I. MARKETPLACE UPDATES: System Fix Affecting Certain

Tuesday, April 21, 2015
This week’s assister newsletter features several important Marketplace updates: first, consumers affected by
the System Fix Affecting Certain Immigrants Below 100% FPL can now apply for a Prospective or
Retroactive SEP; second, consumers affected by the system issue where the FFM was incorrectly
counting the income of certain tax dependents with Social Security income should now report a life
change so they can receive a new eligibility determination that will include appropriately calculated household
income moving forward; finally, CMS has updated the tag lines on Marketplace notices to indicate that the
notice may contain important information and deadlines for action needed, along with information about the
availability of free interpretation services.
Additionally, the TIPS on Filing Taxes section includes two important reminders about the Tax Penalty special
enrollment period (SEP), which ends on April 30, and options for consumers with incorrect Forms 1095-A. We
also encourage you to check out responses to assister questions from the April 2, 2015 assister webinar
on helping consumers report a change in circumstance to the Marketplace in the “Webinar Resources”
section, which also includes presentation slides from the April 10, 2015 presentation, “An Assister’s Guide to
Working with Agents and Brokers.” Finally, see the section titled, “NEW CMS Resource!” to learn more
about CMS’ “Hospital Compare” resource, which now includes star ratings based on survey data to make it
easier for consumers to choose a hospital and understand the quality of care it delivers.

I. MARKETPLACE UPDATES: System Fix Affecting Certain Immigrants Below 100% FPL now allows
for a Prospective and Retroactive SEP / System Issue-FFM Incorrectly Counting Income of Certain
Tax Dependents with Social Security Benefits / NEW - CMS Updated Tag Lines for all Notices /
REMINDER - CMS Announces Opportunity to Apply for Navigator Grants in Federally-facilitated and
State Partnership Marketplaces

II. TIPS on Filing Taxes: UPDATED Healthcare.gov Blog Post “Is your Form 1095-A correct?” and
Reminder of Option to Apply for Tax Filing Extension / Tax Penalty SEP Social Media Promotional
Materials

III. Grab Bag FAQ: COBRA Coverage and the Marketplace / Hardship Exemptions and Catastrophic
Plans / Enrolling a Young Adult in Coverage

IV. Webinar Resources: Presentation Slides from “An Assister’s Guide to Working with Agents and
Brokers” / Q&A from “Helping Consumers Report a Life Event or Change in Circumstance

