Marketplace Notices

The Health Insurance Marketplace sends LOTS of mail. This page has examples of every notice you would receive and why it’s important.

Don’t be that guy and throw away your mail without reading it first. If you are that guy, at least review these notices so you know which ones to look out for.

Marketplace Initialism Meanings

OEP - Open Enrollment Period

FPL - Federal Poverty Level

CSR - Cost Sharing Reduction

DMI - Data Matching Inconsistency

APTC - Advanced Payments of the Premium Tax Credit

SEP - Special Enrollment Period

QHP - Qualified Health Plan

Marketplace Initialism & Common Term Definitions

OEP - The Open Enrollment Period is the time when you can enroll into a health plan for the following year. The Marketplace OEP typically runs from November 1st to December 15th, but when the American Rescue Plan was rolled out in 2021 it was extended to January 15th. It is unknown how long the extended OEP will last.

FPL - The Federal Poverty Level was created by the Government to determine who’s eligible for Financial Help from them.

CSR - Cost Sharing Reduction is available on Silver Plans for consumers in certain income brackets. There are 3 different CSR Income brackets. C is for anyone making under 150% of the FPL. B is for anyone making between 151% and 200% of the FPL. A is for anyone making between 201% and 250% of the FPL. It’s backwards (shocker, the Government created this), but C is the best bracket to be in when it comes to your health plan. CSR lowers your Copays, Coinsurance, Deductible, and Maximum Out of Pocket Costs. Click on the image to your left to view the 2024 FPL Chart.

DMI - Data Matching Inconsistency is when the data you entered into your Health Insurance Marketplace Application doesn’t match what the Government knows about you. Examples: Income entered does not match most recent Tax Return, no proof of Citizenship and/or Immigration Status, or Social Security number doesn’t match their records.

APTC - The Advanced Payment of the Premium Tax Credit (subsidy) is issued monthly by the Government depending on your family size, income, age, geographic location, and tobacco use. The APTC goes straight to the Insurance Carrier and the consumer is only required to pay what the premium is after that is taken out. This is reconciled every year when you file your taxes with the 1095A Tax Form.

SEP - A Special Enrollment Period is for certain individuals who may qualify to enroll in a health plan through the Health Insurance Marketplace after the OEP is over. Examples: Losing Employer Coverage, Losing Medicaid, moving to a different county, or an income change resulting in losing CSR.

QHP - A Qualified Health Plan has coverage for the 10 Essential Health Benefits set by the Government.

Eligibility - The notice that the Marketplace issues once you complete an application letting you know what you’re eligible for as far as the APTC goes and will let you know if you have any DMI.

Auto Enrollment - Means you have been automatically enrolled into a health plan for the following year. This happens to consumers who don’t touch their application during the OEP. It’s HIGHLY recommended to run through your Marketplace application every year to ensure all your information is correct. ESPECIALLY income, because that tends to change, and you don’t want to owe the Government money because you weren’t paying attention.

Migration - Migration means you have been automatically enrolled into a DIFFERENT health plan because the current one you were enrolled in isn’t going to be available to purchase in the following year.

Retroactive - Individual Health Plans are always effective on the 1st of the following month the application was submitted. Some consumers may be eligible for a Retroactive effective date in the past before the application was submitted. One example is when you have a child. When they’re added to health plan, their effective date is Retroactive to the day they were born.

  • If you enroll into a Health Plan directly with the Marketplace, you will not have an agent to contact when you have customer service issues throughout the year. This is not recommended as the Navigators with the Marketplace are not legally allowed to discuss health plan benefit details with consumers. However, during the next Open Enrollment Period, we can take over your Health Policy and you’ll finally have your own personal Agent to contact whenever you have any questions or concerns.

  • If you enroll into a Health Plan directly with Florida Blue, then their Corporate Office will be your Agent of Record and that can NEVER be changed unless you have a lapse in coverage, which is not advised!

NO EXCUSES!!!

I’ve been enrolling consumers into a Health Insurance Marketplace plan since it was rolled out at the end of 2013 for the 2014 Health Plan year. The most COMMON thing I hear is, “I never received that notice.”

Like I said before, DON’T BE THAT GUY!!

The Health Insurance Marketplace is linked with the IRS and run by our lovely Government. You need to be sure to read all mail received from the Marketplace, so you don’t miss anything important.

If you signed up for Electronic Notices (which I don’t recommend unless you are VERY tech savvy), then you need to create a Healthcare.gov Account and load all your Marketplace Applications into it. This is because they don’t just email you the notice. They email you stating, “You Have a Message Waiting.” Then you have to actually login to your Healthcare.gov account to view the message.

Confused as hell? Click on the image above to be directed to our On-Marketplace Health Plan page to learn more.

Not sure how to create a Healthcare.gov account? Click on the image to your right for a How-To Guide.

IMPORTANT!! - If you try to load a Marketplace Application into your Healthcare.gov account and it doesn’t work on the first try, CALL US!!! After 3 attempts, they lock you out from loading ANY application year into your Healthcare.gov account. You would have to call the Health Insurance Marketplace @ 800-318-2596 to get that unlocked and Hold Times are CRAZY right now.