program that offers free health coverage to adults between the ages of 19 to 64, who are not eligible under another category of Medicaid. Coverage includes: Doctor visits, hospital care, pregnancy related services, prescriptions, vision, dental, substance abuse, mental health services, and more. Eligibility Be a United States Citizen or meet Medicaid citizenship requirements. The immigration rules are complex but programmed into The Benefit Bank Have or get a Social Security number Be an Ohio resident Adults with income up to 138% of the federal poverty level Application Submission This application should be printed and mailed/handdelivered to your local County Department of Job and Family Services office. Find your county office here: Clients can also apply through the Ohio Benefits portal: Next Steps Shortly after you enroll in Medicaid, you may get a letter asking you to choose a Medicaid Managed Care plan. The best way to enroll in Managed Care is online through the Consumer Hotline:

3 Page 3 Marketplace Coverage Marketplace Insurance Coverage This is a health care program that offers affordable health coverage. Most people are eligible for health coverage through the Health Insurance Marketplace. The cost of coverage will vary depending on household income, the type of coverage select, and other considerations. Generally, health insurance coverage in the Marketplace covers health care provided by doctors, hospitals, and medical services within the United States. Open Enrollment Period For 2014 coverage, the Open Enrollment period ended March 31, The Open Enrollment Period for 2015 coverage is November 15, 2014 February 15, Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events. More on qualifying life events can be found here: qualifying-life-event/. Eligibility Must live in the United States Must be a U.S. citizen or national (or be lawfully present). Cannot be currently incarcerated Application Submission The fastest way to apply for Marketplace insurance coverage is to apply online at HealthCare.gov. Clients may also apply by phone at or with the assistance of a Navigator or Certified Application Counselor. To Find an in-person assister, visit OhioForHealth.org. Advance Premium Tax Credit (APTC) The Affordable Care Act provides a new tax credit to help you afford health coverage purchased through the Marketplace. Advance payments of the tax credit can be used right away to lower your monthly premium costs. If you qualify, you may choose how much of the credit to apply to your premiums each month, up to a entire credit. If the amount of advance credit payments applied to your premiums throughout the year is less than the tax credit you re due, you ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return. Eligibility If your income falls within % of the federal poverty level, you ll generally qualify for a premium tax credit. The lower your income is, the bigger your credit. Application Submission The fastest way to apply for the APTC is to apply online at HealthCare.gov. Clients may also apply by phone at or with the assistance of a Navigator or Certified Application Counselor. To Find an inperson assister, visit OhioForHealth.org.

4 Page 4 TBB PRACTICE Complete Rajesh s Healthcare Coverage Application Select QuickCheck from your counselor portal. Healthcare Coverage Application Practice Now that you know more about the programs available through the Healthcare Coverage Application, let s see how it looks on The Benefit Bank. The first thing we need to do is perform a QuickCheck with our client to determine for which program we ll need to apply. QuickCheck 1. Today s client lives in Ohio 2. Rajesh Nepal is age He plans to file a 2014 tax return 4. He will not be claimed as a dependent by anyone 5. There are two other people in his household 6. He does not claim anyone on his taxes that doesn t live with him 7. His wife, Katie, is Katie will file jointly with Rajesh 9. Their child, Maya, has yet to turn 1 (0) 10. No one has a physical, mental, or emotional condition that causes limitations in activities 11. No one is pregnant 12. They pay $800/mo in rent 13. They pay $100/mo in utilities 14. They pay for telephone and heating/cooling 15. They did not receive help from HEAP this year 16. Rajesh makes $1,400/mo from work 17. He does not pay alimony, child support, or child care 18. Katie is also Maya s parent After the QuickCheck results load, click Health Coverage on the right side of the page to open the eligibility details. Based on the information we entered today, we can see that these clients are most likely to be eligible for Medicaid Coverage.