V. NEW CMS Resource! Hospital Compare Star Ratings Based on Patient Satisfaction

VI. Reminders: Coverage Effective Dates for Consumers with SEPs / Reminder to use SEP and
Exemptions Tools

VII. Outreach Materials of the Week: U.S. Surgeon General and Elmo of Sesame Street discuss the
importance of vaccines

VIII. Assister Spring Webinar Schedule and Supplemental Webinars

IX. Assister Resources and Contact Information for Assisters
I. MARKETPLACE UPDATES: System Fix Affecting Certain Immigrants Below 100% FPL
now allows for a Prospective and Retroactive SEP / System Issue-FFM Incorrectly
Counting Income of Certain Tax Dependents with Social Security Benefits / NEW - CMS
Updated Tag Lines for all Notices / REMINDER - CMS Announces Opportunity to Apply
for Navigator Grants in Federally-facilitated and State Partnership Marketplaces
1. UPDATE/NEW: System Fix Affecting Certain Immigrants Below 100% FPL now allows
for a Prospective and Retroactive SEP
KEY TAKEAWAY: As we shared in the March 17, 2015 Assister newsletter, we have resolved a system issue
in which not all applicants who were eligible for APTC based on an income under 100% of the Federal Poverty
Level and ineligibility for Medicaid due to immigration status received APTC. Consumers affected by this issue
can now change their applications to receive an updated APTC determination. NEW: The consumers
impacted by this system issue now can qualify for a prospective or retroactive special enrollment
period (SEP).
BACKGROUND: The Marketplace application includes a question to help consumers who have been denied
Medicaid and CHIP by the state because of their immigration status to be assessed for APTC and CSRs. The
question asks:
“Was this person found not eligible [for Medicaid or CHIP] by their state because of their immigration status”?
The question appears when: (1) an applicant attests to being denied eligibility for Medicaid or CHIP, and (2) the
applicant attested earlier in the same application to having a QHP-eligible immigration status. Answering this
question allows the Marketplace to properly evaluate individuals with income under 100% FPL for APTC and
CSRs when they have an immigration status that makes them ineligible for Medicaid or CHIP.
SYSTEM ISSUE: We have resolved a system issue that was affecting certain immigrants with incomes below
100% of FPL who applied for coverage with financial assistance between 11/15/14 and 3/13/15. Previously,
when a household applied for Marketplace coverage and more than one applicant selected “yes” to the
question below asking whether the applicant was denied Medicaid or CHIP eligibility based on his or her
immigration status, the system issue was causing only the first person on the list of applicants to receive
APTC. This issue has been resolved so that all applicants who select “yes” to the question described above
can receive APTC, if otherwise eligible.
If a consumer meets the criteria above they may have been impacted by this system issue, and can confirm by
looking at their Eligibility Determination Notice (EDN) which will display two distinct patterns listed below.
Consumers can also contact the Marketplace Call Center to see if they were impacted by this system issue.
1.
The EDN will show that the first applicant was found eligible for APTC and CSRs, while the other
applicants were not.
2.
Under the EDN section titled “Why Don’t I Qualify for Other Programs?” the applicants who are
affected by this system issue and found not eligible for APTC or CSRs will have the message: “Your
household’s yearly income is too low for a tax credit. Generally, individuals and families whose
household income for the year is between 100 percent and 400 percent of the federal poverty line for
their family size may be eligible for the tax credit.”
NEW INFO FOR IMPACTED CONSUMERS: Assisters can help consumers who were affected by this issue to
see if they are eligible for a Special Enrollment Period (SEP) that can be prospective or retroactive with a
coverage effective date of January 1, 2015. Assisters should help consumers follow the instructions below.
1.
Option 1: Visit Healthcare.gov to determine if consumer is eligible for an existing SEP
(prospective coverage only). Visit Healthcare.gov, log into account, and select “Report a Life
Change” to update application. Consumers who are already eligible for an SEP can choose a plan
and enroll. Consumers affected by the system issue are likely able to attest to the following question
which grants an SEP: “Did any of these people apply for coverage between November 15, 2014 February 15, 2015? (Select their names if they applied through their state or the Marketplace).” If a
consumer is able to enroll through this SEP and does not want retroactive coverage, they can enroll
prospectively with no further action needed. If a consumer is able to enroll through the SEP and
would like to enroll retroactively, they can do so by calling the Marketplace Call Center as outlined
below.
2.
Option 2: Contact Marketplace Call Center for an SEP (prospective and/or retroactive
coverage).Consumers affected by the system issue can call the Marketplace Call Center at 1-800318-2596 / TTY: 1-855-889-4325. Consumers should explain that they were affected by the
“immigration block system issue” and that only some people in their household received APTC when
they applied earlier. A Call Center Representative will help the consumer complete an application and
grant a prospective SEP, if one is not unlocked by answering the question described above.
Consumers can also request a retroactive SEP with a coverage effective date of January 1, 2015. Note:
consumers who request retroactive coverage will be responsible for premiums due back to the coverage start
date and will be responsible for any deductibles, co-pays, and co-insurance for services received during those
months.
2. UPDATE/NEW: System Issue-FFM Incorrectly Counting Income of Certain Tax
Dependents with Social Security Benefits
KEY TAKEAWAY: CMS has resolved a system issue where the FFM was incorrectly counting the income of
certain tax dependents with Social Security income. Consumers who were impacted should report a life
change to the Marketplace and complete the application to receive a new eligibility determination which will
appropriately calculate their household income moving forward.
Income from a tax dependent is only included in the household income if the tax dependent has income that
requires them to file taxes. This is true of all tax dependents, regardless of age. If a tax dependent only has
Social Security benefits, they do not meet the requirement to file taxes and therefore their income should not
be counted toward the household income.
As we shared in the March 10, 2015 newsletter, the Federally-facilitated Marketplace (FFM) was experiencing
a system issue causing income of certain tax dependents with only Social Security income to be incorrectly
included in household income. This did not impact consumers who do not receive Social Security benefits,
households that do not include tax dependents, or households where no tax dependent has Social Security
benefits.
NEW: CMS did implement a system fix on April 17th for this issue, so consumers applying as of April 17th will
no longer be affected by this defect. Consumers who have households with tax dependents whose only
income was Social Security benefits and do not meet the requirement to file taxes may have been impacted by
this issue. Assisters who are helping consumers who were impacted should go back to their application and
report a life change (even if they do not have a change to make), complete the application, and they will then
receive a new eligibility determination based on the corrected household income. Assisters should NOT
change their current approach, which is to help consumers enter all of their income and let the FFM calculate
which income to include or exclude.
We will share more information soon about how consumers who were impacted by this issue can access a
Special Enrollment period (SEP).
3. NEW: CMS Updated Tag Lines for Notices
KEY TAKEAWAY: Assisters working with consumers who speak another language may be interested to know
that CMS has updated the tag lines on Marketplace notices for Individuals/Families to indicate that the notice
may contain important information related to a consumer’s Marketplace coverage and deadlines for action
needed, along with information about the availability of free interpretation services.
On April 17, 2015, CMS updated the tag lines in Federally-facilitated Marketplace systems-generated notices
to better alert consumers that the notice might contain important dates/deadlines for action and provides
information on how to get help to understand the notice in a language of their preference. The tag lines include
15 languages and now appear in eligibility determination notices, appeals notices, and other ongoing
operational consumer notices being generated. The new tag line reads as follows:
“This notice has important information. This notice has important information about your application or
coverage through the Health Insurance Marketplace. Look for key dates in this notice. You may need to take
action by certain deadlines to keep your health coverage or help with costs. You have the right to get this
information and help in your language at no cost. Call 1-800-318-2596 and wait through the opening. When an
agent answers, state the language you need and you’ll be connected with an interpreter.”
4. REMINDER: CMS Announces Opportunity to Apply for Navigator Grants in Federally-
facilitated and State Partnership Marketplaces
Last week, the Centers for Medicare & Medicaid Services (CMS) announced the availability of funding to
support Navigators in Federally-facilitated Marketplaces (FFM), including State Partnership Marketplaces.
Grantees will be selected for a three year project period, and a total of up to $67 million is available for the first
year of the award. The multi-year grant award will be funded in 12-month increments and continued funding will
be contingent on the grantee continuing to meet all Navigator program requirements and on funding
availability. The funding opportunity announcement is open to eligible individuals, as well as private and public
entities, applying to serve as Navigators in states with a FFM. It is open to new and returning HHS Navigator
grant applicants, and applications are due by June 15, 2015.

