As health insurance marketplace nears, research NC options

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WNC organizations working to educate public on choices

Healthcare iconTime is drawing near for enrollment in the health insurance marketplace, which begins Oct. 1. Meanwhile, individuals can get prepared by researching their options or attending a meeting within their community.

Depending on how quickly you want to obtain health insurance, you can enroll before coverage becomes effective in January 2014. Or, you have until March 31, 2014, to choose a plan or opt out.

In North Carolina, four organizations have received about $3 million in federal funding to help educate North Carolinians about the upcoming insurance marketplace, it was announced in August.

They included Community Care of North Carolina, which served as a grant administrator and has awarded 11 grants to a consortium of organizations, Randolph Hospital and the Alcohol/Drug Council of North Carolina. It also included the Waynesville-based Mountain Projects, which provides housing and other services for residents of the seven westernmost counties of North Carolina.

The Alcohol/Drug Council of North Carolina plans on using Navigator grant funds to establish Project Jumpstart. The project aims to help enroll people throughout the state who have personal experience with mental illness, an addictive disorder or a chronic disease.

The Council on Aging in Buncombe County and Pisgah Legal Services are two of the partners in the consortium administered by the Community Care of North Carolina.

“We will be coordinating our activities with other ‘Navigator’ agencies,” said John Wingerter, director of health insurance information services for the Council on Aging. That is to avoid duplication or overlap of these services, he explained.

Wingerter said the council will offer community education outreach through information sessions and there will be individual counseling. In addition to training navigator volunteers, the council plans to use its grant money to hire two navigators.

Each navigator will complete 20 hours of online federal training about the Affordable Care Act and its insurance marketplace, plus an additional 10 hours of training on issues specific to North Carolina, Wingerter said.

The educational outreach could begin by the first of October, he said. He recommends that people who will be enrolling for insurance — particularly those who have not had insurance for a long period of time — first take part in the sessions or obtain information available through the federal websites, www.HealthCare.gov or www.CuidadoDeSalud.gov, or call the toll-free phone line (1-800-318-2596).

The Council on Aging and other participating organizations do not have much time to ramp up their navigator programs to get ready for the open enrollment, which begins on Oct. 1.

“I have ordered bulk educational materials and will be hiring four navigators to help people understand the health coverage options available in the marketplace,” said Patsy Dowling, executive director for Mountain Projects.

Dates for those meetings will be announced, she said.

“Our volunteer center and SHIIP (Seniors Health Insurance Information Program) counselors are also gearing up to help people in our service area understand the process,” she said.

“But, I think it’s important for people to know they don’t have to work with a navigator,” she added. “They can get information from the government website or toll-free telephone line.”


Learn more

Here is some basic information on the process from www.healthcare.gov and from a consumer guide produced by Kaiser Health News. North Carolinians must use the federal website to examine their options and to enroll, as Gov. Pat McCrory chose to allow the federal government to oversee the plan for the state.

Will I have to buy health insurance? What happens if I don’t?

Beginning in 2014, most people will have to have health insurance or pay a fine.

According to Kaiser Health News, the penalty for an individual would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016. For families, the penalty would be $2,085 or 2.5 percent of household income, whichever is greater. The requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs.

My employer provides health coverage. Can I keep my current plan?

If you get insurance through your job, it is likely to stay that way unless that plan doesn’t cover at least 60 percent of health-care costs and if premiums are more than 9.5 percent of your household income. But employers may change the plan and any associated payments. Anyone up to age 26 who can’t get health insurance at a job can stay on their parents’ health plan.

How do I apply?

If you live in North Carolina, you’ll use, www.HealthCare.gov, to apply for coverage, compare plans and enroll. Specific plans and prices will be available on Oct. 1, 2013, when Marketplace open enrollment begins. Coverage can start as soon as Jan. 1, 2014. Open enrollment closes on March 31, 2014.

What if I need coverage before January 2014?

You can buy individual insurance for coverage that starts before Jan. 1, 2014, but some rights and benefits won’t apply yet. For example, women may still be charged more than men, and you may be denied coverage because of a pre-existing medical condition.

What if I make too much money for Medicaid, but still can’t afford to buy insurance?

Premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the federal poverty level, which is $14,856 to $44,680 for individuals.

I’m over 65 and have Medicare. How does the Affordable Care Act affect seniors?

Medicare isn’t part of the Health Insurance Marketplace, so you don’t need to do anything. The Marketplace won’t affect your Medicare choices, and your benefits won’t be changing. However, on a positive note, the Affordable Care Act will close the “doughnut hole” gap for coverage of Medicare recipients who purchase Part D prescription coverage by as much as 75 percent by the year 2020.

Will I be able to purchase dental coverage?

In the Marketplace, dental coverage will be included in some health plans. If a health plan includes dental coverage, you will pay one premium for everything. In some cases separate, stand-alone plans will be offered. You may want to choose this option if the health coverage you plan to enroll in doesn’t include dental coverage.

I have some health issues. Can I still get covered?

Once the exchanges begin, in 2014, insurers may not deny applicants based on your health status, Kaiser Health News states.

What is a platinum plan and is that the best plan for me?

When you compare Insurance Marketplace plans, there are four categories: bronze, silver, gold and platinum. The categories do not reflect the quality or amount of care the plans provide.

With a bronze plan, you’ll likely pay a lower premium, but you’ll pay a higher share of costs when you get care. That might be the best plan for someone who has excellent health and rarely needs to see a doctor. But, keep in mind that a serious illness or accident could result in unexpected out-of-pocket expenses.

Platinum plans will likely have the highest monthly premiums and lowest out-of-pocket costs. That plan might be the best if you need a lot of medical care or want to be covered in the event of a serious illness or accident.

More information on the Affordable Care Act and the insurance marketplace is available at www.healthcare.gov. You can also call 1-800-318-2596, 24 hours a day, seven days a week.

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About the Author

Peggy Manning

Peggy Manning is a contributing reporter for Carolina Public Press. Contact her at pntmoody@bellsouth.net.

One Comment on "As health insurance marketplace nears, research NC options"

  1. David Block September 16, 2013 at 11:41 am ·

    There is another means of obtaining information and expert advice (not just navigation) and that is through licensed and appointed health insurance agents. You may find locally qualified agents at http://www.wncahu.org or at the national site http://www.nahu.org. Please note that navigators and assisters are only allowed to guide and are not supposed to offer opinions or advice; that is relegated to licensed insurance agents only.

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