CMS Issues Final Consumer Applications For Health Care Coverage Under ACA

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By Sara Hansard  


Following criticism that draft application forms to enroll in insurance coverage under the health care reform law were too long and complicated, the Centers for Medicare & Medicaid Services unveiled simplified forms April 30.

The application for individuals without health insurance has been reduced from 21 to three pages, and the application for families is reduced by two-thirds, CMS said in a release. The agency said the forms are “much shorter than industry standards for health insurance applications today.”


The online version of the application will be a “dynamic experience” that shortens the application process based on responses, and it will minimize the administrative burden on states, individuals, and health plans, CMS said.  



Consumers will be able to fill out one application and see their entire range of insurance options, including plans offered in online exchange markets being created under the Affordable Care Act, Medicaid, and the Children's Health Insurance Program (CHIP), as well as tax credits to help pay premiums, CMS said.

Applicants can begin submitting the forms Oct. 1, when open enrollment begins in the online “marketplaces” for plans that take effect Jan. 1, 2014. The initial open enrollment period will last six months. Applications can be made online, by phone, or on paper, and clear information will be provided on how to complete the applications as well as how to get help, the agency said. Millions of people are expected to enroll for coverage.

“Consumers will have a simple, easy-to-understand way to apply for health coverage later this year,” acting CMS Administrator Marilyn Tavenner said in the release. “This is another step complete as we get ready for a consumer-friendly marketplace that will be open for business later this year.”

Online Version 'Dynamic Experience.'

The online version of the application will be a “dynamic experience” that shortens the application process based on responses, and it will minimize the administrative burden on states, individuals, and health plans, CMS said. The paper application was simplified and tailored to meet personal situations based on feedback from consumer groups, it said.

A draft version of the application, which was about 21 pages on paper, had come under criticism from congressional Republicans, who sent a letter to Department of Health and Human Services Secretary Kathleen Sebelius in January. The letter said the draft application was too long and complicated and asked consumers for information they would not be likely to know, such as whether their employers' plans meet minimal value standards under ACA, or whether their employers will offer health coverage in the following year (see previous article).

Sebelius defended the applications April 12 at a House Ways and Means hearing on the HHS fiscal 2014 budget request, saying they were comparable to typical life insurance applications and that the length of the application process will depend on such factors as whether applicants have family members, what their incomes are, and whether they will be eligible for advance premium tax credits or Medicaid under ACA (see previous article).

CMS released an individual short form for single adults who are not offered health coverage by their employer, do not have any dependents, and cannot be claimed as a dependent by someone else. Applicants need to have Social Security numbers and employer and income information to complete it.

Three Applications

Three applications were released. A separate application was released for individuals who do not apply for financial assistance. A 12-page family form includes an application for health coverage and help paying costs. The family form suggests that applicants “apply even if you or your child already has health coverage. You could be eligible for lower-cost or free coverage.”

Both the individual short form as well as the family form ask if applicants are pregnant, whether they have a “physical, mental, or emotional health condition that causes limitations in activities (like bathing, dressing, daily chores, etc.),” or whether they live in a medical facility. The family form asks if applicants “want help paying for medical bills from the last three months.”

Praise From Consumer Advocates

Consumer advocates praised the revised forms. “The revised form demonstrates that in fact it is going to be easier to both apply for premium tax credits and enroll in an insurance plan through the exchanges in 2014 than just enrolling in a health insurance plan is today,” Washington and Lee University law professor Timothy Jost told BNA in an email. Jost is a consumer liaison with the National Association of Insurance Commissioners.

Julie Silas, a senior policy analyst with Consumers Union, said, “I think shorter is better.” She said CMS did a “good job” on the cover sheets explaining who should use which form. Some of the information not directly related to eligibility was moved to appendices, Silas noted. An example is an appendix to the short form to be used by an authorized assistor, she said.

On a draft form applicants were asked for general income, which could have included income that would not count toward eligibility, Silas said. In the final version CMS identified deductions it does not consider income, such as alimony and student loan interest, which do not count as income for eligibility for financial assistance, she said.

Some Questions Moved to Appendices

In addition, information about health coverage from jobs was moved to an appendix, and an employer coverage tool was added as well. “That, I think, will help people,” because the employer information is not readily available to many consumers, Silas said.

“We're glad that they're collecting data around applicants' race and ethnicity,” she said. The information was not collected on forms filed by applicants who are not asking for financial assistance, she noted. “We think that race and ethnicity should be collected for all applicants regardless of their financial need,” she said.

Anne Filipic, president of Enroll America, a group set up to help people get enrolled in health coverage under ACA, said in a release that “the streamlined applications released by HHS today represent a victory for consumers who are getting ready to enroll in the Marketplace in October. The shorter, just-the-facts applications will help empower consumers to make the health care decisions that are right for them, their families, and their budget.”

By Sara Hansard  

Application forms for enrolling in health care coverage are at The individual short form is at The application for individuals without financial assistance is at The family form is at