It’s not uncommon for a client to contact me to file a change with the federal health insurance marketplace, and I’m always reluctant till I learn more. Every other marketplace agent I know shares in this reluctance – want to know why?
1. There’s just shy of a hundred optional questions in the application.
Each question has a purpose, but like any typical government website, they don’t tell you. Answering these questions can lead to an unintended effect. Such effects can be:
- Having your plan changed
- Losing your subsidy
- Losing your coverage altogether
- Having your deductibles restart midway through the year
2. Marketplace employees are NOT licensed for insurance.
That’s right, and for many it’s hard to believe – but the people handling the applications and assisting millions of Americans with getting health insurance are not licensed for such. They’re call center employees who sit in a chair, open the application, and start reading the questions and recording your answers. Like you, they’re waiting to see what the website says.
Remember all the optional questions? The call center employees don’t know what they’re for. If you expect a guide, these ones will do so via trial and error. And on that note…
3. Correcting an application with the health insurance marketplace is hell.
First you have to file an escalation. They’ll send you a list of required document with no explanation of the information they’re needing the documentation to contain.
When your powers of mind reading fail and they deny the change request, you will have to file an appeal. This involves finding the correct form for your state, printing and filling it out, then faxing it in to the appeals office.
The appeals office has no phone number. In eight years, I have never spoken with or met another agent or marketplace employee who has spoken with an appeals office representative. You can’t check the status of your appeal. You don’t know if anything is missing.
If something is missing, they’ll call you from an unfamiliar number, and if you don’t answer? Well, you’re out of luck.
With this picture of hell painted, hopefully you can understand why agents are unenthusiastic about filing changes with the marketplace. The margin for error is high, and the process to overcome error is long, frustrating, and almost always in vain.
But when should you report a change?
A great question! There are generally three times a change might be good to report.
1. When? To update your contact information.
You phone number and/or email has changed. This is pretty basic, but again, DO NOT call the marketplace. Those unlicensed agents will start asking you all the optional questions and mess everything up. It would be better for you to login yourself, and report the changes and do not answer a single optional question.
What would be best is to contact an agent and have them do it for you.
2. When? To add/drop a person.
This is the most obvious, but is more complex than updating your contact information. If it’s not open enrollment, then you’ll have to file a qualifying event, and that’s where those optional questions come in. Some are worded very similarly, so it’s not obvious which one applies to your situation.
A good agent will know this and be able to handle the addition or subtraction of people with ease.
3. When? Maybe to update your income
If you get your health insurance through healthcare.gov, you are probably among the millions who get a subsidy. The subsidy is based off your income estimate for the year, and lots of people contact me to update their income.
My general rule of thumb is that an income update should ideally be filed only once, and only if the income difference is $3000 in either direction of your original estimate. The reason for this is that any change of less than $3K is hardly going to make a difference on your monthly premium or next year’s taxes, and certainly not enough to risk your marketplace coverage being lost, changed, etc, and the accompanying fight to fix it.
Our biggest request is to use your agent. It’s always easier for us to accomplish what you want, and that’s what we’re there for. We can tell you when it’s a good idea to file a change, and when not to.
If you don’t have an agent, we’re happy to help you. Feel free to reach out and schedule an appointment.