Frequently Asked Questions

Individuals and Families

What is Open Enrollment?
Open enrollment is annual six-week opportunity to purchase a health insurance, whether you're renewing an existing plan, changing plans, or selecting a plan for the first time.

When is Open Enrollment?
Open Enrollment begins November 1 and ends on December 15.  If you buy a plan during that time, your coverage will begin on January 1.  But if you miss the deadline, or if you lose your insurance or experience a major life event outside of open enrollment, you should talk to a local expert about whether you're eligible for a Special Enrollment.  The assistance is completely free.

Are there still subsidies available?
YES! Subsidies can discount the cost of monthly premiums, and, in some cases, the direct of healthcare. Both are still available to those New Mexicans who qualify. 

Is it true that rates will increase this year? Will I pay more for the same coverage?
Prices are adjusted every year as insurance carriers go through a renewal process supervised by state regulators.  It's important to remember, however, that even if/when price increase, premium subsidies often increase along with them. You should shop a variety of plans to identify what best fits your needs and budget, and seek free expert help if you need it.

What if I don’t sign up during the Open Enrollment period?
If you miss open enrollment and don’t qualify for the special enrollment period, Medicaid, CHIP or employer-based coverage, it may be that you have no option other than to wait until the next open enrollment period.  You can always ask an expert if you're not sure. 

What would be my effective date of coverage?
If you enroll during open enrollment (November 1 through December 15) and make your first premium payment by the due date specified by your plan, your new health coverage will begin January 1.  If you enroll during a special enrollment period, your coverage will generally begin on the first day of the next month, provided you enroll by the 15th of the month.

I enrolled through an insurance broker last year, do I need to use that broker again this year?
You’re not required to use a broker or even the same broker as you did last year. In fact, you're not required to use a broker at all.  However, a broker does provide value in helping you navigate your options and provide guidance regarding questions you may have about health insurance coverage and what providers accept it.

I like my Marketplace plan just the way it is.  Will it stay the same next year?
That depends.  Insurers are allowed to make changes to policies each year.  Most likely, the premium for your policy will change next year.  There may be other changes to the deductible, coinsurance, or copays rates.  In some cases, an insurer may stop offering a particular policy and offer you new choices instead.  Shortly before open enrollment begins, you should receive a notice from your insurance company alerting you to any changes to your plan. If you want to continue the policy, you can renew coverage for another year.  If you prefer to shop for other coverage, you can do that during open enrollment.

I’m eligible for health benefits at work.  Can I get a better deal on the beWellnm?
You can always shop for coverage (assuming you meet other basic eligibility requirements), but if you have access to job-based coverage, you likely will not qualify for premium tax credits. You may only qualify for premium tax credits if the premium for your employer-sponsored coverage is more than 9.66% of your yearly household adjusted gross income, or if the plan does not meet minimum essential coverage standards. If you want to learn more about this, we recommend talking to an expert as the process often involves some fairly complex paperwork and calculations.

If I have not filed taxes in a prior year, how will the Marketplace determine my income?
If an applicant did not file taxes in a prior year, income will be verified by the Marketplace through use of electronic wage data. If the information cannot be verified electronically, the applicant may be asked to submit additional documentation - such as pay stubs, a work contract or other verification of income - within 90 days.

How do I file an appeal through the Marketplace? You can request an appeal of any Marketplace decision, including decisions about
  • Your eligibility to buy coverage in the Marketplace
  • Your eligibility for, or the amount of, premium tax credits or cost sharing reductions
  • Your eligibility for an exemption from the penalty for not having health insurance
  • Untimely (late) notice from the Marketplace about a decision
To make your appeal, start by reviewing the Marketplace’s decision. You will have received the decision (called a determination notice) online if you initially applied online, or in the mail if you submitted a paper application. The notice will not provide much detail to explain the reasons for the decision, but it will describe the process you should follow if you want to appeal. To request an appeal in federal Marketplace states, you’ll have to submit the appeal in writing.  You can write a letter or use appeal forms available on https://www.healthcare.gov/downloads/marketplace-appeal-request-form-a.pdf.  Your written appeal should provide your name and contact information and an explanation of what you are appealing and why.
 
You can submit documents to the Marketplace that support your case. You can submit documents along with your initial appeal request or at any time during the appeal process, up until a hearing.

The Marketplace may offer you the option of receiving temporary benefits while your appeal is pending. You can accept the temporary benefits or waive them. If you accept temporary benefits during the appeals process and then lose your appeal, you might have to pay back the benefits you weren’t eligible for.

The Marketplace will review your completed appeal once it is submitted. Then the Marketplace will let you know its decision.  If you still disagree with the decision, you can request a hearing. While you are waiting for the hearing to take place, the Marketplace may contact you to try to resolve the dispute informally.

For more information on marketplace appeals: https://www.healthcare.gov/marketplace-appeals/
 
 

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