To access the funding opportunity announcement, visit: http://www.grants.gov, and search for CFDA #
93.332.

To view the CCIIO website dedicated to In-Person Assistance in the Health Insurance
Marketplaces, click here.

To view the press release that accompanied this announcement, click here.
In addition, below are key dates for pre-application calls:

First call: Wednesday, April 29, 2015 from 2:00 to 3:30 p.m. Eastern Time
o Audience URL: Click here
o Webcast title: Navigator Funding Opportunity Announcement Pre-Application Webinar 4-29-15

Second call: Wednesday, May 6, 2015 from 4:00 to 5:30 p.m. Eastern Time
o Audience URL: Click here
o Webcast title: Navigator Funding Opportunity Announcement Pre-Application Webinar 5-6-15

Third call: Wednesday, May 20, 2015 from 11:00am-12:30 p.m. Eastern Time
o Audience URL: Click here
o Webcast title: Navigator Funding Opportunity Announcement Pre-Application Webinar 5-20-15

Fourth call: Wednesday, June 3, 2015 from 2:00-3:30 p.m. Eastern Time
o Audience URL: Click here
o Webcast title: Navigator Funding Opportunity Announcement Pre-Application Webinar 6-3-15
II. TIPS on Filing Taxes: UPDATED Healthcare.gov Blog Post “Is your Form 1095-A
correct?” and Reminder of Option to Apply for Tax Filing Extension / Tax Penalty SEP
Social Media Promotional Materials
1. UPDATED Healthcare.gov Blog Post “Is your Form 1095-A correct?” and Reminder of
Option to Apply for Tax Filing Extension for Consumers with an Incorrect From 1095-A
The HealthCare.gov blog post regarding incorrect Forms 1095-A has been updated; it can be
accessedhere. This updated post includes more recent guidance and information for consumers who received
an incorrect Form 1095-A.
As a reminder, consumers who were unable to file an accurate tax return by April 15 due to problems related to
a Marketplace tax statement (Form 1095-A) had the option to file Form 4868, the Application for Automatic
Extension of Time To File U.S. Individual Income Tax Return. This form needed to be filed with the IRS by
April 15. Also, please note that for consumers who file a Form 4868, the consumers have an extended time to
file, but not an extension to pay any tax they owe. Form 4868 provides further information. Form 4868 is
available on IRS.gov, through tax software or from a tax professional. Finally, please also note that, as
previously announced, any individual who enrolled in qualifying Marketplace coverage, received an incorrect
Form 1095-A, and filed his or her tax return based on that form does not need to file an amended tax
return. The IRS will not pursue the collection of any additional taxes from these individuals based on updated
information in the corrected forms.
For more details about this extension, please see the following links:

Friday, April 3, 2015 Statement from a Treasury Spokesperson on Forms 1095-A

Questions and Answers - Incorrect Forms 1095-A and the Premium Tax Credit (In particular,
please see questions and answers 1, 2, 3, and 8.)
2. REMINDER – Tax Penalty SEP Open Through April 30, 2015; Promotional Materials
Available
Uninsured tax filers who owe a fee on their 2014 taxes for not having minimum essential health coverage in
2014 have 10 more days to take advantage of a Special Enrollment Period through the Federally-facilitated
Marketplace to enroll in health coverage for the remainder of 2015.
“We understand the requirement to have insurance is new, which is why we’re providing this last chance for
those who are uninsured, are paying a fee, and were not aware of or did not understand the implications of the
fee with an opportunity to enroll in affordable coverage for the rest of the year,” said Kevin Counihan. As of
April 13, more than 68,000 consumers have taken advantage of this opportunity to sign up for coverage
through the Federally-facilitated Marketplace. “We hope uninsured tax filers take the next few days to learn
about the options and financial assistance that is available and to enroll in a plan that meets their needs –
rather than taking the risk of choosing to get by without insurance for another year.”
In order to take advantage of this Special Enrollment Period, consumers must meet all of the following
requirements:

They did not know that the health care law required them and their household to have health
coverage, or they didn’t understand how that requirement would affect their family.

