Call one of our coordinators to schedule your meeting.
The NC Connector is a statewide scheduler designed to help consumers connect with an Outreach and Enrollment Coordinator near them to find out more about Health Insurance options under the Affordable Care Act.
Charles Drew Community Health Center
& Burlington Community Health Center
Scott Community Health Center
Sylvan Community Health Center
Prospect Hill Community Health Center
Moncure Community Health Center
Siler City Community Health Center
Carrboro Community Health Center
& Chapel Hill Community Health Center
What is the Affordable Care Act?
The Affordable Care Act (ACA), known more simply as “health care reform,” the Patient Protection and Affordable Care Act (ACA) was passed by the U.S. Congress in 2010. The law has been designed to:
- Lower the cost of health care and coverage for all Americans
- Increase access to primary care providers and specialists
- Add to preventive care and prescription benefits
- Give more rights and help to insured patients
- Extend young adults’ coverage under their parents’ insurance
- Offer coverage to those with pre-existing health conditions
AFFORDABLE CARE ACT Health Insurance 2018 Frequently Asked Questions
Open Enrollment through HealthCare.gov starts on November 1 for the Affordable Care Act Health Insurance. Open Enrollment is the time each year when you can sign up for health insurance, if you don’t already have coverage through your job, Medicare, Medicaid, or another sort of health coverage. There is only one deadline this year, so if you want coverage in 2018, you must sign up by December 15. Insurance coverage begins January 1, 2018. There have been lots of questions so we hope that these questions (& answers) will provide some clarity about the Affordable Care Act (ACA) health insurance program. More questions will be added to this list later.
When does Open Enrollment begin? What’s the deadline to sign up?
How can people enroll in coverage?
- In-person: Free, in-person, local help is available to help people understand their options and enroll in health coverage. In Alamance, Caswell, Chatham and Orange County, you can find free, in-person help at Piedmont Health’s Community Health Centers with the Outreach & Enrollment Coordinators. Other organizations will be providing assistance with the ACA health insurance. It is recommended that if you have questions about the ACA, please schedule an appointment.
All NC residents can call 1-855-733-3711 to find appointments in their area.
- Online: You can also visit HealthCare.gov or CuidadoDeSalud.gov and sign up for coverage online.
- Phone: You can call the Marketplace at 1-800-318-2596 to complete a phone application and sign up over the phone. Operators are available 24 hours a day, 7 days a week.
Last year, I got subsidies to help with my premium. Is this still available?
Is it true that people will have to pay a fee if they don’t have health insurance in 2018?
Won’t the law be repealed soon?
I heard premiums in my area are increasing. Does this mean I will pay more each month?
How will I be impacted by President Trump’s decision to stop funding Cost Sharing Reductions?
I have heard that there will be scheduled times when the HealthCare.gov or CuidadoDeSalud.gov website will be down for maintenance.
- Wednesday, November 1st, overnight outage (exact times unknown)
- Sunday, November 5th, 12am (midnight)-12pm (noon)
- Sunday, November 12th, 12am (midnight)-12pm (noon)
- Sunday, November 19th, 12am (midnight)-12pm (noon)
- Sunday, November 26th, 12am (midnight)-12pm (noon)
- Sunday, December 3rd, 12am (midnight)-12pm (noon)
If I have a 2017 Marketplace plan, do I need to do anything?
For a list of Piedmont Health Community Health Center locations, please click on https://www.piedmonthealth.org/insurance/affordable-care-act/ . Schedule an appointment today!
What do I need to know about Open Enrollment?
Open Enrollment through HealthCare.gov is the time each year when you can sign up for health insurance if you don’t already have coverage through your job, Medicare, Medicaid, or another sort of health coverage. The 2018 Open Enrollment Period runs from November 1 to December 15, 2017. After Open Enrollment ends, you can’t enroll in or change plans, unless you qualify for a Special Enrollment Period. Plans joined during Open Enrollment start January 1, 2018. All consumers—new and renewing—should return to the Marketplace during Open Enrollment to explore their options and enroll in health coverage.
