As you know, CMS, other federal agencies, and non-federal organizations have produced a number of resources to help you in your role as assisters. CMS has just released a new resource for assisters, The Assister’s Standard Operating Procedures Manual, to serve as an instructional guide for assisters. The Assister’s Standard Operating Procedures Manual is the latest “tool” CMS is releasing in the Assister’s Toolkit. The Assister’s Toolkit provides helpful tools and resources to help in your role as a Health Insurance Marketplace enrollment assister.

The Assister’s Standard Operating Procedures Manual provides guidance on how to help consumers in the Federally-facilitated Marketplace for the individual market with activities such as:

  • Preparing, completing, and updating Marketplace applications for health coverage;
  • Enrolling in health coverage through a Marketplace;
  • Understanding eligibility determinations for enrollment in health coverage through a Marketplace application;
  • Resolving data-matching issues (DMIs);
  • Renewing eligibility and enrollment for health coverage through a Marketplace; and
  • Learning how to complete requests for exemptions and appeals.

Click here to view The Assister’s Standard Operating Procedures Manual. As a reminder the toolkit also includes The Assister’s Roadmap to Resources and Catalog of Promising Practices: Creating a Streamlined Enrollment Process. All of the resources available in the toolkit can be found here on along with other Technical Assistance Resources.


Marketplace Call Center vs. the IRS – Where to Refer Consumers with Tax-Related Questions

This chart below provides a reference on when consumers should contact the Marketplace Call Center or the IRS if they have questions about how their coverage status and/or Marketplace financial assistance will affect the tax filing process. Use this resource in your work with consumers to help route their questions accordingly.

Marketplace HCAN website

NEW Tax Tool Available on

On January 15, 2016, the Marketplace launched a new Tax Tool feature on This year, the tool will streamline the consumer experience by combining last year’s second-lowest cost silver plan and lowest-cost bronze plan tools into one tool, which will support consumers in calculating amounts for both the premium tax credit (IRS form 8962) and the affordability exemption (IRS form 8965). In addition, the new tax tool will:

  • Support consumers with both tax years 2014 and 2015
  • Provide options for consumers to print, save, or email their results
  • Offer consumers instructions on what to do next

Click here to access the tax tool.

IMPORTANT TIP: When entering family members into the tax tool, consumers should list family members without health care coverage before family members with health care coverage (i.e. Medicare or employer sponsored coverage) to obtain accurate results.

NEW Updated Spanish Translation of Model Form 1095-A

CMS recently updated its translation of the Spanish Form 1095-A and instructions for using the form. This resource is intended to help Spanish-speaking assisters and consumers understand the English Form 1095-A and instructions that will be mailed to consumers who had Marketplace coverage in 2015. Consumers will need the information on the mailed Form 1095-A to fill out their 2015 federal income tax forms.

To view the instructions and model Form 1095-A in Spanish, click here; you can also view this form in English, along with other tax–related resources located here.

CAC Conference for CACs and CAC Managers set for March 9-10 in Omaha, details TBD

Save the dates of March 9-10, 2016 for the CAC Conference for CACs and CAC Managers to be held in Omaha, NE.  Details will be announced soon with registration information.

Helping Consumers Resolve Data Matching Issues

The Friday, January 8, 2016 assister webinar included a presentation on helping consumers resolve data matching issues (DMIs). The presentation included an overview of DMIs, four complex case scenarios, and tips and resources for assisters. DMIs occur when consumers apply for Marketplace coverage but do not provide enough information to match information available to the Marketplace from trusted data sources, or provide information that does not match up right away with existing records. See our December 23 newsletter for more information on data matching issues.

  • Click here to view the slides from this presentation and click here to view them along with other resources related to the Marketplace application process.
  • Click here to view the slides from the December 18, 2015 presentation on “Tips to Resolve Outstanding Data Matching Issues (Inconsistencies)”.
  • More information can also be found on the Inconsistencies & Data Matching section of


1. Getting Ready for Tax Season

Like last year, assisters can help consumers who enrolled in coverage through the Health Insurance Marketplaces and received advance payments of the premium tax credit (APTC) understand the Form 1095-A that they receive from the Marketplace. Consumers must use the Form 1095-A to complete Form 8962 when they file their taxes. These forms  allow consumers to reconcile the total APTC they received during 2015 with the amount of premium tax credit (PTC) for which they are eligible based on their final 2015 income and household information. Additionally, like last year, assisters may not provide assistance with filing taxes, unless you are also a licensed tax preparer.

