Eligibility Results

Rayana Shelton

Medicaid acceptance with no QHP enrollment through Pennie, APTC for lower costs, Medicaid/CHIP eligibility determined by marketplace, full eligibility results must be shared with customer.

Categories

Community

Slides (14)

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If a customer is accepted into Medicaid, they would not be eligible to enroll into a QHP through Pennie with subsidies.

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If a customer is denied Medicaid, any APTC removed during the evaluation can be reapplied to their initial start date.

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If a customer rejects their Medicaid coverage, they will have to pay the full cost for their marketplace coverage.

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APTC will remain while we await the Medicaid determination

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The marketplace is responsible for determining a customer's final Medicaid/CHIP eligibility

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The amount of APTC a customer receives is determined by

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APTC is used to lower a customer's

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Cost Sharing Reductions lower out-of-pocket expenses such as copay amounts, deductibles, co-insurance rates, and OOP Max

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We need to inform a customer of their full eligibility results after submitting or updating an application

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