While partisan debate continues over whether to repeal the Affordable Care Act, the federal health insurance exchange opens again Sunday for its third year of sign-ups.
As of June, nearly 460,000 North Carolinians were enrolled in coverage through the online exchange, and 92 percent are getting financial assistance to help pay for monthly premiums. In South Carolina, 165,276 people were enrolled through the online exchange.
The Affordable Care Act, which began offering insurance through the online marketplace in 2014, is intended to serve those who don’t have health insurance through employers, Medicare, Medicaid or another source. Eligible Americans who opt out of coverage face penalties at tax time.
Again this year, insurance advocates hope to connect with “hard-to-reach populations,” including Latinos, African-Americans and young adults who remain uninsured, said Lovemore Masakadza, N.C. communications director for Enroll America, an independent nonprofit, nonpartisan coalition of enrollment advocates.
Immigrants are among the hardest people to reach, Masakadza said. Those who are in the country illegally are not eligible, but even those who are citizens or have green cards might be deterred by language or cultural barriers or fear of the government, especially if they have undocumented family members.
Enroll America volunteers will work with leaders in Latino and African-American communities and with refugee assistance groups to spread the word. Legal Services of Southern Piedmont, one of the agencies helping people navigate the online exchange, has Spanish-speakers stationed at the Latin American Coalition and International House on a weekly basis.
“We want to be able to reach populations where they live and make sure they get the information they need to get coverage,” said Madison Hardee, Legal Services lawyer who has helped consumers navigate the federal website. “Many of the remaining uninsured don’t know that financial assistance is available to help them pay for coverage.”
Half of those who are eligible but remain uninsured are 18 to 34, and the majority of the employed uninsured are hourly workers whose employers don’t provide insurance.
“We are making sure that we have plenty of weekend and evening appointments to accommodate 9-to-5 work schedules,” she said. “We know that consumers who got in-person assistance were more likely to successfully enroll than those who didn’t.”
Another challenge continues to be reaching young adults, the so-called “young invincibles.” Insurance officials say one reason marketplace premiums are rising is that the pool does not include enough young, healthy people to bring down overall costs.
Under the Affordable Care Act, young adults can stay on their parents’ workplace insurance until they turn 26. But those who are older may work low-wage jobs and feel like they can’t afford insurance, or they may view themselves as too healthy to need it. To reach more young people, Masakadza said enrollment advocates will host events at community colleges, historically black colleges and fraternities and sororities.
We know that consumers who got in-person assistance were more likely to successfully enroll than those who didn’t.
Madison Hardee, lawyer with Legal Services of Southern Piedmont
What is the enrollment deadline?
The open enrollment window lasts for three months, from Nov. 1 through Jan. 31. But those who want their plan to start by Jan. 1 need to make a choice by Dec. 15. Insurance plans bought on the exchange in 2015 will automatically renew if policyholders do nothing.
“Most people opted for automatic renewal last year,” Hardee said. But she says it’s wise for consumers to research the plans to make sure they’re still appropriate. Rates will go up for many plans, and networks of hospitals and doctors may also change. “We want to make sure they’re enrolled in a plan that includes their doctors, their medications and best meets their needs,” Hardee said.
A federal report released this week shows 31 percent of North Carolinians who re-enrolled last year switched to a new plan for 2015.
How can you enroll?
North Carolina and South Carolina residents can sign up through the federal exchange, www.healthcare.gov. Rates and other details about 2016 plans are available. You can sign up online at www.healthcare.gov, by phone, by mailing in a paper application, or with an in-person assister.
The Get Covered Calculator, a web-based tool, allows consumers to estimate the monthly premium and tax credit/subsidy a consumer can expect. https://www.getcoveredamerica.org/calculator/
What insurance companies are participating this year and what are the rates?
On Friday, the N.C. Department of Insurance released newly approved rates for 2016.
Blue Cross and Blue Shield of North Carolina, the state’s largest insurer, was approved for a 32.5 percent average increase, nearly the full 34.6 percent the insurer had requested. Increases for individual plans offered through the marketplace will range from 5 percent to 42 percent. That affects 397,253 Blue Cross customers.
UnitedHealthcare was approved for a 20.4 percent rate increase, ranging from 2.5 percent to 50.3 percent. The change affects 86,223 UnitedHealthcare customers who have ACA plans.
Aetna, which owns Coventry Health Care of the Carolinas, will raise ACA rates 23.6 percent on average for about 117,000 customers.
The Affordable Care Act’s third year in North Carolina will result in significantly higher rate hikes than last year, when Blue Cross went up 13.5 percent and Aetna 2.9 percent.
Where can consumers get help?
One-on-one appointments can be scheduled anywhere in North Carolina by calling 1-855-733-3711 (English and Spanish) or visiting www.getcoveredamerica.org/connector. (The link for Spanish speakers https://www.getcoveredamerica.org/es-connector/.) Appointments can be booked now, and free in-person assistance will be available seven days a week during the open enrollment period. South Carolinians can go to https://localhelp.healthcare.gov/.
Legal Services has expanded its weekend and evening hours and is also offering enrollment sites in Union and Cabarrus counties. On Nov. 1, Legal Services will host an enrollment event at its office, 1431 Elizabeth Ave., from 12:30 to 5 p.m. Appointments can be scheduled, but walk-ins are also welcome, first-come, first-served.
Get Covered Mecklenburg, a local nonprofit coalition of Affordable Care Act advocates, has scheduled four free county-wide enrollment events at the Children and Family Services Center, 601 E. Fifth St., uptown Charlotte. They will be from 10 a.m. to 4 p.m. on Nov. 7, Dec. 5, Jan. 9 and Jan. 30. Walk-ins will be accepted.
If you’re planning to apply for coverage, bring your Social Security number, date of birth, employer information, proof of household income (such as W-2 or pay stubs) and policy numbers for any existing coverage.
What are penalties for not having insurance?
Last year was the first year for tax penalties for those without insurance. Those who remain uninsured will face even bigger fines when they file 2015 tax returns in 2016 – $325 per adult or 2 percent of household income on 2015 taxes. If they remain uninsured in 2016, the fine goes up to $695 per adult or 2.5 percent of household income.
What about the Medicaid expansion?
More than half a million Carolinas residents will still be left without health insurance because they fall into the “Medicaid gap” created in states that declined the federal money intended to expand Medicaid coverage to the poorest adults. Both North Carolina and South Carolina have declined the expansion.
Because of that, people who fall below the federal poverty level – $11,770 for an individual and $24,250 for a family of four – are too poor to get subsidies for private insurance but can’t get government coverage unless they’re disabled or elderly.
In the past, N.C. Gov. Pat McCrory and some legislators have indicated that Republican leadership may consider covering people in the gap. A handful of GOP-led states that initially rejected Medicaid expansion have created their own alternatives, using federal money. But North Carolina’s 2015 legislative session ended in September with no action on the Medicaid expansion.