What do you do when the Marketplace asks for extra documentation?
Many times when someone signs up for an ACA marketplace plan (think Obama care), they are required to submit additional documentation to prove something on their application. Some common things the Marketplace may ask you to prove is your citizenship, income, non-Medicare coverage, and/or social security number. The Marketplace may request multiple documents, trying to confirm that your application information matches the information that you submitted.
To keep your Marketplace insurance, you must submit the required documentation if they request it. The Marketplace usually gives you months to submit this information, but failing to submit the correct information AND receive approval from the Marketplace can result in losing your subsidy or even your insurance coverage!
Below are the main categories for which the Marketplace may require extra documentation:
Even an infant can have this information requested of them. In this case, the Marketplace wants to verify that you are a citizen, or the status of your citizenship. You can submit your U.S. passport, Certificate of Naturalization (N-550/N-570), Certificate of Citizenship (N-560/N-561) or a combination of materials. You can find a list of more eligible documents HERE.
Whether your income is from your job, self-employment, social security administration, or unemployment benefits, you may have to show documentation of your household income. To prove your income, you must match very closely the income you estimated for the year your insurance is effective.
As an example, last year’s tax return will not work if the income is different than what you put on your application for this year’s plan. If the documentation you have does not match your estimated income, you can change the income estimation on the application, or you can write a letter to go along with your documentation to state why you think your actual income will be different. For example: you only worked part of this year, or you plan to add a seasonal job later in the year.
If you are not sure what income you listed on the application, you can check your Health Sherpa account under your Application History, your Healthcare.gov account or your Eligibility Notice that you should have received after enrolling. These sources will tell you what income you listed. The documentation that you send must match the income you have listed on your account.
To learn more about household income required documents click HERE. Also here is a guide to confirming income information.
Social Security Number
Proof of having a Social Security Number is straightforward such as, Social Security card, 1040 Tax Return (federal or state versions acceptable), U.S. Military ID card, W2 and/or 1099s are all acceptable. See more approved documents HERE.
No Medicaid coverage
Sometimes the Marketplace will ask you to prove a negative. This would be proof that you have not been offered Medicaid. If you have received a statement from Medicaid or Children’s Health Insurance Program (CHIP) that you or your family members were denied their coverage, you can submit that as proof. Or you can write a letter to the Marketplace stating that you were never enrolled in Medicaid or that your Medicaid coverage ended recently. For more detailed information click HERE.
No Medicare coverage
Proving you have not been offered Medicare is not something we see often but it does happen. Typically, you need to just submit a letter from Medicare or Social Security Administration stating that you or your family members were denied coverage from Medicare. If you don’t have that document, you can personally submit a letter stating why you are not eligible for Medicare at this time. Using the following link, you can get the template as a guide to write the letter HERE.
How to submit the documents
With all the above information reiterating the need for you to submit documents you may be wondering how to do so. Thankfully, in our technological age, you can easily upload the items online. If you choose us as your agent, you can upload the information through our user-friendly portal, Health Sherpa. Or you can upload the documents to your Healthcare.gov account. And lastly, you can send the documents through the mail. However, this is not recommended because the mail may not reach the Marketplace before the deadline.
Typically, you have 90 days to resolve your data matching issue. It is important that you submit the documents before the deadline. Missing the deadline could cause you to lose your premium tax credit that lowers your monthly premium. Or even worse, if you do not provide the required documents, you could lose your insurance coverage altogether. Unfortunately, if you lose your plan outside of Open Enrollment you cannot enroll again until November for a January 1st effective date.
The Marketplace typically notifies you of any data matching issues through your email and postage mail. We recommend that you read the information sent to you from the Marketplace to make sure you aren’t missing pertinent information. As your agents, we are looking to protect your insurance from termination or surprise premium tax credit loss, so we check to see if there are any data matching issues on your account and do our best to help you through this process.
Getting Help and Reminders – Choose Tennessee Health Insurance, Inc.
This whole post highlights another reason that it is beneficial to use an independent agency like Tennessee Health Insurance, Inc. Not only will we explain the extra documentation needed when you sign up, we will also send you reminders, make it easy to submit your documentation, or even submit the documentation for you!