Update: New Forms 1095-B and 1095-C

This year, some consumers will receive Forms 1095-B or 1095-C. Like Form 1095-A, Forms 1095-B and C will provide consumers with information about their health coverage during the prior year. Consumers who have health coverage through the Marketplace and receive a Form 1095-A might also receive a Form 1095-B or Form 1095-C if they or members of their household had coverage in 2015 through other programs or plans outside of the Marketplace. Individuals who have questions about a Form 1095-B or 1095-C should contact the entity that provided them with the form.

Forms 1095-C will be provided to consumers by certain large employers. Forms 1095-B will be provided to consumers by health insurance providers, such as health insurance companies and government agencies including Medicare, Medicaid or CHIP. Insurance issuers and carriers aren’t required to file Form 1095-B to report coverage in individual market qualified health plans that individuals enroll in through Health Insurance Marketplaces. This coverage generally is reported by Marketplaces on Form 1095-A. However, health insurance issuers will file Form 1095-B to report on coverage for employees obtained through the Small Business Health Options Program (SHOP).

(Click here to view an IRS Q&A with more information about who will receive Forms 1095).

Note that while the deadline for the Marketplace to provide Form 1095-A is February 1, 2016, the deadline for insurers, other coverage providers, and certain employers to provide Forms 1095-B and 1095-C has been extended to March 31, 2016. Consumers expecting to receive a Form 1095-A should wait to file their 2015 income tax return until they receive that form, but it is not necessary to wait for Forms 1095-B or 1095-C in order to file.

Click here to view the IRS Q&A that offers more about new tax forms related to the health care law, including when consumers will receive these forms, how they should use them, and who will provide them.

Also check out a new blog by Marketplace CEO Kevin Counihan that addresses what people with different health coverage situations need to know as they prepare for the tax season. Please use the links below to view this blog in English or in Spanish.


Free CEUs available from George Washington University Cancer Institute: Cancer Survivorship E-learning Series for Primary Care Providers, 9 modules including breast cancer

Free CEUs available from George Washington University Cancer Institute: Cancer Survivorship E-learning Series for Primary Care Providers, 9 modules including breast cancer.

PDF here, GW Cancer Center survivorship e-learning series for Primary Care Providers

CMS Announces Accountable Health Communities Funding Opportunity to Improve Community Linkages to Address SDOH

The Accountable Health Communities Model is based on emerging evidence that addressing health-related socials needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Over a five-year period, the Centers for Medicare and Medicaid Innovation (CMMI) will implement and evaluate a three-track model based on promising service delivery approaches. Each track features interventions of varying intensity that link beneficiaries with community services (from referrals to actual alignment).

CMMI will award a total of 44 cooperative agreements to successful applicants to implement the Accountable Health Communities model through one of the three tracks in partnership with state Medicaid agencies, clinical delivery sites, and community service providers.

NACHC strongly encourages health centers, PCAs, and HCCNs to apply!  If your organization is considering an application, please let us know!  Email Michelle Proser at

Learn more!  A link to the funding announcement can be found here. CMMI will host webinars on January 21st and 27th to provide more information about this opportunity.  CMMI staff will also speak on a January 20th webinar  hosted by the American Public Health Association, Prevention Institute, Public Health Institute, Trust For America’s Health and its Dialogue4Health.  Finally, the CMS Low Income Access Open Door Forum will discuss this funding opportunity on February 18th from 2-3 pm EST.


While the deadline to sign up for coverage effective January 1, 2016 has passed, consumers can come to the Marketplace to select a plan until Open Enrollment ends on January 31, 2016. Consumers can also return to select a different plan even if they have already selected a plan earlier during Open Enrollment.

Click here to view a NEW blog that reminds consumers that they have until January 15, 2016 to enroll in or change plans for 2016 health insurance that begins on February 1, 2016.

Click here to view important coverage effective dates, including the following.

  • January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016

January 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between January 16 and January 31 take effect March 1, 2016.