Georgetown University’s Center on Health Insurance Reforms released a report this week, funded by the Robert Wood Johnson Foundation, that provides new insights into the many challenges facing consumers and those tasked with assisting them when enrolling into coverage through the Affordable Care Act (ACA) marketplaces. The findings can help policymakers better understand the kinds of systemic gaps that remain and target training and educational resources more appropriately for the next open enrollment season.

During a three-month enrollment period (November 2015—January 2016), the federal marketplace’s Assister Help Resource Center (AHRC) fielded nearly 1,400 calls pertaining to complex application filings for health insurance, eligibility determinations, and enrollment scenarios.

Here are some of the findings:

• Determining whether someone is eligible for financial assistance, and for how much, is really hard. Close to 40 percent of questions to the AHRC arose from challenges in this area.
• The myriad sources of income, aside from wages, that sustain American families make projecting household income for the year ahead very challenging. Calls about this represented almost 15 percent of the AHRC’s total call volume.
• Many people struggle with the very first step: Problems creating an account represented the second most common topic fielded by the AHRC.
• The AHRC fielded an extremely diverse array of questions from assisters, requiring deep and nuanced expertise in Marketplace, Medicare, and Medicaid eligibility rules, federal tax law, immigration law, and health plan design.

For more, read the report.

Among the more complex cases and questions posed to the AHRC:

• How can a father who is under court order to provide insurance for his kids, purchase coverage when the mother has custody, claims the children as dependents, and lives in another state?
• Will a consumer who sells property in December have to pay back tax credits for the entire year, or just for the month of December when income rose?
• Is someone who is self-employed, resides in the U.S. just six months of the year and files, but does not pay U.S. taxes, eligible for advanced premium tax credits?
• How should a clergy member account for his housing stipend when calculating income?

To learn more, you can download the report here.