All of the plans available on HealthCare.gov must cover essential health benefits that keep you healthy and are there in case you have an accident or get sick. Financial help is available to help lower monthly premiums and other health care costs, such as deductibles and co-payments. In NC, 9 out of 10 people who enroll in coverage through HealthCare.gov receive financial help to lower their monthly premium. In addition, two-thirds of North Carolinians with a Marketplace plan receive financial help to lower deductibles and other health care costs. Sign up by December 15.
Will I be able to enroll after December 15?
If you don’t act by December 15, you can’t get 2018 coverage unless you qualify for a Special Enrollment Period. It’s best to apply and enroll as early as possible during the Open Enrollment Period. After Open Enrollment ends, Special Enrollment Periods are only available for people who have had certain qualifying events, such as losing other health coverage, getting married, or having a baby. If you want coverage in 2018, you must sign up by December 15.
What information do I need to have before starting an application on HealthCare.gov?
When you apply for or renew your coverage in the Health Insurance Marketplace, you’ll need to provide some information about you and your household. You’ll need to have:
- User name and password for HealthCare.gov account, if you already have an account
- Addresses & birthdates for everyone applying for coverage
- Social security numbers for household members who have one
- Immigration document information for legal immigrants who are applying for coverage
- Employer and income information for every member of the household (for example, paystubs or W-2 forms)
- Your best estimate of what your household income will be in 2018
- Information about any job-based health plans you or someone in your household is eligible for
- Any information about health care providers you see or prescriptions you take so that you can compare plans
The Marketplace application requires citizenship or immigration status information only from people applying for coverage. The application may not ask for citizenship or immigration status information about other people who are a part of the household who are not seeking coverage.
How do I know if I qualify for Marketplace health insurance and any subsidies?
The only way to know for sure if you qualify is to complete an application on HealthCare.gov. For free, in-person help in NC, call 1-855-733-3711. Most people can shop for coverage in the Marketplace. To be eligible you must be a citizen or be lawfully present in the U.S. and you must not currently be incarcerated. If you have Medicare or Medicaid, you are considered covered and do not need to purchase additional coverage through the Marketplace. What you will pay for Marketplace insurance depends, in part, on whether you’re eligible for financial help with premiums. Factors such as income, household size, and availability of other coverage affect your eligibility for financial help. Even if you don’t qualify for financial help, the plans may be affordable for you. Complete a Marketplace application to find out if you’re eligible for help and the cost of plans available to you.
What is the penalty for not having health coverage? Will the IRS be enforcing the requirement to have health insurance?
If you do not have health insurance, and do not qualify for an exemption, you will be subject to a tax penalty. All tax filers will have to answer a question on their tax return about whether members of the household had qualifying health coverage. The IRS will not accept returns that don’t answer this question.
For 2017, the fee is calculated two different ways – as a percentage of your household income or per person. You’ll pay whichever amount is higher. Under the per person calculation, the fee is $695 per adult who is uninsured and $347.50 per child under 18. Under the percentage of income calculation, the fee is 2.5% of household income. If you didn’t have health insurance in 2017 and don’t qualify for an exemption, you’ll pay the penalty when you file your taxes.
Free, in-person help is available to help you understand your health insurance options and help you learn about exemptions that may apply in your situation. In Caswell County, you can find free, in-person help at Prospect Hill Community Health Center in Prospect Hill and Caswell Family Medical Center in Yanceyville. For appointments with Caswell Family Medical Center, call (336) 694-1181, ext. 242. For appointments at Prospect Hill Community Health Center, call (336) 639-0427. All NC residents can call 1-855-733-3711 to find appointments in their area.
If I can’t afford health coverage, will I have to pay the penalty?