They owe a fee for not having minimum essential coverage for one or more months in 2014;

They are not already enrolled in minimum essential coverage for 2015.

They live in a State with a Federally-facilitated Marketplace; some State-based Marketplaces are
offering similar Special Enrollment Periods as well.
For those who are required to file taxes, the fee for not having minimum essential coverage in 2014 was 1
percent of household income or $95 per person, whichever is greater. This fee will increase in 2015 to 2
percent of household income or $325 per person, whichever is greater. The fee is pro-rated based on how
many months a person is uninsured. If an individual who would otherwise have to pay a fee enrolls in coverage
for the remainder of 2015, they will pay the fee only for the months they were uninsured.
Additional information for consumers:
Consumers seeking to take advantage of the Special Enrollment Period can find out if they are eligible by
visiting this page on HealthCare.gov. Consumers should also be aware of the following:
1.
Act now to avoid owing the full fee next year. This Special Enrollment Period is only open until
April 30, 2015. Consumers who don’t have minimum essential coverage for the remainder of 2015 risk
owing the fee for whatever portion of the year they don’t have coverage.
2.
Plans might be more affordable than you think. Eight out of 10 people can find minimum essential
coverage for $100 or less a month with tax credits through the Marketplace.
3.
You benefit from increased competition and choice. Compared to last year, there are over 25
percent more health insurance companies participating in the Marketplace in 2015. More than 90
percent of consumers will be able to choose from three or more health insurance companies—up from
74 percent in 2014- and consumers can choose from an average of 40 health plans in their county for
2015 coverage—up from 30 in 2014.
4.
More information and help is available. Consumers can explore their options and get answers to
questions at HealthCare.gov. Personal assistance is also available 24-7 by calling the Marketplace
Call Center at 1-800-318-2596.
Tax Penalty SEP Social Media Promotional Materials: This blog posting on HealthCare.gov provides a
consumer-friendly summary of this SEP, and the SEP Screener Tool includes it as one of the options. Use this
shortened hyperlink to the blog to insert in the sample Tweets below: http://1.usa.gov/1GQhenr. The blog is
also available in Spanish; use this shortened link for the sample Spanish –language
Tweets:http://1.usa.gov/1GpT8my. Finally, English and Spanish language graphics are available here.
Tax Penalty SEP Promotional Language:
The Health Insurance Marketplace is providing individuals and families who paid the fee for not having health
coverage when they filed their 2014 taxes with one last chance to get covered for 2015.
Get covered, avoid the fee. The fee for people who don’t have health coverage increases in 2015 to $325
per person or 2% of your household income – whichever is greater. The good news is you have until April
30 to learn about the options and financial assistance that is available and to enroll in a plan that meets your
needs.
Join the millions who are saving: 8 out of 10 people can find coverage for $100 or less a month with tax
credits through the Marketplace.
The Special Enrollment Period ends next week; act now to take advantage of this extended opportunity to
get quality coverage this year.
III. Grab Bag FAQ: COBRA Coverage and the Marketplace / Hardship Exemptions and
Catastrophic Plans / Enrolling a Young Adult in Coverage
This Grab Bag FAQ section features answers to questions that assisters asked during the March 6, 2015
assister webinar presentations on health insurance oversight and the Exemptions Screener Tool.
1. COBRA Coverage and the Marketplace
Q: Can a consumer who loses his or her job opt not to take COBRA because he or she considers this
option too expensive, and then qualify for a special enrollment period (SEP) to enroll in Qualified
Health Plan (QHP) coverage on the Marketplace?
A: In situations like the one this question poses, Consumers who are eligible for COBRA due to a loss of
employer-sponsored coverage (ESC), but have not yet enrolled, can choose not to enroll in COBRA coverage
and may instead qualify for subsidies through the Marketplace. If this occurs outside of the Marketplace Open
Enrollment Period, these consumers may be eligible for an SEP to enroll in QHP coverage on the Marketplace
outside of the annual Marketplace Open Enrollment Period based on the loss of their employer-sponsored
coverage.
Consumers who are eligible for COBRA and choose to enroll in COBRA coverage, will only be eligible to enroll
in QHP coverage on the Marketplace if it is during the annual Marketplace Open Enrollment Period or when
their COBRA coverage expires. Consumers who voluntarily end their COBRA coverage early (before it expires)
and it is outside of the annual Marketplace Open Enrollment Period are not eligible to enroll in QHP coverage
on the Marketplace. There are several additional situations related to COBRA coverage that it may be helpful
to understand. The cases below apply to consumers who do initially accept an offer of COBRA coverage;
options for these consumers depend on two things: if it's during an annual Open Enrollment Period, and if they
dropping their COBRA coverage before it runs out.
Therefore, consumers who lose ESC outside of Open Enrollment and opt not to take COBRA, opt to take
COBRA and it expires outside of Open Enrollment, or opt to take COBRA and drop it during Open Enrollment,
are all eligible to enroll in QHP coverage on the Marketplace. While, consumers who lose ESC, opt to take
COBRA, and then decide to drop COBRA outside of Open Enrollment and before it expires, are not eligible for
QHP coverage on the Marketplace.
For more information about COBRA and the Marketplace, see this page on HealthCare.gov
2. Hardship Exemptions and Catastrophic Plans
Q: If a consumer is eligible for a hardship exemption, but applies for it outside of Open Enrollment, can
she still buy a catastrophic plan?
A: Consumers may only enroll in catastrophic coverage plans outside of Marketplace open enrollment periods
if they qualify for an SEP due to changes to their household, income, or certain other factors. For more
information about hardship exemptions and catastrophic coverage see this fact sheet onMarketplace.cms.gov,
and this page on HealthCare.gov.
3. Enrolling a Young Adult in Coverage
Q: Does a parent have to enroll a young adult child in his or her employer-sponsored coverage?
(Note: clarification in underlined and bold from Q and A included in the April 14, 2015 newsletter.)
A: No, a parent is not required to enroll a young adult child in his or her employer-sponsored
coverage. However, the young adult may be subject to the individual shared responsibility requirements (the
fee for not having health coverage) if he or she goes without minimum essential coverage for three or more
monthsand is not eligible for an exemption from the requirement to have health coverage. If the young adult is
still a tax dependent, the fee will be assessed as part of the parent’s tax return when the parent files taxes the
following year. If the young adult is not a tax dependent and files his or her own taxes, the young adult will be
responsible for paying the fee with his or her tax return when filing taxes the following year.
IV. Webinar Resources: Presentation Slides from “An Assister’s Guide to Working with
Agents and Brokers” / Q&A from “Helping Consumers Report a Life Event or Change in
Circumstance
1. NEW Presentation Slides from “An Assister’s Guide to Working with Agents and
Brokers” Assister Webinar
The Friday, April 10 2015 assister webinar featured a presentation on how and when assisters can work with
and/or refer consumers to agents and brokers. The presentation was based on this CMS tip sheet, which was
released last February 2015. Last week’s newsletter included a summary of this presentation, along with
answers to assisters’ questions addressed during the webinar.

