When you apply for ACA Marketplace coverage, several critical pieces of information are verified to determine your eligibility. These include:
- Citizenship: Confirming your citizenship status.
- Income: Assessing your current monthly household income, annual household income, and family size.
- Coverage: Verifying the coverage details you’ve provided.
In some cases, you may find the Marketplace requires that you submit additional documentation to further prove one of these pieces of information listed. This occurs due to something known as a Data Matching Issue (DMI).
What Are DMIs?
A DMI occurs when any information on your application is either missing, inaccurate, or does not match the data found in the Marketplace’s trusted sources. As a result, the Marketplace will request further documentation to verify the details on your application.
Common Triggers for DMIs
Four common causes for DMIs being generated include:
- Missing Social Security Number (SSN): Ensure you provide your SSN accurately on your application.
- Incomplete Household Income: Include all household income details in your application.
- Immigration Document Numbers and ID Mismatch: Verify that these numbers match correctly.
- Name Discrepancies: Ensure your name on your application matches the one on your citizenship document when possible (discrepancies are especially common for people who have had name changes, which can sometimes be unavoidable).
Risks Associated with DMIs
When you receive a DMI, it’s vital that you submit the requested documents by the deadline given to you to validate any discrepancies. Missing your deadline poses a few risks:
- Loss of Coverage: Missing your deadline could lead to losing your coverage altogether, and unfortunately, if you lose your plan outside of Open Enrollment you won’t be able to enroll again until November for a January 1st effective date.
- Loss or reduction of Financial Assistance: DMIs can cause your premium tax credit (which lowers your monthly premium) to be decreased or lost completely, possibly making your coverage unaffordable.
Quick Tips for Preventing and Resolving DMIs
- Thorough Application Completion: Fill out all application fields accurately.
- Name Consistency: Ensure your name matches your official documents.
- Double-Check Details: Review your application for errors or typos.
Understanding Different Types of DMIs and their Deadline Expirations
- Annual Income DMI Expiration
- Description: When an applicant fails to document that their annual household income is within 50% or $12,000 (whichever is greater) of their attested income.
- Result of missing the deadline to verify income: Your household eligibility for financial assistance is adjusted, potentially resulting in no assistance at all. Additionally, If the annual income reported on your application is less than your actual income reported during tax filing, you may need to repay some or all of your premium tax credit!
- Citizenship/Immigration DMI Expiration
- Description: When an applicant fails to verify eligible citizenship or lawful presence status and needs to provide documentation to support their status
- Result of missing the deadline to verify this status: You will lose eligibility for Marketplace coverage altogether, leading to termination of your policy if you are already enrolled.
- American Indian / Alaskan Native Status DMI Expiration
- Description: When an applicant fails to verify membership in a Federally recognized tribe or shareholder in an Alaska Native corporation (ANCSA).
- Result of missing the deadline to verify this status: You will lose eligibility for financial assistance (such as your premium tax credit) specifically provided to members of Federally recognized tribes.
- Non-ESC Minimum Essential Coverage DMI Expiration
- Description: When an applicant cannot verify their non-enrollment in Non-Employer Sponsored Coverage.
- Result of missing the deadline to verify this: You will lose any financial assistance if already enrolled in a plan, thus making your plan more expensive.
DMI Resolution Periods
- Consumers with all DMI types (except citizenship or immigration DMIs) have 90 days to resolve issues, or they risk losing eligibility for Marketplace coverage and/or financial assistance.
- Consumers with citizenship or immigration DMIs have 95 days to resolve issues. If not resolved within this period, their coverage will be terminated.
- The Marketplace usually notifies you of any DMIs via your email and/or by sending paper notices to the mailing address listed on your Marketplace application. Remember, addressing DMIs promptly ensures accurate coverage and secures your financial assistance!
As your agent, our team at Georgia Health Insurance, Inc., will explain and give you guidance on the extra documentation needed (if a DMI occurs when you sign up), we also send you reminders of your upcoming deadline, as well as offer to submit your documentation for you! We are looking to protect your insurance from termination or surprise premium tax credit loss so that your plan remains affordable and in effect all year long! Our services are always free and we truly do care about our clients!
Sources:
https://www.cms.gov/marketplace/technical-assistance-resources/helping-consumers-resolve-dmi-.pdf
https://www.hhs.gov/guidance/document/how-resolve-income-data-matching-issues-dmis
https://faq.healthsherpa.com/en/articles/6060708-data-matching-issues-dmis
