CMS Weekly Assister Newsletter: January 13, 2016

January 13, 2016

Highlights from this week’s newsletter:

  • A NEW CMS Blog on getting ready for tax season (also available in Spanish);
  • Slides from the December 18, 2015 assister webinar presentation on health coverage and the tax filing season; and
  • A NEW HHS report on enrollment-related activity in the individual market Marketplaces during the first part of the 2016 Open Enrollment Period.

***Please note that as of this week, the assister newsletter will go out every other week. Dates of newsletters in the coming weeks include January 27, February 10, and February 24.***



A NEW HHS report provides national and state-level data on enrollment-related activity in the Health Insurance Marketplaces during the first two months of the 2016 Open Enrollment Period (OEP) for all 50 states and the District of Columbia. The report indicates that nearly 11.3 million individuals selected or were automatically reenrolled in Marketplace plans during the first eight weeks of the 2016 OEP, from November 1, 2015 through December 26, 2015, and includes detailed state-level data on the characteristics of these individuals.

Click here to view this report.



As tax season approaches, we’ll be featuring information that you can use when helping consumers understand how their insurance coverage may affect their tax filing process.

1. Getting Ready for Tax Season

Like last year, assisters can help consumers who enrolled in coverage through the Health Insurance Marketplaces and received advance payments of the premium tax credit (APTC) understand the Form 1095-A that they receive from the Marketplace. Consumers must use the Form 1095-A to complete Form 8962 when they file their taxes. These forms  allow consumers to reconcile the total APTC they received during 2015 with the amount of premium tax credit (PTC) for which they are eligible based on their final 2015 income and household information. Additionally, like last year, assisters may not provide assistance with filing taxes, unless you are also a licensed tax preparer.

Update: New Forms 1095-B and 1095-C

This year, some consumers will receive Forms 1095-B or 1095-C. Like Form 1095-A, Forms 1095-B and C will provide consumers with information about their health coverage during the prior year. Consumers who have health coverage through the Marketplace and receive a Form 1095-A might also receive a Form 1095-B or Form 1095-C if they or members of their household had coverage in 2015 through other programs or plans outside of the Marketplace. Individuals who have questions about a Form 1095-B or 1095-C should contact the entity that provided them with the form.

Forms 1095-C will be provided to consumers by certain large employers. Forms 1095-B will be provided to consumers by health insurance providers, such as health insurance companies and government agencies including Medicare, Medicaid or CHIP. Insurance issuers and carriers aren’t required to file Form 1095-B to report coverage in individual market qualified health plans that individuals enroll in through Health Insurance Marketplaces. This coverage generally is reported by Marketplaces on Form 1095-A. However, health insurance issuers will file Form 1095-B to report on coverage for employees obtained through the Small Business Health Options Program (SHOP).

(Click here to view an IRS Q&A with more information about who will receive Forms 1095).

Note that while the deadline for the Marketplace to provide Form 1095-A is February 1, 2016, the deadline for insurers, other coverage providers, and certain employers to provide Forms 1095-B and 1095-C has been extended to March 31, 2016. Consumers expecting to receive a Form 1095-A should wait to file their 2015 income tax return until they receive that form, but it is not necessary to wait for Forms 1095-B or 1095-C in order to file.

Click here to view the IRS Q&A that offers more about new tax forms related to the health care law, including when consumers will receive these forms, how they should use them, and who will provide them.

Also check out a new blog by Marketplace CEO Kevin Counihan that addresses what people with different health coverage situations need to know as they prepare for the tax season. Please use the links below to view this blog in English or in Spanish.



2. December 18, 2015 Assister Webinar Presentation Slides

The December 18, 2015 assister webinar included a presentation on Form 1095-A and how assisters can help consumers during the 2016 tax season. Consumers must use the Form 1095-A to complete Form 8962 when they file their taxes. These forms  allow consumers to reconcile the total APTC they received during 2015 with the amount of premium tax credit (PTC) for which they are eligible based on their final 2015 income and household information. 

  • Click here to view the slides from the December 18 webinar presentation; you can also view these slides, along with other resources on helping consumers during the tax season, on

For more tax –related information and tips, see “Taxes & the Health Insurance Marketplace” section on, the “Tax information” section on, and the “Affordable Care Act Tax Provisions” section of the IRS website.



As you help consumers sign up for Marketplace coverage, remember that consumers who would like coverage that begins on February 1, 2016 must enroll by this Friday, January 15, 2015. Consumers who sign up during the second half of the month (January 16 – 31) will have coverage that takes effect March 1, 2016.

Click here to view a NEW blog about the January 15, 2016 deadline.

Click here to view important coverage effective dates, including the following.

  • January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016
  • January 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between January 16 and January 31 take effect March 1, 2016.



1. Helping Consumers Resolve Data Matching Issues

The Friday, January 8, 2016 assister webinar included a presentation on helping consumers resolve data matching issues (DMIs). The presentation included an overview of DMIs, four complex case scenarios, and tips and resources for assisters. DMIs occur when consumers apply for Marketplace coverage but do not provide enough information to match information available to the Marketplace from trusted data sources, or provide information that does not match up right away with existing records. See our December 23 newsletter for more information on data matching issues.

