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Fired, freed or married? Health insurance aid may help

ACAspecial
T. Ortega Gaines - ogaines@charlotteobserver.com
Sondra Hoffman worked as a nurse for 25 years before she lost her job with a home-care agency. She has struggled to get unemployment or find a new job, but one bright spot was discovering she's eligible for health insurance subsidies that let her get good coverage for just over $10 a month.

More Information

  • Sneak peek at 2015 rates? Not in NC
  • More coverage of Affordable Care Act
  • Are you eligible now?

    Here are some of the changes that can trigger a special 60-day eligibility to get subsidized health insurance on the federal exchange. For details and signups, go to www.healthcare.gov/screener/ or call 855-733-3711 to schedule an appointment in North Carolina.

    • Losing a job that provided coverage.

    • Marriage.

    • Divorce (if it involves loss of coverage).

    • Birth or adoption of a child.

    • Moving to a new plan’s coverage area.

    • Getting out of jail or prison.

    • Getting legal immigration status.

    • Turning 26 and losing coverage under parent’s policy.

    • Losing Medicaid or N.C. Health Choice coverage.


  • Income and insurance

    Eligibility for help with health coverage is based on income. Here’s how it works in North Carolina.

    Medicaid

    People with a low household income may be eligible for Medicaid if they fall into certain categories, such as children, pregnant women and people with disabilities. Many people who fall below the federal poverty level – $11,490 for one person and $23,550 for a family of four – get no help.

    Maximum subsidy

    Income between 100 percent and 250 percent of poverty level – up to $28,725 for an individual and $58,875 for a family of four – qualifies for subsidies to help pay premiums and out-of-pocket costs.

    Some subsidy

    Income between 250 and 400 percent of poverty level – up to $45,960 for one person and $94,200 for a family of four – qualifies for help with premiums but not out-of-pocket expenses.

    Source: HealthCare.gov



In bridal shops and jails, moms’ groups and charities, the search is on for people who qualify for low-cost health insurance and don’t know it.

When open enrollment for subsidized insurance ended this spring, the spotlight on the Affordable Care Act dimmed. But advocates in Charlotte and around the country are working to let people know that life changes that range from losing a job to saying “I do” can trigger an opportunity to sign up before the 2015 enrollment period starts in November.

“A lot of these folks aren’t looking for this information because they don’t know it’s there,” said Mark Van Arnam, who is leading Charlotte-area efforts for the nonprofit Enroll America.

For Sondra Hoffman, a 62-year-old nurse who lives in southeast Charlotte, getting subsidized insurance was a bright spot in a tough year.

She worked for a home-care agency for almost nine years before losing her job in November. She got a job with another agency, was injured on the job and ended up unemployed again. As she struggled to get unemployment compensation and pay her bills, she went to Crisis Assistance Ministry, where a health insurance navigator from Legal Services of Southern Piedmont told her she was eligible for special enrollment.

She learned she qualified for a $666 monthly tax credit, which meant she could get a good Blue Cross Blue Shield policy for $10.56 a month. It was similar to the policy she had through her first agency, she said. There, her share of the premium came to $90 a week when she was part time and $25 a week when she was full time.

“This is truly a blessing from God,” Hoffman said. “This is incredible.”

Lives keep changing

“We know that a lot of people are eligible for special enrollment but we don’t know how many are taking advantage,” says Larry Levitt, a Kaiser Family Foundation executive who studies health reform and insurance. The California-based foundation focuses on national health issues.

The federal government last reported the number of sign-ups for subsidized health insurance in May, based on open enrollment through the end of March. At that point, just over 8 million people across the country had chosen plans through the Affordable Care Act marketplace, and 85 percent qualified for subsidies.

In North Carolina, almost 357,600 signed up and 91 percent qualified for aid. South Carolina had about 113,300, with 88 percent eligible for subsidies.

But that was just the beginning of the quest to get more people insured and improve the quality of their health care.

Insurance agents and navigators, who are trained to help people figure out the new insurance options, say they’re staying busy with follow-up. In some cases that means helping people with new policies figure out how to find a doctor who’s in their insurance network or understand which health care expenses come out of their pockets.

And as lives change, so does eligibility for insurance and/or aid. People who weren’t eligible for help when open enrollment ended March 31 – or who didn’t choose to buy policies then – may qualify for special enrollment if they lose a policy or go through life changes such as marriage, divorce, giving birth or adopting a child.

People being released from jail and gaining legal immigration status also become eligible. New signups must happen within 60 days of the event that triggers eligibility. That’s why groups such as Legal Services and Enroll America are putting information at jails, bridal shops, colleges and offices that issue marriage licenses. They’re urging churches, mothers’ groups and agencies that work with refugees and people in crisis to help them spread the word.

“People are thrilled to find out that even after open enrollment ended they may be qualified to sign up,” said Madison Hardee, a lawyer with Legal Services.

Refund or bad news

Changes in income can also trigger changes in subsidies, even if the person keeps the same policy.

Hoffman, for instance, is seeking a new job. If she gets one – even one that doesn’t offer insurance – her 2014 income would go up and her subsidy would go down. At that point, she’d have to go back to the federal website to make an adjustment or pay back the difference at tax time.

Jason Falls, a Kings Mountain insurance agent, says many fail to realize that the subsidies are actually tax credits based on estimated income. The money goes directly to the insurance company, but the taxpayers settle up with the federal government when they file 2014 returns.

Someone who got a raise or worked more hours than expected might end up owing money, while a slump in earnings could have the opposite effect.

Levitt says it’s like other developments that affect income taxes: “Do you get a refund and a pleasant surprise or do you owe money and get an unpleasant surprise?”

Helms: 704-358-5033; Twitter: @anndosshelms This article is done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.
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