Presentation slides from the April 10, 2015 webinar can be accessed here; you can also view them
along with other Guidance & regulations on assister programs here.
2. NEW Q&A from “Helping Consumers Report a Life Event or Change in Circumstance”
Webinar
The April 2, 2015 assister webinar featured an updated presentation on “Helping Consumers Report a Life
Event or Change in Circumstance.” There are multiple reasons why consumers may need to report a life
change, including marriage, pregnancy, or a change in income. It is important for consumers to report a life
change as soon as possible to the Marketplace because (1) this information may change the coverage or
savings for which consumers are eligible; or (2) consumers may be eligible for a special enrollment period
(SEP) as a result of the life change.
It is also important to remember that consumers can adjust the amount of APTC they have by reporting a life
change, regardless of their SEP eligibility. (See the Grab Bag FAQ section of the April 7, 2015 assister
newsletter for more information on how to adjust APTC.)
We will post slides from the webinar as soon as they become available; note that a detailed summary
of this presentation was featured in the April 7, 2015 assister newsletter. Answers to questions that
assisters asked during the webinar are included below.
Q1: Is a new diagnosis of chronic disease like cancer considered as life change?
A1: No, a new diagnosis of a disease, whether it is chronic or acute, is not considered a reportable life change
to the Marketplace.
Q2: Is eligibility for an SEP for Medicaid or CHIP denial only given if the consumer started a
Marketplace application prior to end of Open Enrollment?
A2: Consumers who applied for coverage on the Marketplace through HealthCare.gov or the Call Center
during Open Enrollment and were assessed potentially eligible for Medicaid or CHIP, but were later determined
ineligible for Medicaid or CHIP by their state’s Medicaid or CHIP agency, can come back to the Marketplace
and receive an SEP to enroll in prospective Marketplace coverage, if otherwise eligible. To do this, consumers
can either pick up and complete their pre-populated application after receiving a notice from the Marketplace,
or, upon receiving their Medicaid or CHIP denial letter, return to the Marketplace, report a life change, and, in
response to the appropriate questions, select the names of the individuals who were denied Medicaid or CHIP
(within the required timeframes) and who applied during Open Enrollment.
Consumers who applied for Medicaid or CHIP at their state Medicaid or CHIP agency during Open Enrollment
and were determined ineligible, can also apply for this prospective SEP in the same manner. In addition,
consumers who originally applied for coverage on the Marketplace through HealthCare.gov or the Call Center,
were assessed potentially eligible for Medicaid or CHIP, but were later determined ineligible by their state
Medicaid or CHIP agency, and want to avoid a gap in coverage, may contact the Marketplace Call Center to
request an SEP with a retroactive coverage effective date.
Q3: Can consumers be eligible for an SEP if they have employer-sponsored coverage but did not
realize that it is not considered minimum essential coverage?
A3: Consumers who have ESC that is not considered MEC do not qualify for an SEP.
Q4: Is tobacco cessation during the coverage year considered a reportable life change or does the
consumer have to wait until the next Open Enrollment Period?
A4: After being determined eligible for a QHP, HealthCare.gov asks, “Within the past 6 months, have you used
tobacco regularly (4 or more times per week on average excluding religious or ceremonial uses)?” If the
consumer answers “yes”, then the date of last tobacco use is recorded, and subsequently used to determine if
the tobacco rate applies. Consumers may quit or start using tobacco products during the year but they can only
be re-rated to reflect their changed answer to these questions during the Open Enrollment period or during an
SEP. If there is a change in their tobacco use, consumers should come back to the Marketplace during Open
Enrollment to make this update to their application. If a consumer does not come back to the Marketplace to reenroll, the Marketplace will automatically re-enroll consumers with the same tobacco status that they reported
on their last application.
Q5: What happens if a consumer does not report a life change to the marketplace?
A5: Consumers are required to report life changes that impact eligibility to the Marketplace within 30 days of
the change. Certain life changes can make a difference in the kind of coverage and financial assistance for
which consumers qualify. If consumers have a qualifying life event, consumers may also be eligible for anSEP
to change plans outside of Open Enrollment. Changes can make a difference in the amount of advance
payments of the premium tax credit (APTC) or cost-sharing reductions a consumer is eligible for and may
impact the amount of premiums they pay. Also note, consumers who are currently receiving APTC and fail
to report a change in income or household size might have to pay back the difference when they file
their federal income tax return for the coverage year.
Q6: Do consumers have 30 days or 60 days to report a life change to the Marketplace?
A6: All consumers are required to update their Marketplace account within 30 days of changes regarding
eligibility standards.
Q7: What happens if consumers get new employment but decline employer-sponsored coverage (ESC)
because they did not know that it affects their APTC or CSRS?
A7: Consumers that decline ESC that is affordable and meets the minimum value standard because they were
unaware that it would affect their ability to qualify for APTC and CSRs are ineligible for Marketplace coverage
with APTC and CSRs, even if they apply for that coverage during the Marketplace Open Enrollment Period.
Q8: If a consumer qualifies for an SEP as a result of a life change and decides to change plans, will the
amount they have paid toward deductibles be forfeit?
A8: If a consumer reports a life change and decides to change plans, all accumulators, including deductibles,
will reset when a consumer switches plans. So if someone pays $1,000 towards her deductible in January, and
then switches plans with coverage effective March 1, she will have to start over with the new deductible on
March 1.
Q9: What kinds of life changes qualify consumers for an SEP? Are there any non-life change events
that may also make consumers eligible for an SEP? What changes don't make them eligible for an
SEP?
A9: Certain life events, such as a change in family status (like marriage or birth of a child) or loss of other
health coverage, qualify consumers for an SEP. Qualifying consumers will receive an SEP to enroll in QHP
coverage upon completing or updating their application on HealthCare.gov or by calling the Marketplace Call
Center. CMS released an SEP Screener Tool that assisters can use to help consumers determine whether
they may be eligible for an SEP to enroll in health insurance coverage through the Marketplace or may qualify
for Medicaid or the Children’s Health Insurance Program (CHIP), prior to completing a full Marketplace
application.. Remember, this tool is not an application for an SEP; it is just a tool to help consumers
understand what they may be eligible for.

