Updates to Healthcare.gov and How to Combat Issues Enrolling Consumers

By Liz Hagan

We learned of some new features on Healthcare.gov, such as an expanded plan compare tool that allows consumers to see summary of benefits, formularies, and provider networks even before a consumer completes the application! And we’re hearing that Healthcare.gov is working more smoothly for consumers.

While that is great news, some people are still having issues enrolling and may need help applying. To help those assisters that are still encountering problems enrolling consumers in coverage in federally facilitated marketplaces (FFM), the Centers for Medicare and Medicaid Services (CMS) just released a tip sheet for in-person assisters. This tip sheet goes over four common scenarios (listed below) and suggested solutions for each. It’s also important to note that call center representatives can now elevate application and enrollment issues that consumers are dealing with to caseworkers.

  1. What to do if a consumer is stuck somewhere in the application. One helpful hint is to remove a consumer’s current application from their account and start a new one or to call the call center (at (800)-318-2596) to have the problem escalated to a caseworker. CMS is working on creating the ability for consumers to edit their submitted applications if they realize it has errors. In the meantime, however, removing an application and restarting may be the best approach.
  2. What to do when a consumer has submitted a paper application but hasn’t heard anything. CMS suggests to either call the call center to see if an eligibility determination has been made or to start a new online application to expedite the process.  Once a consumer submits a paper application, they can get their application ID number from the call center in order to see their application status online. CMS estimates that the turnaround time for a consumer to get their application ID number is 3-5 days after the paper application is received by the Marketplace.
  3. How to work with a consumer who wants to submit a paper application as opposed to an online application. CMS is strongly encouraging consumers to enroll online to ensure coverage begins January 1. But they acknowledge that some consumers may not be comfortable applying online, so they provide tips on how to complete and submit a paper application to ensure it moves through the system quickly and suggest that assisters make follow-up appointments with consumers to help them pick a plan once they’ve received their eligibility determination in the mail or via email from CMS.
  4. What the next steps are for a consumer who is eligible for Medicaid or CHIP. The Marketplace will send consumer information to state Medicaid or CHIP agencies in order for them to make a Medicaid or CHIP determination, but there will be times when those agencies require the consumers to submit additional information. If consumers haven’t heard back from their state agency, CMS suggests consumers call their state Medicaid or CHIP agency to find out the status of their application.

We’ve talked with many assisters, certified application counselors, and navigators who have all combated issues with enrolling consumers. In FFM states, some have decided to focus their efforts on outreach and education, or have turned to the paper application instead of going through Healthcare.gov. However, we now know that Healthcare.gov is working much better and can provide consumers with that real time eligibility decision that will make their enrollment process much smoother. As more kinks are being worked out, this tip sheet can be a good place to turn to for solutions. We anticipate more tip sheets by CMS to be released soon, so stay tuned!

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