You may now qualify for new lower-cost health care coverage.
On Jan. 1, 2015, Pennsylvania added new Medicaid coverage for adults. Pennsylvania now
offers  benefits  like  those  you’re  getting  now.  The  following  people  in your household may
qualify for this lower-cost health coverage:
[Insert name(s) of newly eligible individuals from FFM data file]
What do I need to do?
1) See if you qualify for health care coverage in PA.
Go to HealthCare.gov and update your account. If it looks like you qualify for
Pennsylvania’s  health  care  coverage,  HealthCare.gov will send your information to
Pennsylvania’s  Department  of  Human  Services  (DHS).
2) If HealthCare.gov sends your information to DHS, you can do one of two things:
A. Wait for a final decision on your health care application and then cancel your
HealthCare.gov plan and tax credits.
OR
B. End your HealthCare.gov plan and tax credits now and wait for your final health care
coverage decision.
You will find step-by-step directions attached.
What happens if I wait to cancel my HealthCare.gov health plan and tax credits?
Your HealthCare.gov coverage will continue until you cancel it. You will not have a gap in
coverage if you wait until you receive a final decision from DHS.
If you qualify for Pennsylvania’s  health  care  coverage, you must go back to HealthCare.gov
and cancel your HealthCare.gov health plan  and  tax  credits.  If  you  don’t  cancel this
coverage, you may have to repay your tax credits.
What happens if I end my HealthCare.gov health plan and tax credits now?
If you end your HealthCare.gov plan now, you will not have to repay any tax credits. But you
may not have any coverage until you get a final decision from DHS.
If you get a final decision stating that you do not qualify for Pennsylvania’s  health  care  
coverage, you will have to re-enroll at HealthCare.gov. To re-enroll in a HealthCare.gov plan,
call 1-800-318-2596 (TTY: 1-855-889-4325).

1

 What if I have questions?
You can call HealthCare.gov at 1-800-318-2596 (TTY: 1-855-889-4325)
You can also get in-person help. Go to https://localhelp.HealthCare.gov
If you have questions about health care coverage in Pennsylvania call 1-877-418-1187

Important: If you qualify for Pennsylvania’s  health  care  coverage, you must end your tax credits and
coverage.  If  you  don’t  end  your  tax  credits  and  coverage,  you  may  have  to  pay  back  any  tax  credits  you  
get through HealthCare.gov in 2015. You will get a written notice from DHS telling you that you qualify.

 Step-by-Step Instructions
Step 1. Go to Healthcare.gov. Log in.
Once  in  your  HealthCare.gov  account,  click  “Visit  the  Marketplace  for  Individuals  and  
Families.”      
Follow the steps to start or finish a 2015 application. When you have finished the 2015
application,  hit  the  “submit”  button.

Step 2. Review your eligibility results. Make a decision to wait or cancel your
health plan and tax credits.
If everyone on the application will be sent to Pennsylvania’s  Medicaid plan:
You can wait for a final decision from DHS on whether you qualify for health care
coverage. If you disagree with the decisions, you can ask DHS to review. This is called
an appeal.
OR
You can end your Marketplace coverage right away. If you end your Marketplace
coverage, you might have a gap when you have no coverage at all.
To end your coverage:
1. Go to www.HealthCare.gov and log in
2. Select  “My  Applications  & Coverage”  from  the  pull-down menu on the right corner
of the page.
3. Decide which application to use
If  you  see  a  2015  application  and  an  enrollment  for  2015,  under  “Your  Existing  
Applications”,  select  the  2015 application.
If you do not see an enrollment for  2015,  under  “Your  Existing  Applications”,  
select the 2014 application.
4. On  the  left  side  of  the  screen,  select  “My  plans  &  programs.”  Scroll  down  and  select  
the  red  button  that  says  “End  all  coverage”.    
5. End your Healthcare.gov plan coverage
If your coverage has started, you will be asked when you want to end your
coverage, starting 14 days from the current date.
If your coverage has not started, you can end your coverage right away.
Note: If you are trying to end your 2014 coverage after Dec. 15, you may need to wait
until the Marketplace re-enrolls you in 2015 coverage. Then cancel that coverage before
it starts.

 If some Marketplace enrollees on the application are sent to Medicaid, but others are eligible
for Marketplace coverage:
1. Go to www.HealthCare.gov and log in.
2. Select  “My  Applications  &  Coverage”  from  the  pull-down menu on the right corner
of the page.
3. Decide which application to use
A. If  you  see  a  2015  application  and  an  enrollment  for  2015,  under  “Your  Existing  
Applications”,  select  the  2015  application.  
B. If  you  do  not  see  an  enrollment  for  2015,  under  “Your  Existing  Applications”,  
select the 2014 application.
4. On the left side of the screen,  select  “My  plans  &  programs.”  
5. After  you  go  through  your  2015  application,  you  will  see  a  green  “Continue  to  
Enrollment”  button  on  the  “Eligibility  results”  screen.  
6. Click this button. Complete all the steps on the screen.
Note: Only the names of consumers who qualify for QHP coverage will be listed. The
name of people who have been sent to PA’s  Medicaid plan will not be on the list.
7. Choose a health plan for the people who are listed.
Important: When you choose a plan for the people who are listed, you will also end
coverage, tax credits and help for the people who were sent to PA’s  Medicaid plan.
Choosing a plan now for the people on the list means that they will be able to choose a plan
for 2015 and get the right amount of tax credits and help with cost-sharing.

Step 3. If you qualify for Pennsylvania’s  health  care  coverage  and you had
health coverage through HealthCare.gov, you must do two things: end your tax
credits and cancel your health plan.
To end your tax credits and cancel your health plan, see the to end your coverage
instructions above.