Today, the Centers for Medicare & Medicaid Services published the much anticipated revised Marketplace Consumer Applications. There is an Individual Short Form, which is just 3 pages long (as compared to the previous 21 page version), a Family Form, which is just 7 pages long, and a 3 page application for those not seeking financial assistance.
The Individual Short Form is for single adults who are not offered health insurance by their employer, looking for private health insurance plans and the availability of a tax credit or subsidy to help pay for premiums. If employed, the applicant provides information about his or her employer, average hours worked each week, and income. This information will likely trigger an inquiry with the employer if an applicant indicates he or she works 30 or more hours each week for a single employer.
The Family Form emphasizes that a family of 4 earning as much as $94,000 a year may qualify for free or low-cost insurance. The Family Form asks for information about the citizenship status, employment and income of each individual in the family. Additional information is collected on Appendix A if any member of the family works for an employer that offers insurance. How will the Marketplace know if the insurance offered by an employer meets the minimum value standard and is affordable? The Form asks specifically if the employer offered health plan “meets the minimum value standard” and refers to the IRS Code for the definition (i.e., the plan’s share of the total allowed benefits costs covered by the plan is no less than 60 percent of such costs). The Form then asks what the premium cost is for “the lowest-cost plan that meets the minimum value standard.” Wellness program discounts are also considered. Applicants are asked to identify the premium cost if the maximum discount for any tobacco cessation program is received. The question seems to imply that affordability will be based on the premium cost after wellness program discounts are applied, not before.
Finally, the Application for Health Coverage, for those individuals or families not seeking financial assistance, is the simplest application and requires the least amount of information. Each form indicates that the health insurance marketplace will follow up with applicants 1-2 weeks after an application is submitted.
