Despite all the news about the Affordable Care Act, Regina Thomas of Charlotte didn’t know it was an option until she was desperate.
The 45-year-old New York transplant suffers from crippling back pain. She couldn’t get Medicaid in North Carolina, and her husband’s insurance has such high out-of-pocket costs it didn’t help. In January one of his coworkers suggested they check out the ACA marketplace.
Her new, low-cost coverage kicked in Sunday. On Feb. 25, she’ll finally see a doctor – a welcome change from racking up $700 emergency room bills when she can’t stand the pain.
“When I got my (Blue Cross) card I was screaming – you would have thought I won the lotto,” she said.
Advocates have two more weeks to find people like Thomas who need care, lack insurance and haven’t realized they can get help. On Feb. 15, open enrollment for 2015 ends.
So far almost 468,000 North Carolinians have signed up. More than nine out of 10, including Thomas, qualified for help covering costs. Based on her husband’s salary as a security guard, she got coverage for $17.85 a month, with no deductible.
Thomas will start by seeing her new primary care doctor, who can get her caught up on blood pressure and cholesterol treatment. Then she hopes to see a specialist who can give her the spinal cortisone injections that bring the only real relief.
Thomas, who spent years working as a customer service representative, hopes getting healthy is a first step toward her dream of owning a home and building a stable life in Charlotte.
“I miss working. Oh, how I miss working,” she said. “I know with this health insurance the pain will be eased.”
How does it work?
Anyone can shop for health insurance on the federal marketplace, www.HealthCare.gov. Blue Cross and Blue Shield of North Carolina, Coventry Health Care and UnitedHealthcare offer a range of policies, with options and fees that vary by location.
Subsidies are based on family size and income. Those who fall between 100 percent and 250 percent of the federal poverty level (that’s $23,850 to $59,625 for a family of four) can get help with premiums and out-of-pocket costs. Subsidies for premiums only are available up to 400 percent ($95,400 for a family of four).
Who’s left out?
People who are eligible for coverage that meets minimum standards through their employer or government programs such as Medicaid and Medicare can’t get subsidies, even if that would provide a better deal.
Neither can people who fall below 100 percent of the poverty level in states such as North and South Carolina, which opted not to expand Medicaid.
Besides the “even healthy people can get hit by a truck” factor, tax penalties are lurking for people who decide they don’t want to pay for insurance. In 2015 it will be $325 per uninsured adult or 2 percent of household income, whichever is higher.
Open enrollment continues through Feb. 15, with coverage taking effect in March. After that, people can do special enrollment only after certain life changes.
People who had subsidized insurance in 2014 will soon get tax forms showing the value of those subsidies, which are actually tax credits. If their income didn’t match their estimates, they could owe money or get a refund.
How to enroll
• Get details and do online enrollment atwww.HealthCare.gov
• Learn more from the Kaiser Family Foundation by going towww.kff.org
and searching for “health reform FAQs
• In North Carolina, get free help at855-733-3711
• In South Carolina, call888-998-4646
• Get Covered Mecklenburg will take walk-ins for last-minute enrollment from 10 a.m. to 4 p.m. Feb. 14 at the Children and Family Services Center, 601 E. Fifth St.