Health Insurance Marketplace Applications Published
September 27, 2013
On September 26, the Department of Health and Human Services (HHS) released the final applications that individuals will use to apply for coverage on the new Health Insurance Marketplace/Exchange beginning October 1. The applications are posted on the Centers for Medicare and Medicaid Services (CMS) website.
These applications will be used in all states with federally facilitated or state partnership Marketplaces. The applications for state-run Marketplaces may differ. The applications will be used both to apply for coverage and to determine whether an individual or family is eligible for a subsidy.
There are three different applications and instructions for each:
- Individual Short Form – For single adults with no dependents who are not eligible for employer health coverage and who want to determine if they are eligible for subsidies.
- Standard Form – For anyone who is eligible for employer health coverage and wants to determine if they are eligible for subsidies.
- Individual Without Financial Assistance – Form that can be used by anyone who does not want to provide employment and income information to determine if they are eligible for subsidies.
Beginning October 1, the forms can be completed online through www.healthcare.gov, or paper forms can be submitted by mail.
What Employers Need to Know
The Standard application includes a section where individuals who are eligible for employer-sponsored health coverage will need to provide information about that coverage.
- If the employer sent the Marketplace Notice – including the optional page 3 – to all employees as required by October 1, individuals will have all the information they need to complete that part of the application.
- If the employer did not send the Marketplace Notice or did not include page 3 of the notice, the individual will not have all the information needed to complete the application.
Page 2 of the Marketplace Notice includes basic information about which employees and dependents are eligible for coverage. The optional page 3 indicates whether the individual receiving the notice is eligible for coverage that meets the minimum value standard, the cost of employee-only coverage and what changes the employer is planning to make for the next plan year.
The Standard application includes a section called the Employer Coverage Tool, which individuals are instructed to take to their employer to get the required information about their employer coverage. The Employer Coverage Tool includes the same information as the Marketplace Notice. All information in the Marketplace Notice and the Employer Coverage Tool is numbered in the same way to make it easier for individuals to transfer the information to the application.
The Application Process
All consumers will be directed to www.healthcare.gov to get information about Marketplace coverage. They will have the opportunity to answer a few questions about their age, the state where they live and whether they currently have coverage. If they live in a state that has a state-run Marketplace, they will be directed to their state Marketplace for more information.
Individuals will complete an application to determine if they are eligible for a subsidy and to review coverage details and premiums for the plans for which they are eligible. They must enroll by December 15 for coverage to be effective on January 1, 2014. The enrollment period will continue through March 31, 2014.
Marketplace Application Checklist
- Social Security Numbers or document numbers for legal immigrants.
- Employer and income information for every member of the household who needs coverage – for example, pay stubs or W-2 forms.
- Policy numbers for any current health insurance plans covering members of the household.
- Information about every job-based plan someone in the household is eligible for, even if they are not enrolled in the plan.
Links to the Applications
Use these links to review the applications:
We encourage you to bookmark our health care reform website, InformedOnReform.com.