CMS: Selling in the Marketplace

Following the end of the continuous enrollment condition on March 31, 2023, states are now required to resume regular eligibility and enrollment operations for Medicaid and the Children’s Health Insurance Program (CHIP), including renewals and coverage terminations. As an agent or broker, you are an essential partner in connecting consumers with health insurance coverage during these transitions. This is also a great opportunity to grow your book of business or gain referrals and connections.

Common Misconceptions

CMS has identified answers to common misconceptions to clarify some of the confusion you may experience regarding transitions between Medicaid or CHIP and Marketplace coverage. Each month, they’ll feature a few misconceptions or questions they’ve identified using your feedback to help you assist consumers transitioning coverage. For additional information, review the Agent and Broker Toolkit: Transitions in Coverage resource.

As we begin Open Enrollment, CMS is focusing on questions regarding potential Medicaid and CHIP coverage on the HealthCare.gov application.

 Misconception

Consumers who recently lost Medicaid or CHIP coverage will automatically be sent back to their state when they submit a Marketplace application.

 Truth

When applying for Marketplace coverage through HealthCare.gov, consumers will be asked questions regarding Medicaid and CHIP coverage and should answer those questions truthfully. Those questions are used to make sure consumers get the right eligibility determination and are not improperly sent back to the state. Refer to the toolkit linked above for guidance regarding how to understand these questions.

Key Resources

• Transitions in Coverage Toolkit: This toolkit offers guidance on how agents and brokers can reach and assist consumers affected by loss of coverage. Inside you’ll find materials like a checklist for transitions in coverage and talking points that agents and brokers can use when assisting consumers to help address common questions and scenarios.
• Leave Behind resources (full color version or printer friendly version): Consumers are often unaware that they have lost health coverage until they are visiting their doctor or pharmacy, and do not know where to go for help. CMS has created a fillable contact card for agents and brokers to share with community partners that includes high-level information about receiving low-cost, quality health coverage through the Marketplace, a space for contact information, and a link for further information about transferring to Marketplace coverage.
• This FAQ provides situations in which inbound account transfers (when the state Medicaid or CHIP agency sends a consumer’s application information via secure electronic file to the Marketplace) are triggered and states the conditions in which inbound account transfers will not be sent for individuals whose coverage has been terminated.
• This FAQ reviews the state-specific resources that you should direct consumers to who are unsure of whether their Medicaid or CHIP coverage was terminated by their state Medicaid or CHIP agency. It is important for consumers to know the status of their enrollment and that their contact information is updated for their state Medicaid or CHIP agencies.
• Medicaid to Marketplace HealthCare.gov: This webpage details the steps that consumers should take when they lose Medicaid or CHIP coverage, including instructions for reapplying through their state to see if they still qualify for Medicaid or CHIP coverage. Additionally, this webpage covers how the Marketplace may contact consumers who lose coverage.

CMS wants to hear from you! If you have feedback for CMS regarding Medicaid and Marketplace transitions, please complete this short survey.

Call us today at 866-568-9649!