For additional information about SEPs, see the HealthCare.gov page, “Getting 2015 Coverage with a
Special Enrollment Period.”
There are other limited circumstances beyond qualifying life events that may make consumers for an SEP,
including certain enrollment errors, benefit display errors, and exceptional circumstances. Please note that
these SEPs are handled using specific protocols and are not available to consumers through the online
Marketplace application.
Q10: If consumers relocate to a new address within the same county, does that qualify as a reportable
life change and will that make them eligible for an SEP?
A10: Relocating to a new address is a reportable life change and consumers should notify the Marketplace that
they have moved by logging into their HealthCare.gov account and reporting the new address as a change in
circumstance. Consumers are only eligible for an SEP if they move to a location where new QHPs are offered.
For example, moving to a different county and zip code may trigger a SEP. Moving to a new state will trigger
an SEP.
V. NEW CMS Resource! Hospital Compare Star Ratings Based on Patient Satisfaction
Last week, CMS introduced star ratings on Hospital Compare, the agency’s public information website, to
make it easier for consumers to choose a hospital and understand the quality of care they deliver. This initiative
builds on a larger effort across HHS to build a health care system that delivers better care, spends health care
dollars more wisely, and results in healthier people. As assisters, we wanted to share this resource in hopes
that you can encourage consumers to use this new tool to compare the quality of care at hospitals.
The Hospital Compare star ratings relate to patients’ experience of care at almost 3,500 Medicarecertified acute care hospitals. The ratings are based on data from the Hospital Consumer Assessment of
Healthcare Providers and Systems Survey (HCAHPS), which has been in use since 2006 to measure patients’
perspectives of hospital care. HCAHPS includes topics like how well nurses and doctors communicated with
patients, how responsive hospital staff were to patient needs, how clean and quiet hospital environments were,
and how well patients were prepared for post-hospital settings. (For more information on HCAHPS,
please click here.)