  • Click here to view the slides from this presentation and click here to view them along with other resources related to the Marketplace application process.
  • Click here to view the slides from the December 18, 2015 presentation on “Tips to Resolve Outstanding Data Matching Issues (Inconsistencies)”.
  • More information can also be found on the Inconsistencies & Data Matching section of


2. Updates on the Small Business Health Options Program

The Friday, January 8, 2016 assister webinar included an update on the Small Business Health Options Program (SHOP) and the SHOP Call Center. The presentation covered SHOP Marketplace basics, as well information on how assisters can work with the SHOP Call Center. Please note that the SHOP Call Center is different from the Marketplace Call Center and has a different toll-free number.

SHOP Call Center representatives can answer general inquiries related to SHOP eligibility, policies, and procedures, and assist employers and employees with the online enrollment process. SHOP Call Center representatives can access employer and employee accounts at the request of the account contact person or their designated agent/broker. When contacting the SHOP Call Center, the account primary or secondary contact, agent/broker, or employee must provide a verbal authorization for the SHOP Call Center representative to speak with the designated assister on the consumer’s behalf; this is a one-time authorization and is in effect for the duration of the call.

Marketplace assisters wanting to help a consumer establish a SHOP account, create a SHOP enrollment, or make account updates may contact the SHOP Call Center.

SHOP Call Center contact information:

  • Number to call: 1-800-706-7893
  • Hours of operation: Monday through Friday from 9:00 a.m. ET to 7:00 p.m. ET
  • Navigators and other Marketplace assisters should select Option 4 when contacting the SHOP Call Center to hear general SHOP information or to be connected to a SHOP Call Center representative.


Additional information:

  • SHOP Call Center: Monday – Friday, from 9am-7pm Eastern Time; 1-800-706-7893 | TTY 1-800-706-7915.


“ORHP, ACA, and You” Office Hours: Engaging with Rural Hospitals in O&E: Financial and Community Benefit

This call with the Health Resources and Services Administration (HRSA) Office of Rural Health Policy (ORHP) will focus on best practices for engaging with rural hospitals in outreach and enrollment efforts. The call will feature a presenter from the Internal Revenue Service to discuss community benefit requirements and outreach and enrollment, as well as a HRSA Rural Outreach Benefits Counseling grantee who works with a network of Critical Access Hospitals. The call will also feature the findings from a qualitative study that focused on best practices for rural hospital engagement in outreach and enrollment.


Connecting Kids to Coverage National Campaign Webinar: Planning an Effective Media Strategy for 2016

Thursday, January 28 | 2:00 p.m. ET: Click here to register

The Connecting Kids to Coverage National Campaign is looking forward to another year of providing partners and grantees with strategic and actionable support to carry-out their Medicaid and Children’s Health Insurance Program (CHIP) outreach and enrollment objectives. A Campaign webinar this month will address how to develop an effective media strategy to support outreach and enrollment efforts in 2016, with a specific focus on social media strategy.


Connecting Kids to Coverage

Children and teenagers in your congregation or community may qualify for free or low-cost health insurance coverage through Medicaid and the Children’s Health Insurance Program (CHIP). Many parents may be eligible for Medicaid as well. Learn about the nationwide effort to identify children and youth eligible for Medicaid and the Children’s Health Insurance Program (CHIP) and get them enrolled.



Please note that assister webinars now take place every other week and begin at 2:00 pm ET unless otherwise noted.

  • Friday, January 22, 2016
  • Friday, February 5, 2016
  • Friday, February 19, 2016



1. Standing Assister Resources

Below are some resources that assisters use on a regular basis. 


2. Marketplace Call Center and SHOP Call Center Hours

Health Insurance Marketplace Call Center: For customer service support, to start or finish an application, compare plans, enroll or ask a question. 1-800-318-2596 (TTY: 1-855-889-4325). Available 24 hours a day, 7 days a week. Closed Memorial Day, July 4th, and Labor Day.

SHOP Call Center: For customer service support, including assisting employers and employees apply for and enroll in SHOP. 1-800-706-7893 (TTY: 711). Available M-F 9:00 am-7:00 pm EST. Closed New Year’s Day, Martin Luther King Day, Memorial Day, July 3rd, Labor Day, Veterans Day, Thanksgiving and the day after, and Christmas.


3. Stay in Touch

To sign up for the CMS Weekly Assister Newsletter, please send a request to the Assister Listserv inbox (*protected email*) write “Add to listserv” in the subject line, please include the email address that you would like to add in the body of your email.  For requests to be removed from the listserv, please forward a copy of a webinar invite or newsletter received and write “Remove” in the subject line.

If you have specific questions or issues that you would like to see us highlight in our weekly webinar series or here in this newsletter please contact us.

  • For HHS Navigator grantees – please get in touch with your Navigator Project Officer or send a request to *protected email*.
  • For CAC Designated Organizations in FFM or SPM states – please send an email to *protected email*.

Follow @HealthCaregov Twitter with the hashtag #ACAassisters for updates, reminders, and new publications for assisters.

We welcome questions, suggestions and comments, so please feel free to contact us!

Please note that the information presented in this Assister Newsletter is informal, technical assistance for assisters and is not intended as official CMS guidance.




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