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Topics of interest to both consumers and agents related to Covered California and the ACA biased in favor of the successful implementation of the Exchange and deliberately apolitical.

Marketplace Online Application Released

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Here’s an early look at what the health insurance marketplace online application process will look like. A demonstration copy was released for comment by the feds last week. It will be used as the online application for federally-facilitated State Marketplaces and will also serve as the model that may be used by Covered California and other state-operated marketplaces. This application is a big improvement when compared to online applications in use today by health insurance companies and online retailers.

Real-Time Verification

With integrated electronic verification, the information the applicant enters will be integrated with data from other sources including the IRS, Social Security, and the Department of Homeland Security.

Smart Application

Because this application is a dynamic tool, certain questions appear only for appropriate applicants. For example, only female applicants are asked about pregnancy. Another example is that only people between the ages of 18 and 22 are asked if they are full-time students.

Household Size

Verifying household size is a complex task, but because the application is dynamic, information is requested only once. The applicant must identify anyone on his or her federal income tax return, including spouse, children, and live in partner if they have children together who need health insurance. Tax filing, employment and income information is verified for each household member.

Income Verification

When federal income tax data is available the applicant’s income data from his last federal income tax return in 2012 is already displayed and serves as a reference point to help determine his or her estimated income for the year in which he wants insurance coverage.

Eligibility for Tax-Credit

Once the applicant’s household size and income is known, the system can determine if the applicant is eligible to receive a premium subsidy and cost-sharing reductions to help pay premiums. Next, the applicant is asked whether he or she receives or could receive affordable employer-sponsored coverage through his job. Assuming the applicant does not, the system puts him or her on the path to receive advance payments of the premium tax credit.

Eligibility Confirmation

The applicant receives congratulations, a list of programs for which he qualifies and what his next steps are. Applicants can print the eligibility page and have their eligibility determination saved to their electronic account. With the application process complete, the applicant can enroll in a qualified health plan and apply his tax credit right away.


I wonder if we can add to our personal websites the link to this online application? Either way though better question is if we have clients that would like to sign up online, how then will the system know to link it to the agent helping the client? Hhmmm still so many questions up in the air…

Please explain, if one member of the household is on medicare, then how rest of the family can buy insurance through exchanges. Whether the ss received by the retired person will be part of the house hold income or not.
Thank you...

The taxable portion of the Social Security income for the Medicare beneficiary would count toward family income. The subsidy (tax credit) would be based on family income.

These things are extremely unclear to me. Thanx god I have my consultant, who helps me to figure these things out.

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