5 Page 5 Create a Client Next we ll begin the application process. Use the information on the right side of the page to create a client account for Rajesh Nepal. Please keep in mind that this is not a real address. A message will appear informing us of this. Click continue with the address you entered to move forward. After you ve successfully created the account, sign into the client s account, agree to the Terms and Conditions of Use, and choose Healthcare Coverage Application from the list of benefits. Choose a UNIQUE login name. Do not use rnepal When done, click Save Household Information 19. Rajesh s title is Mr. 20. Yes, there are other people in his household, his wife Katie and daughter Maya 21. Use the table below to complete the Household Information section. Household Member Date of Birth Marital Status Sex Social Security Number Citizen? Disabled/ Blind? Rajesh S. Dec 1, 1966 Married M Yes No Katie M. Feb 5, 1971 Married F Yes No Maya L. Oct 1, 2013 Single F Yes No 22. Rajesh prefers English 23. He does not have a separate mailing address 24. His home telephone number is

6 Page 6 Healthy U and Other Programs 25. Rajesh is not receiving Food Assistance, cash assistance, or Medicaid at this time 26. No one in the household is a veteran 27. No one lives with a long-term medical condition such as arthritis, diabetes, high blood pressure, or heart disease 28. Rajesh is not a caregiver but Katie is a caregiver 29. Katie is interested in receiving more information about caregiver resources 30. Yes, they would like to give consent to send their name and contact information to the Area Agency on Aging Voter Registration 31. Rajesh is already registered to vote - select no Additional Relationships 32. Katie M. Nepal is Maya L. Nepal s mother Healthcare Coverage Options 33. The Nepals would only like to apply for Medicaid and Marketplace coverage Healthcare Applicants and Tax Information 34. Rajesh and Katie plan to file a joint tax return 35. Maya will be claimed as a dependent on their tax return 36. They will not claim a dependent who does not live in their home 37. All members of the household would like to apply for coverage Income 38. Rajesh has two work-related incomes from wages 39. The first income source is Smith and Honor : 987 N High St., Columbus, OH The employer s phone number is He just got paid last Friday 42. His gross income from this source is $1,000 paid once per month 43. This gross income does not include any deductions 44. He works 20 hours a week at this job 45. He is still employed by this employer Select the button labeled click here if you have more information to enter to add another work-related income 46. Rajesh s second work-related income source from wages is Fun for All Skate Zone : 123 Funday Ave., Columbus, OH The employer s phone number is He was last paid two Fridays ago 49. His gross income from this source is $200 and he gets paid once every two weeks 50. This gross income does not include any deductions 51. Rajesh works 5 hours per week at Fun for All Skate Zone

7 Page He is still employed by this employer 53. He does not have any other income sources to enter 54. Confirm the monthly income calculations Income Deductions 55. Rajesh pays $150 in student loan interest each month Current Healthcare Coverage 56. The Nepals are not covered by Medicaid, CHIP, Medicare, TRICARE, Veterans Affairs healthcare programs, or Peace Corps healthcare 57. No one is offered healthcare coverage through their employer 58. No one is enrolled in any other type of healthcare coverage Final Questions and Forms 59. Rajesh did not change jobs, start working fewer hours, or stop working 60. No one s income changes from month to month 61. No one has a physical, mental, or emotional condition that causes limitations in activities 62. No one lives in a medical facility or nursing home 63. Katie is not pregnant 64. The Nepals do not want help paying bills for medical services they received in the past three months 65. Maya did not have healthcare coverage through a job and lose it within the past three months 66. Maya is not a full-time student 67. No one is in jail, prison, or a juvenile detention center 68. The Nepals are not American Indian nor Alaskan Natives 69. They do not have a Hispanic or Latino background 70. Rajesh, Katie, and Maya are Nepali 71. They prefer to speak, read, and write in English 72. They do not wish to name an authorized representative 73. Please select whether you are a navigator/certified application counselor or not 74. Rajesh would like to use their primary phone number that we already entered 75. He would like to receive information about the application using the address we already entered 76. Yes, Rajesh would like Medicaid or the Marketplace to use information from tax returns during the healthcare coverage renewal period for the next 3 years Please make sure to review the Application for Health Coverage and Help Paying Costs as well as the Ohio Health Coverage and Help Paying Costs Follow-Up Instructions.

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