If you can’t afford health coverage, or can’t enroll for other reasons, you may be eligible for an exemption. If you qualify for a health coverage exemption you don’t need to pay the fee even if you are uninsured. Exemptions are available based on a number of circumstances, including certain hardships, some life events, health coverage or financial status, and membership in some groups. You claim most health coverage exemptions on your federal tax return. Some require you to fill out and mail an application to the Marketplace. You may be eligible for an exemption if:
- You don’t have to file a tax return because your income is below the level that requires you to file
- You lived in a state (like NC) that didn’t expand its Medicaid program but you would have qualified if it had
- The lowest-priced coverage available to you, through either a Marketplace or job-based plan, would cost more than 8.05% of your household income
- You were uninsured for no more than 2 consecutive months of the year
- You’re a U.S. citizen living abroad, a certain type of non-citizen, or not lawfully present
Free, local help is available to help you understand what exemptions may fit your circumstance. In Caswell County, you can find free, in-person help at Prospect Hill Community Health Center in Prospect Hill and Caswell Family Medical Center in Yanceyville. For appointments with Caswell Family Medical Center, call (336) 694-1181, ext. 242. For appointments at Prospect Hill Community Health Center, call (336) 639-0427. All NC residents can call 1-855-733-3711 to find appointments in their area.
Are there any times I won’t be able to access HealthCare.gov?
HealthCare.gov is scheduled to undergo routine maintenance during Open Enrollment, so it will not be available during these times:
- Sunday, November 26th, 12am (midnight)-12pm (noon)
- Sunday, December 3rd, 12am (midnight)-12pm (noon)
You can access your Marketplace account beginning at noon on these Sundays.
Make sure you sign up by December 15.
What is covered under Marketplace plans?
All plans offered in the Marketplace cover the same set of essential health benefits, including emergency services, hospitalizations, prescription drugs, mental health and substance use services, and labs. Marketplace plans cover preventive services– like shots and screening tests — at no cost to you. All Marketplace plans must cover treatment for pre-existing medical conditions. No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any preexisting condition you had before your coverage started.
What is a provider network?
A provider network is a list of the doctors, other health care providers, and hospitals that a plan has contracted with to provide medical care to its members. These providers are called “network providers” or “in-network providers.” A provider that hasn’t contracted with the plan is called an “out-of-network provider.” You’ll usually pay more if you get care from a provider who isn’t in your plan’s network and for some plans, your insurance company may not pay for any services provided by an “out-of-network” provider. You can find out what providers are covered in your plan’s network on HealthCare.gov, on your insurance company’s website, or by calling your insurance company.
I already signed up for a 2018 plan on HealthCare.gov. Is there anything else I need to do?
After you sign up for coverage, you must pay your premium for your coverage to start. You’ll pay your part of the premium directly to the insurance company — not to the Health Insurance Marketplace. If you don’t receive information from the insurance company on how to make a payment, call them. Your insurance company should send you an insurance card that you will bring with you to medical visits to show proof of insurance.
Once your coverage starts, make sure to take advantage of free, preventive services including physicals and well child checks, etc. Check to see what providers are considered in-network under your plan and make an appointment for a check-up.
Make sure you continue to pay your monthly premiums to your health insurance company on time. If you don’t, the insurance company could end your coverage. Also, make sure to respond to any requests for information from the Marketplace, especially if you were asked to send in proof of income or other application information.
I got a notice that my premium is going up for 2018. What can I do?
The most important thing to do is to return to the Marketplace before December 15 to shop around for coverage. It’s important to know that when premiums go up, the subsidies that people get to help with premium costs go up. Since 9 out of 10 NC Marketplace enrollees receive tax credits, many people will not pay more. People who had a Marketplace plan in 2017 may be receiving letters from their insurance companies about their 2018 coverage. The 2018 premiums listed in the letters reflect last year’s premium tax credits, rather than the updated 2018 amounts. The amount of tax credits most consumers receive to help pay their 2018 premiums will increase, so the amount listed in the letters does not show what consumers will actually pay in 2018. Even if you don’t qualify for premium tax credits, it’s important to shop around on the Marketplace before December 15 to make sure you have the best deal for 2018.
Marketplace Call Center: 1-800-318-2596 or call one of the Coordinators for assistance if you have questions.
The Open Enrollment period for 2018 coverage is: November 1, 2017 – December 15, 2017. After December 15, 2017, you can enroll or change plans only if you qualify for a Special Enrollment Period.
The “Marketplace” is the general collective name for state and federal health insurance exchanges. It was created to help uninsured Americans find and select a health insurance plan.
Expect to see varied levels of coverage and associated costs. Make sure to explore your options fully to ensure you find the coverage you want at a price that’s right for you.