2019 Marketplace Open Enrollment Has Ended

You Have Health Care Coverage! Now, How Does It Work?

Your health care coverage provides you access to health care providers — like physicians, specialists, labs and hospitals — to receive the medical care you need. Many plans require that you pick one doctor – an internist, general practitioner or family practitioner -- to serve as your main doctor, called your Primary Care Physician (PCP). If you have children, you can select a pediatrician for your children. This one doctor will be the first one you call when you need regular medical care. Your PCP may treat you or may refer you to another doctor called a specialist if you need a specific type of care. Your PCP also will coordinate your care if you need medical tests or procedures or need to be treated in the hospital. Building a good relationship with your main doctor will help you make the most of your coverage.

Leave the emergency room for emergencies! Your main doctor (PCP) will be the best place to get care if you are not feeling well. If you have a cold, sore throat, or similar illness that is not life-threatening, call your main doctor. You will pay less for the visit and your main doctor will know you better than the emergency room doctors. If you go to the emergency room and you do not have an emergency, they will take sicker patients first. You might have to wait a long time to be seen. Then, after you are seen, you will have to pay more for the emergency room visit than you would if you saw your main doctor.

One-on-one help is available! Assisters are available to help you understand how to use your health care coverage. They are a great, knowledgeable and trusted source of information.

Here is a written guide that can help you learn more about your coverage.

If you prefer to watch videos, click on the links below to learn more about your health care coverage.

1. My New Health Plan
2. Understand the Plan
3. Words to Know
4. Where to Go for Care
5. Finding a Doctor (Provider)
6. Making an Appointment
7. Almost Ready
8. My First Visit
9. Like or Dislike
10. The Day After
11. The Final Word

It’s Tax Time!

In addition to reporting your income and deductions for 2018, now you will report whether you had health care coverage during 2018 as well. Use this tax preparation checklist to gather the documents you will need to complete your taxes.

If you had health care coverage through the Marketplace, you will receive Form 1095-A in the mail from the Marketplace in early February. You can also download a version by logging into your account on healthcare.gov.

The 1095-A will provide important information you need to complete your taxes:

• The number of months you had coverage through the marketplace
• The amounts you paid in premiums
• Advanced premium tax credits (APTC) that you received

The amount of premium tax credits you are eligible for will be calculated by your tax preparer or the tax preparation software you use. If you received more tax credits than you earned, you will have to repay those. If you received less, you may be entitled to a refund. You may have to file Form 8962, Premium Tax Credit Form, when submitting your taxes.

If you did not have health care coverage for part of 2018, you probably will need to file Form 8965. This form will show whether you will have to pay the fee for not having health care. For 2018, the fee is $695 per adult and $347.50 per child up to a maximum of $2,085 or 2.5% of your annual income above the tax filing threshold, whichever is more. You may qualify for an exemption from the fee if you meet certain requirements.

Of course, help is available! You can visit IRS.gov/freefile and IRS.gov/VITA to learn about support and filing options available to you. You can talk with an application assister, but application assisters cannot prepare your taxes or give tax advice. They can help you get ready to have your taxes done and can answer questions from your tax preparer. You also can call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)

Getting Health Care Coverage During the Special Enrollment Period (SEP)

During the year, situations occur that could make you eligible to enroll in a health care plan through the Marketplace after Open Enrollment ends. These are called qualifying life events. Examples include, but are not limited to:

• Getting married or loss of coverage due to a divorce
• Losing your employer-sponsored health care coverage, or coverage under FAMIS or Medicaid
• Turning 26 so you are no longer eligible for coverage under a parent’s health care plan
• Having or adopting a baby
• Moving

If you have experienced a qualifying life event and are determined eligible to participate in a Special Enrollment Period, you will be able to choose from all the health care plans available in your area. You may qualify for financial assistance too! Known as advance premium tax credits (APTC), these credits lower the amount of money (called a premium) you pay for your health care coverage each month.

You can use healthcare.gov to determine if you are eligible to enroll during this Special Enrollment Period. If you are, you can create an account on healthcare.gov and enroll in a Marketplace plan. You may be asked to provide proof of your qualifying life event, so make sure to save any notices about loss of coverage and other important documents.

There are also new rules for Virginia’s Medicaid program that may affect you if your 2019 Marketplace coverage ends. Beginning on January 1, 2019, Virginia’s Medicaid health insurance has a new option for adults. This means that some adults who qualified for financial assistance to purchase a Marketplace plan before may now qualify for full-benefit Medicaid coverage, such as single adults earning up to $16,754 a year. You can find more information for Marketplace enrollees newly eligible for Medicaid here and more about the new Medicaid coverage option for adults here. If you are eligible for the new Medicaid Health coverage, you can apply at any time. There is no Open Enrollment period for Medicaid - you can apply at any time of the year.

Help is Always Available

Application Assisters are available to talk with you and help you find out if you can still enroll. Click here to find an Assister today!