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[Yagents]

Go into sherpa, search marketplace, search healthcare.gov, log in in as agent, search client, open app, report life change, start app, get to agent page, change aor, keep income same, finish app, elig letter, back to sherpa, select same plan, you are now aor. Will show up in carrier book within a couple days or week or 1st of month depending on carrier. Sherpa will now show u as aor

 

[DonP]

I've known how to do that. But last yr during non open enrollment they told me wouldn't work.Also health Sherpa told me several times you must change something on the app to be the new aor like adjust income by $1. Is that true ?

 

[Yagents]

No, not true

 

[DonP]

But next yr I read on proposals for 2023 there going to require a sig from customer verifying there income . Probably by email . So many agents lieing about income them clients gets big tax bill .

 

[hockeyday]

But next yr I read on proposals for 2023 there going to require a sig from customer verifying there income . Probably by email . So many agents lieing about income them clients gets big tax bill .

Where did you see that? I don't see the point , they all ready get multi letters telling them what their income is and tax credit amount..

 

[DonP]

About 2 weeks ago I saw it . Might have been an email from healthcare. Gov. . I get so much stuff . It was suggestions for 2023 . It basically acted like they've had problems with agents . These were suggestions . Yes people get letters from Healtcare. Gov but many never opel them .

 

[Yagents]

Its a verbal consent on income

https://khn.org/news/article/hhs-pr...ans-carries-a-hefty-dose-of-consumer-caution/

 

[DonP]

It will still stop bogus aors however they implement it . There's tons of brokers running face book ads were when somebody fills out a ad at the bottom it says " you agree by pressing submit your giving me authorization to be your broker " . How the heck do you think some brokers are writing 500-1000 during open enrollment?The ad asks for their name , address and dob .Brokers then switch the aor . It's unethical as crap but many brokers doing that .

 

[Yagents]

The Marketplace does need to add additional security features for app entry besides just name and date of birth.

 

[Yagents]

Page 19

https://www.federalregister.gov/doc...ce-of-benefit-and-payment-parameters-for-2023

Fourth, to minimize consumer harm stemming from the IRS reconciliation process, as well as to protect Exchange operations from inaccurate APTC and CSR determinations, we propose to add proposed new § 155.220(j)(2)(ii)(D), which would provide that when submitting household income projections on applications submitted to the Exchange to determine a tax filer's eligibility for APTC in accordance with § 155.305(f) or CSRs in accordance with § 155.305(g), an agent, broker, or web-broker may only enter a household income projection for a consumer that the consumer or the consumer's authorized representative designated in compliance with § 155.227, has authorized and confirmed is an accurate estimate. We propose to require that household income projections on Exchange applications must be attested to by the consumer or their authorized representative, and clarify that the agent, broker, or web-broker may answer questions posed by the consumer or their authorized representative related to household income projection, such as helping determine what qualifies as household income.

HHS is proposing this change because it has observed several instances in which agents, brokers, and web-brokers have provided inaccurate consumer household income projections on Exchange applications to obtain the lowest monthly premium rate for QHP coverage. This is problematic in situations when consumers are enrolled without their knowledge or consent because if a consumer is enrolled in an Exchange policy with a zero-dollar monthly payment, the consumer may not be aware they have been enrolled because there would not be a monthly bill. HHS has observed several instances where consumers have gone months without realizing they are enrolled in a QHP with APTC, typically finding out about the unauthorized enrollment when the IRS contacts them regarding money they owe due to not qualifying for all or part of the APTC paid for this coverage or when the IRS delays release of a tax refund.

Pursuant to § 155.305(f), a tax filer is, in general, not eligible for APTC unless the Exchange determines that the tax filer is expected to have household income, as defined in 26 CFR 1.36B-1(e), of greater than or equal to 100 percent but not more than 400 percent of the FPL for the year for which coverage is requested.[263] It is crucial that consumers applying for a QHP or applying for APTC and CSRs for QHPs provide an estimate of their projected household income that is as accurate as possible for an Exchange to be able to determine their eligibility for APTC. Failure to provide correct information on household income can harm consumers by creating liability during the reconciliation process or delaying the issuance of a tax refund, as well as prevent the efficient operation of the Exchange. More specifically, although eligible consumers may use APTC to lower their monthly premiums for QHP coverage through an Exchange if a consumer's projected household income on his or her Exchange application submission is inaccurate and lower than the actual household income, the consumer is likely to have excess APTC (the extent to which APTC exceeds the allowed PTC), all or a portion of which must be repaid when the consumer files his or her federal income tax return for the year of coverage as required under 26 U.S.C. 36B(f) and 26 CFR 1.36B-4. Each year, consumers for whom APTC is paid must submit Form 8962 with their annual federal income tax return to the IRS. On Form 8962, the consumer must reconcile the APTC paid on his or her behalf with the PTC [264] the consumer is allowed. Generally, consumers whose projected household annual income at enrollment is less than the actual annual household income will have excess APTC that must be repaid, subject to a repayment limit for consumers with household income below 400 percent of the FPL. Consumers are required to repay excess APTC by increasing their tax liability for the year by all or a portion of the excess APTC. Good-faith income projections, versus an income projection designed to achieve the lowest monthly rate, better protect the consumer from the unexpected cost and burden of repaying large amounts of APTC. Additionally, per § 155.305(b), Exchange enrollees must report changes that may impact their eligibility for financial assistance or coverage, including their projected annual household income, within 30 days of the change.

CSRs are similarly tied to a consumer's household income and they lower the amount that certain eligible individuals have to pay for deductibles, copayments, and coinsurance. Incorrect projections of a consumer's household income would also lead to incorrect CSR determinations, which would harm Start Printed Page 647 QHP issuers and prevent the efficient operation of the Exchange.

An estimate of a consumer's household income is required on the Exchange application if the consumer is applying for APTC and CSRs. As outlined above, agents, brokers, or web-brokers who are intentionally or negligently entering inaccurate household income projections on a consumer's Exchange application can harm consumers and prevent the efficient operation of the Exchange. We therefore propose in this rule to clarify and codify that if household income projections are included on the Exchange application, the estimate must be attested to by the consumer or the consumer's authorized representative as designated in compliance with § 155.227 to comply with the FFE standard of conduct under § 155.220(j)(2)(ii) to provide correct information to the Exchange.

As noted previously in this rule, the proposal to amend § 155.220(j)(2)(ii) to add proposed new § 155.220(j)(2)(ii)(A) through (D) is not intended to constitute an exhaustive list of practices that govern providing correct information to the Exchange under § 155.220(j)(2)(ii); rather, these are areas where HHS has thus far identified a need for more direct and clear guidance to protect consumers and the efficient operation of the Exchanges.

We seek comment on these proposals.