Explore Health checks certain information on your application to make sure you qualify for:
- Health coverage
- Financial help
- Special savings programs
This process is called verification.
What information may need to be verified
Explore Health may verify:
- Income
- Social Security number
- Citizenship or immigration status
- Oregon residency
- Other health coverage
- Incarceration status
Most information is checked electronically using trusted state and federal data sources.
Sometimes Explore Health may ask you to provide documents if information cannot be confirmed automatically.
Common documents you may need
Examples of documents include:
- Pay stubs
- Tax returns
- Social Security cards
- Birth certificates
- Immigration documents
- Proof of address
- Letters showing other health coverage ended
Documents must be:
- Clear and easy to read
- Current and valid
- Related to the information being verified
Data Matching Issues (DMIs)
Sometimes the information on your application does not match information from government databases.
When this happens, Explore Health sends a notice called a Data Matching Issue (DMI).
A DMI does not always mean something is wrong. It simply means more information is needed.
Time to respond
Most people have:
- 90 days to resolve application-related DMIs
- 30 days for some program integrity or coverage-related issues
Your notice will explain:
- What information is needed
- How to submit documents
- Your deadline to respond
Letters of Explanation (LOEs) / Attestation Form
If you cannot get certain documents, you may be allowed to submit a Letter of Explanation (LOE) or Attestation Form.
LOEs are only accepted in certain situations after a DMI has been issued.
Some types of information, like citizenship or immigration status, still require official documents under federal rules.
What happens after you submit documents
Once your documents are reviewed, Explore Health may:
- Keep your coverage the same
- Update your financial help
- Remove financial help if you are not eligible
- End coverage if you no longer qualify
If you do not respond
If documents are not submitted by the deadline, you could lose:
- Premium tax credits
- Cost-sharing savings
- Health coverage eligibility
Periodic checks during the year
Explore Health may review eligibility information during the year to make sure coverage and financial help are still correct.
If you receive a notice asking for updated information, respond as soon as possible to avoid changes to your coverage or savings.
Reporting changes helps avoid problems
Reporting changes quickly can help prevent:
- Delays
- Incorrect financial help amounts
- Loss of coverage
Be sure to report changes to:
- Income
- Household size
- Address
- Other health coverage
- Immigration or citizenship status