Every day, our journalism dismantles barriers and shines a light on the critical overlooked and under-reported issues important to all North Carolinians.
Before you go …
Thanks for reading. If you like what you are reading and believe in independent, nonpartisan journalism like ours—journalism the way it should be—please contribute to keep us going. Reporting like this isn’t free to produce and we cannot do this alone. Thank you!
Schedule an info session with navigator through new call center
Frustration, fear and confusion are all appropriate words to describe the attitude of a handful of people who showed up on a recent frigid day in Asheville to learn more about how to sign up for health insurance through the Affordable Care Act insurance marketplace.
John Wingerter, director of health insurance information services for the Council on Aging of Buncombe County, gave a brief overview of the mandated program Nov. 13 at the West Asheville Library.
The Council on Aging and Pisgah Legal Services are coordinating the educational sessions in Buncombe County. Agencies in other counties are offering similar sessions.
Wingerter said he does not know how many people have successfully enrolled through the marketplace, since the agency is focusing on providing information. People then return home to complete the process, he said.
A centralized call center has been launched so people can schedule a session with an insurance navigator, Wingerter said. The number to call to schedule an appointment is 1-855-733-3711.
Here are some of the details shared during the session:
Who is offering insurance in NC?
Two insurance providers in North Carolina are participating in the insurance marketplace. Blue Cross Blue Shield of North Carolina is offering 26 plans in all 100 counties, but not all those plans are available in every county. Coventry Health Care of the Carolinas is offering 25 plans in 39 counties, but, again, not all those plans are available in every county, Wingerter said.
Before beginning the enrollment process, individuals will need to have several pieces of information ready: income statements for every member of the family, Social Security numbers for each and the policy number of the current health plan, if any.
To purchase health insurance through the Marketplace, call the federal enrollment number, 1-800-318-2596; submit a paper application; apply via the internet at www.healthcare.gov; or contact a broker, agent or health insurer.
What subsidies are available, and how do I qualify?
Tax credits are available for people whose annual household incomes fall between 100 percent and 400 percent of the federal poverty level. If someone is approved for the government subsidy, it is paid directly to the insurance company on a monthly basis. For a household of two that is a combined income between $15,510 and $62,040.
People whose annual household incomes fall between 100 percent and 250 percent of the poverty level may also qualify for reductions of deductibles and co-pays. That is between $15,510 and $38,775 for a household of two.
The silver level, which pays 70 percent of the cost of medical expenses, is the only level where a subsidy can be applied. The other levels are bronze, which pays 60 percent; gold, 80 percent; platinum, 90 percent; and catastrophic coverage for persons under the age of 330 or in certain hardship cases.
However, the only way to obtain a tax credit or subsidy is to purchase insurance through the marketplace, Wingerter stressed.
Over or under payment of the premium tax credit may be adjusted during the year or reconciled when filing a tax return for the year.
How do I get insurance?
Wingerter 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 website or toll-free phone line.
When applying through the Healthcare.gov website it will likely require several sessions, Wingerter said, since the tax credit may not be known immediately or applicants may want to think about the health plan options before deciding.
Community members question navigators, plan
Several questions were asked at the conclusion of the presentation. One woman said she had heard that no background checks were done when hiring the navigators, who then have applicants’ Social Security numbers and other personal information.
Wingerter said that was “absolutely incorrect.” He said criminal background checks were conducted on every navigator and references were checked on each.
Another woman, who said she earns only $8,000 annually, asked what her options were since she falls under the poverty level and would not qualify for a tax credit or Medicaid.
Wingerter explained that there are health centers in most counties that offer medical care on a sliding fee scale. He also explained that if the woman could not afford the premiums, she would have to apply for an exemption.
Persons who have Medicare or other health insurance are covered and do not need to do anything, Wingerter said.
Everyone else must have insurance or opt out by March 31, 2014. The penalty for not having insurance, unless exempted, is $95 or 1 percent of the household income, whichever is greater; and increase to $695, or 2.5 percent of income, by 2016. The requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs.
“Eventually, the insurance marketplace website will be functioning the way it is supposed to,” Wingerter said.
The Patient Protection and Affordable Care Act presentation is available on the Council on Aging’s website at www.coabc.org or by reviewing the presentation here:
The Patient Protection and Affordable Care Act October 2014 (PDF)
The Patient Protection and Affordable Care Act October 2014 (Text)