Application Process for Individual Health Insurance Options for 2014 Continues to Develop

Much of the coverage of the implementation of health care reform so far has focused on the impact on employers and health care providers. But ultimately the law is intended to expand health insurance coverage to more people, and gradually it is becoming clearer how individuals will participate in this new world of health insurance.

For example, in January the Centers for Medicare and Medicaid Services (CMS) published a Notice (78 FR 6109, January 29, 2013) with information relating to how the new state-based health insurance Exchanges or marketplaces will collect information from individuals in order to determine their eligibility for either Medicaid or for premium subsidies to purchase private insurance through the Exchange.

The Notice also includes information about how the Exchanges will collect information from small businesses to determine if they are eligible to get insurance coverage for their employees though the new Small Business Health Options Program (SHOP) as well as collect information from employees of small businesses to see if they are eligible to get insurance through SHOP.

The Notice was part of the ongoing process by CMS to develop a streamlined way to apply for health insurance starting October 1, 2013, for the 2014 plan year. CMS is working with other federal agencies, such as the Internal Revenue Service, the Social Security Administration, and the Department of Veteran Affairs, as well as state Medicaid agencies, consumer advocates, and others, in developing this process. The January 2013 Notice includes a link to a CMS web site with sample applications and guidance documents.

The web site includes two sample applications. The long application is used if the individual wants to determine eligibility for Medicaid, the Children’s Health Insurance Program, or coverage through the health insurance exchange and related assistance. This application also includes questions about possible existing health insurance coverage for the applicant or anyone in the applicant’s family.

The short application  would be used if the applicant only needs to determine eligibility to purchase health insurance plans offered by a state’s Exchange.

It’s important to emphasize that these applications—which have not been finalized–don’t enroll the applicant in health insurance. The applications state that the applicant will be contacted later with the options for enrolling in a private insurance plan, Medicaid ,or CHIP.

Individuals will be able to submit an application online, through the mail, over the phone to a designated call center, or in person. CMS expects 4.3 million people will fill out one or the other application for 2014, with 4 million of that total expected to fill out the application looking for insurance affordability options.