Please click here for more details, including other initiatives using HCAHPS data, such as Nursing
Home Compare and Physician Compare, and to view this announcement online.

Please click here to view the Hospital Compare website, where you can explore ratings and learn
more about this initiative, including a consumer-facing definition of Hospital Compare.

Please click here to view a consumer-friendly CMS Guide to Choosing a Hospital.
VI. Reminders: Coverage Effective Dates for Consumers with SEPs / Reminder to use
SEP and Exemptions Tools
1. REMINDER: Coverage Effective Dates for Consumers with SEPs
Assisters can remind consumers who qualify for SEPs that their plans’ coverage effective dates will be based
on the type of SEP for which they qualify. Click here for a list of coverage effective dates for different SEPs
(scroll to slide 17).
2. Reminder to use SEP and Exemptions Tools
CMS recently released two new tools to help consumers better understand SEPs and exemptions. We
encourage assisters to use the SEP Screener Tool and Exemptions Screener Tool to help educate consumers
and determine what they may be eligible for. More information is also available at the following links: Getting
2015 coverage with a special enrollment period; Exemptions from the fee for not having health coverage.
VII. Outreach Materials of the Week: U.S. Surgeon General and Elmo of Sesame Street
discuss the importance of vaccines
Last week, U.S. Surgeon General Vivek H. Murthy talked with Elmo of Sesame Street about the importance of
vaccines and making sure that all children are protected from easily preventable diseases. Vaccines are
among the most successful and cost-effective public health tools we have for preventing disease and death.
They not only help protect vaccinated individuals, but they also help protect entire communities by preventing
and reducing the spread of infectious diseases. Please click here to see the video, and here to read the
interview, and see below for promotional materials.
These fun, consumer-focused messages are great to pair with the first step of the From Coverage to Care
Roadmap, which encourages consumers to “Put your health first” by living a healthy lifestyle and getting the
preventive services that are right for them. Click here to view the Roadmap in multiple languages, along with
other C2C resources.
Twitter

Nervous about #gettingvaccinated? @Elmo & @Surgeon_General can walk you through it easypeasy! http://on.fb.me/1E7zN9G

Getting a #vaccination is easy as ABC! Just ask @Elmo &
@Surgeon_General.http://on.fb.me/1E7zN9G

#Getvaccinated w/ @Elmo & @Surgeon_General! http://on.fb.me/1E7zN9G

Come on everybody, #getvaccinated w/ @Elmo & @Surgeon_General! http://on.fb.me/1E7zN9G

Get your vaccinations on time to stay healthy. @Elmo did and he’s telling all his friends to do it, too!
@Surgeon_General http://on.fb.me/1E7zN9G

Get your vaccinations on time to stay healthy. @Elmo did and he’s telling all his friends on
@SesameStreet to do it, too! @Surgeon_General http://on.fb.me/1E7zN9G

Tell all your friends on your street to #getvaccinated! @Elmo’s telling his friends on @SesameStreet!
@Surgeon_General http://on.fb.me/1E7zN9G

#Vaccinations protect can keep you healthy. Join @Elmo & @Surgeon_General and
#getvaccinatedhttp://on.fb.me/1E7zN9G

@Elmo & @Surgeon_General want everyone to know #vaccinations protect and keep us healthy!
Help spread the message http://on.fb.me/1E7zN9G
Facebook

Just like carrying an umbrella keeps you dry from rain, #gettingvaccinated is safe and can protect you
from getting sick. The U.S. Surgeon General and Elmo both agree and want to share a special
message with you: http://on.fb.me/1E7zN9G

How do you stay safe and protected? Super heroes and dreams can be fun but a more surefire way is
to #getvaccinated. The U.S. Surgeon General and Elmo have a special message for
you:http://on.fb.me/1E7zN9G

Elmo recently visited his friend the U.S. Surgeon General and they talked about how #vaccinations
can keep you healthy and protected from germs. They also talked about super heroes (heard of
Paperweight Boy?!). You can check the video out here: http://on.fb.me/1E7zN9G

Don’t let #vaccinations make you nervous! Elmo and the U.S. Surgeon General tell us they are safe
and can keep us healthy. Catch the video http://on.fb.me/1E7zN9G
VIII. Assister Spring Webinar Schedule and Supplemental Webinars
1. Assister Spring Webinar Schedule
Please note that webinars will take place every other week, instead of weekly, during the rest of the
spring and though the summer. The schedule below reflects this change.

Friday, April 24, 2015 at 2:00 pm EDT

THURSDAY, May 7, 2015 at 2:00 pm EDT*

THURSDAY, May 21, 2015 at 2:00 pm EDT*

Friday, June 5, 2015 2:00 pm EDT

Friday, June 19, 2015 2:00 pm EDT
*Please note that this webinar will take place on a Thursday instead of on a Friday. Thank you!
2. NEW Supplemental Webinar: Addressing the Healthcare Needs of the Transgender
Patient – HHS Health Resources and Services Administration (HRSA)

Thursday, April 30, 2015 | 1:00 pm EDT – 2:00 pm EDT: To register, please click
here(registration in advance is required to attend).

