less than Bronze
One can qualify for the Catastrophic level, Health Care.gov (high deductible) if they are under 30 or the premium is unaffordable as being more than 8% of income, or possibly a hardship exemption. Blue Cross Blue Shield . See the Federal Hardship Exemption Form for more information.
individuals (and their dependents) whose household income is less than the filing threshold for federal income taxes for the applicable tax year will not be subject to a penalty, as well as those whose required contribution for self-only coverage for a calendar year exceeds 8% of household income
Required contribution is defined as
(1) in the case of an individual eligible to purchase minimum essential coverage through an employer (other than through the exchange), the portion of the annual premium that is paid by the individual for self-only coverage, or
(2) for individuals not included above, the annual premium for the lowest cost bronze plan available in the individual market through the exchange in the state in which the individual resides, reduced by the amount of the premium credit for the taxable year.
Household income is defined as the modified adjusted gross income (MAGI) of the taxpayer, plus the aggregate MAGI of all other individuals for whom the taxpayer is allowed a deduction for personal exemptions for the taxable year. Modified adjusted gross income is defined as adjusted gross income [line 37 1040] increased by foreign earned income (section 911 of the IRC) and any amount of tax-exempt interest received or accrued by the taxpayer during the taxable year. Congressional Research Service 8.2011
On December 19, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a new policy allowing individuals to enroll in the “catastrophic” level of ACA-compliant health plans in 2014 if both of the following are met:
• Their existing individual or small group, non-ACA compliant coverage is being discontinued by their current health plan
• The individual believes replacement coverage for their cancelled policy is “more expensive” than other available products.
Previously, eligibility for coverage at the catastrophic level was confined to those under age 30, or those who are exempt from the federal mandate to maintain minimum coverage because they cannot afford coverage or because they experienced one of the other previously established hardships. The new policy provides an additional hardship exemption to those over 30 allowing individuals whose polices were cancelled to enroll in catastrophic plans for the 2014 coverage year.
The new CMS policy is here.
Health Net is Accepting Catastrophic Enrollments per the New CMS Policy
• If your clients wants to apply for catastrophic coverage under the new CMS policy, you may assist them by completing the following steps:
o First, download the “hardship exemption” form at http://www.healthcare.gov. Or it’s located here: http://marketplace.cms.gov/getofficialresources/publications-and-articles/hardship-exemption.pdf
o Fill out the hardship exemption form by hand.
o Next, download a Health Net application form.
Go to http://www.healthnet.com > Shoppers > Plans for Individuals and Families (the THIRD hyperlink from the top) > Forms and Brochures > Learn More > Individual and Families Plans Materials to Apply for 2014 > Individual & Family PPO Enrollment Application (2014).
• Complete this form by hand, too.
o Under “Choice of Coverage at the top of Page 2, be sure to check the box labeled “PPO Catastrophic $0/$6,350.”
Note: The Catastrophic Plan is only available in the following counties: Napa, Solano, Marin, Sonoma, San Francisco, Contra Costa, Santa Clara, San Mateo, Santa Cruz, Monterey, San Benito, San Joaquin, Stanislaus, Merced, Mariposa, Tulare, Kern, Los Angeles, San Bernardino, Riverside, Orange and San Diego.
• Make a copy of the letter your client’s health insurer sent notifying them their current coverage ended on December 31, 2013.
o If an applicant does not have a copy of the cancellation letter, we will still enroll them and CMS will confirm the applicant’s eligibility for the hardship at a later date.
o If the individual’s previous coverage was with Health Net, we will confirm the cancellation based on our internal records.
• Mail all three documents (hardship exemption, Health Net application and cancellation letter) to the address noted on the Health Net application:
Health Net Individual & Family Enrollment
PO Box 1150
Rancho Cordova, CA 95741-1150
• Note: Because deadlines for January 1, 2014, coverage have already passed, the earliest the catastrophic coverage will take effect is February 1, 2014. The deadline to enroll for a February 1, 2014 effective date is January 15, 2014.
According to CMS, if your client’s health insurance has been cancelled, there are a number of options available to them:
• Your clients have an opportunity to buy any individual market policies available to them in 2014.
• Your clients may shop for coverage through the Health Insurance Marketplace (the Marketplace). Depending on their income and other factors, they may be eligible to receive a premium tax credit that will help cover the cost of purchasing coverage through the Marketplace or cost-sharing reductions for Marketplace coverage. They may also be eligible for Medicaid.
• Your clients may also shop for policies outside the Marketplace. This is a good option if they do not qualify for premium tax credits or cost-sharing reductions based on their income. If they do qualify for premium tax credits or cost-sharing reductions, they can only get such assistance if they enroll through the Marketplace.
• If you or your clients have any questions regarding these options, you can contact CMS
Copper Plans? 50% Actuarial Value?