GEAR Newsletter: April, 2016



Assister Help Resource Center (AHRC) Closed for the Season

The AHRC, a platform provided to enrollment assisters for post-enrollment assistance, is closed for the season as of April 15, 2016. We will let you know when it opens back up.

SEP for Consumers Moving out of the Coverage Gap 

moving out of cg

Under CMS eligibility rules that began in April 2015, consumers moving out of the coverage gap because of income changes have 60 days from the date of income change to apply for coverage. This SEP is only available via phone request and cannot be done online. Enrollment assisters may need to take the consumer’s SEP application to the Marketplace supervisors if the first line of Marketplace representatives seem to be unfamiliar with this type of request.

Tax Filing and Reconciliation: Helping Consumers with IRS Letter 12C


Wait! Tax related work isn’t over yet. Tax filing period may be over but consumers may still need follow-up assistance. Enrollment assisters have been reporting that some consumers have received 0012C or 12C Information Request letters from the IRS after filing their 2015 taxes. We want to make sure you understand how to explain these letters to consumers and what to do about them. The IRS sends a 12C Information Request letter to those people that received an Advanced Premium Tax Credit (APTC), but did not include Form 8962 (Premium Tax Credit) with their 2015 taxes. Without Form 8962, the APTC cannot be reconciled. If consumers do not complete Form 8962 as part of their 2015 taxes, they will lose their APTC and cost-sharing reductions for the 2016 calendar year.


New Retiree Coverage 

new retiree flowchart

Do you assist new retirees? This flowchart developed by In-the-Loop helps simplify the health insurance choices for new retirees who are not yet eligible for Medicare.


Assister Guide to the Immigration Section of the Online Marketplace Application 

Lessons Learned from the Third Open Enrollment Period 
Families USA



GEAR Newsletter: March, 2016


OE3 debrief

Thank you to everyone who joined GHF, HHS, and Enroll America for the OE3 debrief! We appreciate everyone’s feedback on what went well, what can be improved upon in the future, and plans for OE4. We had great participation from all the partners in attendance and look forward to continuing to work with all of you. If you have any questions or comments about the debrief, please contact Whitney at 404-567-5016 x 5.


New SEP requirements – We want to hear from you!

CMS recently announced new requirements that require enrollees to provide proof for SEP enrollments. Failure to provide supporting documents may cause the Marketplace to deny an SEP. At GHF, we want to make sure that this new requirement is not putting up unnecessary barriers for consumers. If you are experiencing problems enrolling consumers during a special enrollment period due to the new requirements, we want to hear from you! Please use this SEP story collection form to let us know about any issues you may be experiencing. Once completed, please return the form to Pranay.

Say what??? Do you know how to allocate and reconcile premium tax credits for shared policies? 

Buckle up – we’re going to deep dive into a complex issue that has been popping up for enrollment assisters: shared policy allocation. What is that? Shared policy allocation is when consumers who receive tax credits as a household (i.e. a married couple or a family) need to split up their tax credits because they are now filing taxes separately. If allocation is not done properly, it may lead to tax filing complications and a delay in tax returns.

Here’s what you need to know: Allocations are reported on Part IV lines 30 – 33 of the form 8962. Allocation can be done in three different ways: (1) agreement based (2) non-agreement based and (3) 100% allocation. For more information please check our new resource.

We know this is tricky! If you have any questions or would like more information please contact Pranay at 404-567-5016 x 4.


As we all know, enrollment is a year round activity. However, once tax season is over you may have a bit more time on your hands. The months between open enrollments are a great time to do post enrollment education. Our GEAR resources provide a wide range of post-enrollment assistance materials for enrollment assisters.

Finding a Primary Care Provider

Health Insurance Complaints and Appeals

ACA and Taxes

If you have any questions regarding post-enrollment assistance and resources, let us know!


Guidelines on Overlapping Medicaid and Marketplace Enrollment

Have you dealt with consumers that have had overlapping Medicaid and Marketplace coverage? It can be tricky, but the IRS has finally released guidelines on how to handle these situations. Fortunately, our friends at the Georgetown University Center for Children and Families have written a blog post to help explain the IRS guidelines. This resource is also helpful for anyone working with a consumer that had a retroactive Medicaid eligibility determination.

Plain Language Working Group – In the Loop
Plain language materials can be very helpful while assisting consumers. A group of In the Loop enrollment assisters has come up with “plain language” explanations of health insurance terms and concepts to better help consumers understand complex health insurance terms. This resource from the plain language working group aims to increase consumers’ understanding and confidence as they make decisions about their health insurance.


Premium Tax Credits Tips and Tricks 
Health Reform: Beyond the Basics

Tax Filing Preparation: FAQs in the Navigator Resource Guide