For more information, please contact Valerie Gallo at 415-437-8095 or vgallo@hrsa.gov.
This webinar aims to build competency in addressing the clinical needs of transgender patients in a culturally
appropriate manner and will feature promising practices of HRSA grantees in Region IX—some of which
specialize in serving transgender patients, and others which have improved their practices to serve their
diverse patient mix.
The target audience is other HRSA grantees, healthcare providers, public health officials, and advocates
wanting to improve their competency in serving the needs of the transgender patients in their practices.
3. Additional Supplemental Webinars*
*Note: These webinars were also featured in last week’s assister newsletter; please refer to that newsletter
(Tuesday, April 14) for descriptions of the events. Many of the registration pages also include event
descriptions.
A.
Helping Newly Enrolled Families Understand and Use their Medicaid and CHIP Coverage

B.
C.
D.
E.
Wednesday, April 22, 2015 | 3:00 PM EDT: Click to Register
Preventive Screenings 101 and Next Steps in Using Your Health Insurance

Monday, April 20, 2015 | 3:00 PM EDT

Register for the webinar using this link | To join by phone only: 1 (415) 655-0059, Access Code:
690-504-310, Pin Number is the # key.
Special Enrollment Periods and Resources for the Uninsured

Wednesday, May 6, 2015 | 2:00 PM EDT: Click to register | To Join By Phone Only: 1 (415) 6550059, Access Code: 419-734-181, Pin Number is the # key.

Wednesday, June 17, 2015 | 2:00 PM EDT: Click to register | To Join By Phone Only: (415) 6550051, Access Code: 564-443-351, Pin Number is the # key.
Got Coverage? Next Steps in Using Your Health Insurance

Tuesday, May 19, 2015 | 3:00 PM EDT: Click to register | To Join By Phone Only: 1 (646) 3071706, Access Code: 763-833-558, Pin Number is the # key.

Tuesday, June 23, 2015 | 4:00 PM EDT: Click to register | To Join By Phone Only: (415) 6550051, Access Code: 379-833-859, Pin Number is the # key.
Affordable Care Act 101 Webinars for Small Employers**

Thursday, April 30, 2015 | 2:00 PM ET: Click to Register

Thursday, May 14, 2015 | 2:00 PM ET: Click to Register

Thursday, May 28, 2015 | 2:00 PM ET: Click to Register

Thursday, June 11, 2015 | 2:00 PM ET: Click to Register

Thursday, June 25, 2015 | 2:00 PM ET: Click to Register
**To view an audio recording of the ACA 101 webinar, click here
F.
Spanish-language ACA 101 Webinars for Small Employers

Tuesday, May 19, 2015 | 2:00 PM ET: Click to Register

Tuesday, June 16, 2015 | 2:00 PM ET: Click to Register

Tuesday, July 14, 2015| 2:00 PM ET: Click to Register

Tuesday, August 11, 2015| 2:00 PM ET: Click to Register
IX. Assister Resources and Contact Information for Assisters
1. Standing Assister Resources
Below are some resources that assisters use on a regular basis.

Technical Assistance Resources

CMS Marketplace Applications & Forms

CMS Outreach and Education Resources

Marketplace.CMS.gov Page

CMSzONE Community Online Resource Library Pilot for Marketplace Assisters https://zone.cms.gov/

HHS.gov Healthcare Web Page

Center for Consumer Information & Insurance Oversight Page

Find Local Help

CAC Email Inbox Address (CACQuestions@cms.hhs.gov)

HealthCare.gov Website

Medicaid.gov Website

Department of Labor Affordable Care Act Page

IRS Affordable Care Act Tax Provisions Page

Department of Veterans Affairs Affordable Care Act Page

OPM's Multi-State Plan Program and the Marketplace Page
2. Marketplace Call Center and SHOP Call Center Hours
Health Insurance Marketplace Call Center: For customer service support, to start or finish an application,
compare plans, enroll or ask a question. 1-800-318-2596 (TTY: 1-855-889-4325). Available 24/7. Closed
Memorial Day, July 4th, Labor Day, Thanksgiving, and Christmas.
SHOP Call Center: For customer service support, including assisting employers and employees apply for and
enroll in SHOP. 1-800-706-7893 (TTY: 711). Available M-F 9:00 am-7:00 pm EST.
3. Stay in Touch
To sign up for the CMS Weekly Assister Newsletter, please send a request to the Assister Listserv inbox
(ASSISTERLISTSERV@cms.hhs.gov) and write “Add to listserv” in the subject line. For requests to be
removed from the listserv, please write "Remove” in the subject line.
If you are a Navigator grantee and have specific questions or issues you’d like to see us highlight in our weekly
webinar or here in this newsletter, please get in touch with your Navigator Project Officer or send a request
to navigatorgrants@cms.hhs.gov. If you are a CAC designated organization, please send an email
toCACQuestions@cms.hhs.gov. We welcome suggestions and comments, so please feel free to contact us.