ACA and the 21-page Application

Believe it or not, the federal government is actually trying to simplify our lives…well, at least one tiny little part of it as it pertains to the Patient Protection and Affordable Care Act (PPACA or ACA).  Back in late 2012 / early 2013 when the Department of Health and Human Services (HHS) started really getting into the nitty-gritty details of how the new Health Insurance Exchange (or Marketplace) was going to work, they developed  a cumbersome 21-page application for all enrollees.  Yep, anyone who wanted to find out if they qualified for a premium tax credit to help offset their premium costs (when purchased through the Exchange) had to fill it out.

The original 21-page application required enrollees to list basic information about themselves and their dependents (address, age, gender, relationship,) AND how much money they made the prior year based on their W-2s.  Then the application would get bounced around different federal agencies (Internal Revenue Service, Social Security Administration, Dept of Homeland Security) to verify what was said on the application was correct. After passing “Go”, the Exchange would spit out the your premium tax credit allowance and subsequent qualified health insurance plans.

Well, the Exchange application still exists but it’s shorter and it multiplied.  That’s a ‘yeah’… I think.    Instead of one long form, two forms will be used to determine eligibility for premium tax credits based on income and the number of dependents.  The third form is a basic, information-gathering form.

  1. Application for Health Coverage & Help Paying Costs: Individual Short Form with Financial Assistance
  2. Application for Health Coverage & Help Paying Costs:  Family Form with Financial Assistance
  3. Application for Health Coverage:  Individual Form without Financial Assistance

The Individual Short Form requires basic information about you – address, date of birth, social security number, sex, employer(s) name and address, prior year’s income, etc.  There are boxes to identify your race/ethnicity as well if you so choose.  I did find the optional “Race” question interesting.  You can select from 15 “races” (i.e., white, black, Asian Indian, Filipino, Korean, Samoan, etc., etc., etc.) OR you can select ALL 15 as it states “check all that apply”.   I guess this is where you get to really identify with your heritage.

The second application (the Family Form) is similar to the first application except you must include the basic information and their earnings for EACH family member/dependent that will be covered under the health insurance plan.

The third application is a basic, health insurance form for individuals and family members.  The form is gathering information so you can purchase standard minimum essential health insurance through the Exchange without applying for financial assistance.  This form will NOT be vetted through the other federal agencies.

I will again repeat this important point….you ARE required to have “minimum essential” health insurance in place by 2014 as mandated by the ACA but you are NOT required to purchase it through an Exchange.  It is only necessary to purchase through the Exchange if you are requesting premium tax credits.  For those whose income is greater than 400% of the federal poverty level (approximately $94,000 for a family of four) you are not eligible for federal assistance.  Hence, you are NOT required to fill out any of the applications NOR are you required to purchase your health insurance through the Exchange.    So, check around on the open market (insurance carriers, agents, brokers – like us) to see if there is a better plan that fits both your medical and monetary needs.  Compare, compare, compare BEFORE you sign on the dotted line.

Copies of the Marketplace Consumer Applications, in draft form, can be found at:

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