5 steps to staying covered under Obamacare

The window for enrollment and renewal for marketplace coverage is Nov. 1-Dec. 15. Here are tips on how to stay covered.
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The window for enrollment and renewal for marketplace coverage is Nov. 1-Dec. 15. Here are tips on how to stay covered.


The deadline for getting health insurance is Dec. 15. Here’s what you need to do right now.

By John Murawski


October 30, 2017 12:25 PM

The deadline for signing up for health care coverage under the Affordable Care Act is Friday, Dec. 15. N.C. Gov. Roy Cooper has asked the U.S. Department of Health and Human Services to extend the deadline, but it’s unclear if that will happen.

If you haven’t signed up yet, here’s some things you need to know.

Q: Does the ACA still pay financial subsidies to offset my cost of health insurance?

A: Yes, the subsidies are still part of the ACA. There are two types of subsidies, and both are available to individuals and families. Premium tax credits discount monthly premium payments for people whose household incomes are between 100 percent and 400 percent of the Federal Poverty Level. More than 90 percent of people in North Carolina insured through the ACA qualify for premium tax credits.

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Cost sharing reductions are an additional subsidy available to people whose incomes are between 100 percent and 250 percent of the Federal Poverty Level; they discount out-of-pocket costs: deductibles, co-payments and coinsurance. About two-thirds of people in North Carolina insured through the ACA qualify for both subsidies, and those on the lower end of the income scale have most of their health insurance subsidized.

Q: Could anything prevent me from getting my subsidy?

A: Yes, you may be denied premium tax credits in 2018 if you haven’t filed your IRS Form 8962 with your 2016 federal income tax return. If you’re among those who haven’t filed, you still have time to file an amended return with the Form 8962.

Q: Who is supposed to sign up for ACA open enrollment?

A: Anyone who buys individual health insurance directly from an insurance company, through an insurance agent or on healthcare.gov. Currently that’s more than 500,000 people in North Carolina. ACA open enrollment does not apply to you if you buy health insurance through your employer or through a federal program like Medicare, Medicaid or Tricare. In past years, you could buy an individual health insurance policy off the ACA exchange, offering additional options for people who made too much money to qualify for subsidies, but those plans will not be available in 2018.

Q: Where can I find a navigator to help me?

A: Go to NCNavigator.net to find a planned public navigator event in your area, or to make an appointment. You can also call 1-855-733-3711. There is no charge.

Q: What’s the penalty if I don’t sign up for health insurance?

A: The penalty will be the greater of two possible outcomes. The minimum penalty is $695 for an adult or up to $2,085 for a family. The maximum penalty is 2.5 percent of household income above the tax filing threshold, capped at $3,264 for single person, $6,528 for couple, $9,792 for three individuals, $13,056 for four people, and $16,320 for policy covering five or more people. You can apply for a penalty waiver if you meet certain hardship exemptions. Perhaps the biggest penalty, however, might be personal bankruptcy if you’re hit by a catastrophic medical bill.

Q: Which insurers are selling ACA plans for 2018?

A: Blue Cross and Blue Shield is selling ACA plans in all 100 North Carolina counties. Cigna is selling ACA plans in five counties: Chatham, Johnston, Nash, Orange and Wake.

Q: Why should I sign up during open enrollment? Don’t insurers automatically renew your coverage?

A: Insurers automatically renew your coverage by selecting a plan that their algorithm thinks most closely matches the plan you currently have. That may not be the plan you would choose for yourself. Plans and pricing change every year, so you should shop around.

Q: I fell behind on my bills this year and still owe money to my health insurer. Does that prevent me from signing up for ACA coverage?

A: Technically, yes. Under a new rule that went into effect June 19, insurers can require payment for past unpaid premiums before they issue coverage for 2018. Your insurer is expected to be flexible with this rule if you agree to set up a repayment plan for your unpaid 2017 premiums. You can get around this requirement if you switch insurers, from Blue Cross to Cigna or vice versa, but that option is available only in the five counties where Cigna sells ACA policies and would restrict your health insurance options.

Sources: Kaiser Family Foundation, Legal Aid of North Carolina, N.C. Justice Center, Georgetown University Health Policy Institute’s Center on Health Insurance Reforms, Blue Cross and Blue Shield of North Carolina, Cigna

John Murawski: 919-829-8932, @johnmurawski