Enrollment
The Open Enrollment checklist that actually prevents problems
Eleven things to have in hand before November 1, in the order they will be asked for, so your application does not stall on a data-matching issue.
Applications do not usually fail because someone chose the wrong plan. They fail because a document was missing, a name did not match a federal record, or an income figure could not be substantiated inside the window the Marketplace gives you. All three are avoidable, and all three are avoidable in advance.
This is the checklist, in roughly the order you will be asked for things.
Before you open the application
1. Social Security numbers for everyone applying
Not just yours. Every person seeking coverage needs one, and the name on the application has to match the Social Security Administration record exactly. A married name that was never updated with the SSA is the single most common cause of an identity verification failure.
2. Dates of birth, exactly
Age drives premium under the federal standard age curve, and a wrong birth year changes the price. It also changes eligibility, since a child ages off at 26 and catastrophic plans have an under-30 rule.
3. Immigration document numbers if applicable
Permanent resident card, employment authorisation document, or whichever document establishes lawful presence. Have the document number itself, not just the category. Lawfully present immigrants are eligible for marketplace coverage and for premium tax credits, including some who are not eligible for Medicaid.
4. Your tax filing status and who is on the return
Household for marketplace purposes means tax household, not the people living in your home. A roommate is not in it. A child you claim who lives at university is. Married couples generally must file jointly to receive a premium tax credit, with narrow exceptions for domestic abuse and abandonment.
The income section, which is where the trouble is
5. A defensible projection of annual household income
This is a projection for the coming year, not last year's number. If your circumstances have changed, project the change. If your income is genuinely unpredictable, project conservatively and plan to update it, because a projection that runs low all year produces a repayment bill in April.
6. Recent pay stubs for every W-2 earner
Two or three recent ones. If the Marketplace flags an income data-matching issue, these are the fastest way to close it.
7. Net profit figures if you are self-employed
Net profit after business expenses, which is the Schedule C bottom line, not gross receipts. People routinely enter gross receipts and hand themselves a wildly inflated income and a wildly deflated credit.
8. Last year's tax return
You are not required to file with it, but having the adjusted gross income figure to hand makes every other question easier to answer.
The coverage section
9. Details of any employer coverage offered to anyone in the household
This matters even if nobody took it. If an employer offers coverage that meets the affordability and minimum value tests, the people it covers are not eligible for a premium tax credit at all. Get the employer coverage tool filled in by HR before you apply rather than discovering the problem at reconciliation.
10. Your doctors, by name, and your hospital
Networks are county-specific and change every year. Verify each provider against each specific plan for the specific plan year. A carrier you recognise nationally can have a narrow network on your street.
11. Your prescriptions, with dosages
Check the formulary, not just whether the drug is covered. The same medication can sit on a $10 generic tier on one plan and a $340 specialty tier on another, and a drug that is off-formulary entirely is your problem alone.
Dates that bind
- November 1: Open Enrollment opens
- December 15: last day to enrol for coverage starting January 1
- January 15: Open Enrollment closes, coverage generally starts February 1
Some state-based marketplaces run longer windows than the federal one. The date that binds you is the one your state uses, not the one in the national news coverage.
The mistake to avoid entirely
Do not let the plan auto-renew without looking at it. Auto-renewal is convenient and it is also how people end up on a plan whose network dropped their hospital, whose deductible rose by $1,400, or whose premium rose while the benchmark fell so their credit shrank at the same time. Renewal is a decision. Make it deliberately, once a year, in about twenty minutes.
Demonstration content
CoverBridge is a fictional company built as a design and engineering demo. This article describes real mechanics of the Health Insurance Marketplace accurately, but every figure in it is illustrative and none of it is licensed insurance advice. For your actual eligibility, usehealthcare.govor your state marketplace.