Individual and Family
All About Open Enrollment: Qualified Health Plan Checklist
Updated on December 18, 2019
Before you apply for a Qualified Health Plan (QHP), you should gather the necessary information to make your application process go more smoothly. Gather these things before open enrollment to make your application experience quicker and easier! Keep in mind that if you are applying for a QHP, but not subsidies, you may not need all of this information on hand during open enrollment. However it’s a good idea to make sure you have all of this information if you do end up qualifying for cost saving subsidies.
Basic household information
When you apply for a QHP during open enrollment you will be asked for basic information, such as your name and date of birth. You should know this information for yourself and each person in your household, even if they are not applying for coverage.
Your household typically includes your tax filers and dependents. However, there are exceptions, sometimes the marketplace may include people you live with who aren’t in your tax household.
You can expect to include the following people on your application in addition to yourself:
- Your spouse
- Your children – even if they file a tax return
- Anyone you include on your tax return as a dependent, even if they don’t live with you (a common example of this is an adult child)
- Anyone else under 21 that you take care of
- Your unmarried partner if they are your dependent for tax purposes or if they are the parent of your child.
Your address is very important to determine what QHP you are eligible for, so make sure that you have your home address – and your mailing address if it is different – on hand as open enrollment approaches.
If anyone on your application has a different address, you may need to provide that information as well.
Social Security Numbers
When applying for a QHP, you will be asked to supply a Social Security Number (SSN) for everyone on your application. Make sure that you have each person on your applications 9-digit SSN available before you being applying.
If you choose to not supply an SSN on your application during open enrollment, you will be asked to supply more information at a later time.
Keep in mind that your SSN will only be used to determine your eligibility for a QHP.
You will only need to supply immigration information if you are applying for health insurance as a lawfully present immigrant.
If you or anyone on your application is a lawfully present immigrant you will need to supply immigration document information to qualify for a QHP during the open enrollment period.
Before you apply for a Qualified Health Plan, you will need to have both tax and income information readily available. Firstly, you will need to know how you file taxes. If you are married, you will need to let the Marketplace or broker know if you are filing separately or jointly. You will also be asked about who you claim as a dependent.
Employer and income information
You will also be asked about income and expenses. You will need to have income, expense, and deduction information for yourself and everyone in your household – even those who are not applying for insurance.
You will need to know the following income information for both yourself and everyone else in your household:
- Wages and salaries, as reported on W-2 forms and pay stubs
- Net income from any self-employment
- Unemployment compensation
- Social Security payment – including disability payments but not Supplemental Security Income (SSI)
- Rental Income
- All other taxable income
You will have to supply the best estimate of your household income for the year for which you are applying for coverage. Keep in mind that this will be an estimate you make during open enrollment for the following year.
This estimate is typically what is used to determine if you qualify for Affordable Care Act (ACA) subsidies. These subsidies help those who typically have a yearly income between 100% and 400% of the Federal Poverty Line (FPL) afford the monthly premiums – and in some cases out-of-pocket costs – of your QHP.
Changes to income
If you experience a change in income that differs from the estimate you reported during open enrollment, make sure to report that to your marketplace as soon as possible. If you experience a drop in income, you may end up qualifying for subsidies even if you previously did not qualify.
However, if you experience an increase in income you may no longer qualify for subsidies. If you do not report this change in income, you may end up having to pay back the subsidies for the months you no longer qualified during tax season.
Make sure to report any changes in your income that differ from what you reported during open enrollment so that you don’t miss out on savings you may qualify for or so you don’t end up with an unexpectedly large tax bill at the end of the coverage year.
If you have more questions about subsidies, read our article that answers ACA Subsidy FAQs!
A note on data matching issues
During open Enrollment, after completing your application to enroll in a QHP you may be asked to submit documents to verify your information – such as your income or citizen status. This is sometimes called a data matching issue or inconsistency. To resolve this issue and enroll in a QHP, you must submit copies of certain documents.
A data matching issue is when there is some sort of difference between the information that you put on your health insurance application and the information received available from other resources.
These issues may relate to your annual income, citizenship or immigration status. You will receive a notice about a data matching issue; once you receive the notice, you’ll have to verify the information by sending certain documents by a due date. If you do not meet the deadline, you could lose your health insurance or savings.
The kind of documents you need to submit to resolve a data matching issue, depend on what kind of data matching issue you have.
Common things insurers need to verify are:
- Yearly income estimate
- Immigration status
- Adoption, foster care placement, or court order
If you expect that there may be a data matching issue concerning any of these or other pieces of information, it may be a good idea to gather documents that can resolve the issue before the open enrollment period.
Common documents that may resolve a yearly income estimate data matching issues are
- A 1040 federal or state tax return
- A W-2 or 1099
- A Pay Stub
- Or self-employment ledger documentation
Keep in mind that all of these documents must contain your first and last name as well as other important information such as income amount, frequency of pay, or net income.
Common documents that may confirm your immigration status are
- A Permanent Resident Card – also known as a “green card”
- A Reentry permit
- A Refugee Travel Document
- Or a machine readable Immigrant Visa
Common documents that may confirm your U.S. citizenship status are
- A U.S. passport
- A Certificate of Naturalization
- A Certificate of Citizenship
- Or a State-Issued enhanced driver’s license
Common documents that may confirm an adoption, foster care placement, or court order are
- An adoption letter or record
- Foster care papers
- Or another court order
Make sure that if you are asked to submit documents to resolve a data matching issue that you do not send in the original document.
You can visit healthcare.gov for more information on how to resolve data matching issues.