Resources for Enrollment Assistance

In the Loop was an innovative online community for enrollment assisters jointly run by Community Catalyst and the National Health Law Program (NHeLP) from October 2013 - May 2019. In the Loop provided crucial support for over 5,000 enrollment assisters who received real-time answers to enrollment questions and best practices from other assisters. Additionally, it served a vital role in the early years of HealthCare.gov identifying application and other implementation issues that were resolved by state and federal policymakers. Over the years, In the Loop supported thousands of Navigators, certified application counselors, legal aid organizations, hospitals, community health centers, and others who were engaged in enrollment. We are grateful for their participation on making In the Loop a success and we appreciate their continued partnership.

You can find In the Loop’s previous fact sheets on key enrollment issues as well as on NHeLP’s website, here. Some policies change year by year, please refer to the ‘last updated’ date on each fact sheet to determine accuracy. For any questions, please contact Carrie Mead, cmead@communitycatalyst.org. To join NHeLP’s mailing list click here. To join Community Catalyst’s mailing list click here.

• 2019 Enrollment Cheat Sheet (November 2018)

  This fact sheet includes the Federal Poverty Guidelines, affordability threshold percentages and the minimum and maximum percentages premium contribution percentages all in one place.

• Tip Sheet on Onboarding New Assisters (September 2016)

  This tip sheet includes information for onboarding new enrollment assisters.

• ACA and Tax Filing for Married, Separated, and Abandoned Spouses (April 2018)

  The Affordable Care Act (ACA) requires married couples to file joint federal income tax returns to qualify for subsidies when purchasing health plans through the marketplace. However, in some circumstances, persons who are married may be considered unmarried for federal tax filing purposes.

• Advanced Premium Tax Credits (August 2018)

  Under the ACA, new federal tax credits, called Advanced Premium Tax Credits (APTCs), make private insurance more affordable for eligible consumers by offsetting a portion of the monthly insurance premium.

• Enrollment for Survivors of Domestic Violence Flowchart (March 2018)

  This flow chart is for understanding how survivors of domestic violence can access Marketplace health coverage.

• Determining Income: Monthly vs. Yearly Calculations (October 2017)

  In determining eligibility for health insurance coverage, the marketplace asks for a consumer's estimated yearly income. Medicaid, however, generally uses a "point-in-time" or current monthly income to determine eligibility.

• Enrollment for Survivors of Domestic Violence (March 2018)

  Survivors of domestic violence (DV) and spousal abandonment are able to enroll in marketplace health coverage through a unique set of rules and considerations.

• Medicare & the Marketplace (June 2017)

  While many consumers transition smoothly to Medicare once they are eligible, some consumers find themselves caught in a complicated web of Medicare-marketplace eligibility rules. Below is the pertinent information assisters need to help consumers navigate the Medicare-marketplace web and answers to the most frequently asked questions on this topic.

• Grace Periods in the Marketplace (July 2018)

  One of the Affordable Care Act’s (ACA) consumer protections is an extended “grace period” that ensures continued coverage for consumers who receive Advanced Premium Tax Credits (APTCs) while they catch up on overdue premium payments. This fact sheet explains what grace periods are and how they work in the marketplaces.

• Reconciliation of Advanced Premium Tax Credits (March 2018)

  Under the Affordable Care Act (ACA), new federal tax credits, called Advanced Premium Tax Credits (APTCs), make private insurance more affordable for eligible consumers by offsetting a portion of the monthly insurance premium. Consumers who receive tax credits throughout the year to help pay for health insurance must reconcile the amounts they received with the actual amount they are eligible for when they file their federal income tax return.

• Marketplace & Medicaid Eligibility: What Definition of Child Applies (January 2015)

  The Internal Revenue Service (IRS) establishes requirements for dependents as a “qualifying child.” The Medicaid program features various definitions of “child” to determine eligibility for parents and caretaker relatives. However, these definitions don’t always align. The following overview describes and compares the various definitions of “child” to help clarify which applies in a given situation.

• MAGI: When to Count Dependents' Social Security Income (August 2018)

  The Affordable Care Act introduced Modified Adjusted Gross Income or MAGI as a new way of calculating income eligibility for various federal tax benefits. A major source of confusion with the new MAGI rules is when to count the Social Security income of dependents.

• MAGI: Modified Adjusted Gross Income (August 2018)

  The Affordable Care Act introduced Modified Adjusted Gross Income or MAGI as a new way of calculating income eligibility for health coverage through the state and federal marketplaces, as well as for the Children’s Health Insurance Program (CHIP) and many Medicaid categories.

• Catastrophic Plans (October 2017)

  Catastrophic plans are high-deductible health insurance plans that protect consumers against large medical bills in case of emergency. Compared to other metal plans, catastrophic plans have lower monthly premiums, higher deductibles, and limited benefits until the deductible is met.

• COBRA (September 2014)

  COBRA is an extension of employer-sponsored insurance for employees who lose health insurance coverage when they leave a job, either voluntarily or involuntarily, or when their employment status changes due to a reduction in hours.

• Special Enrollment Periods (updated November 2018)

  The Affordable Care Act (ACA) designates a specific period of time each year, known as the open enrollment period, when eligible consumers can enroll in a marketplace health plan. However, consumers who experience certain changes in circumstances outside of open enrollment may be eligible for a Special Enrollment Period to enroll in or change marketplace health plans.

• Terms to know about Health Insurance and the ACA (October 2014)

  The following list defines key terms related to the ACA and frequently-used terms regarding health insurance. These terms may not be familiar to many individuals enrolling in health insurance, especially for those accessing health insurance for the first time because of the ACA.

• Cost Sharing Reductions (Updated October 2017)

  One of the leading goals of the Affordable Care Act (ACA) is to make health insurance more affordable for consumers. Under the ACA, consumers may be eligible for Cost-Sharing Reductions (CSRs) to lower the amount they have to pay for out-of-pocket expenses such as deductibles, co-pays and co-insurance.