NC Healthcare.gov Insurance Options
Enroll in Affordable Health Coverage with Healthcare.gov
Whether you call it Healthcare.gov, The Affordable Care Act, Obamacare, or even the Marketplace, you can enroll in a plan when you have a qualifying event or during the annual open enrollment period. If you are eligible for a Healthcare.gov plan, any pre-existing health conditions are covered IMMEDIATELY, upon enrollment. You also may be eligible for federal tax credits that can reduce your monthly premium.
Heathcare.gov Enrollment Windows
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Annual Open Enrollment for Healthcare.gov - November 1st – January 15th of each year. Coverage always starts on the 1st day of your effective date.
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Special Enrollment Periods - You have 63 days from the date you lost your health coverage due to the following special events to sign up for Healthcare.gov coverage. Special Enrollment Periods include:
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​Getting Married or Divorced if you are currently on a health plan with your soon to be ex-spouse.
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Having a baby
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The primary subscriber passes away and you are covered under their health plan currently.
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You move to a new state or a new county that is serviced by your existing healthcare.gov carrier.
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You lose group health insurance, military benefits, or Medicaid coverage.
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Your COBRA or Medicaid coverage ends or your dependent turns 26.
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Are You Eligible For Healthcare.Gov Premium Tax Subsidies?
Depending on how many people are in your family, and your total annual Modified Adjusted Gross Income (MAGI), you may be eligible for federal tax credits that can reduce your HEALTHCARE.GOV monthly premium. Please note that you must estimate what your combined MAGI for next year will be when you apply for premium tax subsidies. When you do file next year’s taxes, your estimate will be compared with your actual Modified Adjusted Gross income. If your estimate was in line with your return, you will not be required to pay any of the premium tax subsidy back when you file your taxes. If, however, your MAGI is higher than your estimate, you will need to pay back the premium tax subsidy funds that you were not eligible for. Therefore, it is imperative that you calculate your estimated income carefully.
If your income is too high to qualify, you won’t be able to receive federal subsidies that will reduce your HEALTHCARE.GOV Health plan’s monthly premium. If you are in the annual open enrollment period of November 1st to January 15th of the upcoming year or have a qualified special enrollment, you can still buy an HEALTHCARE.GOV Health plan but will not be eligible to receive subsidies.
If your income is below 100% of the federal poverty level based on the number of individuals on your tax return, you may qualify for NC Medicaid. You can submit an application on HC.gov and Medicaid will be notified of your eligibility through HC.gov or you can apply directly at https://medicaid.ncdhhs.gov/. LSM Insurance Associates is not able to answer questions about Medicaid based on your application.
What else should you know?
In North Carolina, many of the HEALTHCARE.GOV health plans require you to use doctors that participate in a regional provider network. It is your responsibility to confirm whether your doctor participates in that network. If your plan has out of network benefits, please note that the out of network deductible is 5x the in-network deductible.
If you apply before the 15th of the month, your coverage can start as the FIRST of the NEXT month.
Advantages of Buying an Affordable Care Plan
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NO PRE- EXISTING CONDITION EXCLUSIONS
The biggest benefit of purchasing an Affordable Healthcare (ACA) plan is that YOU can't be turned down if you have a pre-existing condition. This means that as soon as your coverage starts you are eligible for any eligible medical expense and are covered for any medical condition including maternity or cancer.
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FEDERAL TAX CREDITS COULD LOWER YOUR MONTHLY PREMIUM
Depending on your INDIVIDUAL circumstances, you may qualify for a federal subsidy which will lower the monthly cost you pay. The subsidies are based on the number of people that are on your tax return and your income. Becoming eligible for subsidies is based on the income you report when you initially apply and is on a sliding scale because the subsidies are also determined by how many individuals are counted on your annual tax return. A big challenge is that you must estimate how much you are going to earn in the current year. If you are self-employed, or if you have different jobs during the year, your income may change. This is a concern because when you file your taxes for the current year, the government will look at the income amount you applied with. If it is dramatically different and is higher or lower when you submit your annual taxes, you could have to pay the federal subsidy back to the government!
Use This To Determine If You Are Eligible For Subsidy
If you fall below 100% of the federal poverty level or above 400% of the federal poverty level (FPL), you aren't eligible for subsidies. Determine how many people will be included on your next tax return and see if your income falls within 100% to 400%
Can I still buy an ACA plan if I make too much/too little?
You can still buy a plan during open enrollment or when you have a qualifying event if you don't qualify for federal subsidies. In these cases, you must pay 100% of the monthly premiums. We can send you quotes so you can determine the plans that work best for you.
Disadvantages Of Buying ACA -Healthcare.Gov, Obamacare Plan
The rates for these plans are based are solely based on your age. Men and women pay the same rate. This means that the rates are higher than you may have anticipated. In addition, the federal legislation allows insurance carriers to rate individuals that are older at 3x the rate for those in their 20's. Lastly, the plans will charge you 20% more if you are a smoker, which is defined as someone that has smoked cigarettes and/or vapes within the last 12 months.
Open Enrollment
If you don't join during the open enrollment, you can only join if you have a special qualifying event. A Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period when you can sign up for health insurance without any waiting periods for pre-existing conditions. A special qualifying event includes the following life events:
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Lose EMPLOYER health coverage at work
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Move to of the state
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Get married, or divorced
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Lose your spouse to death
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Have a baby
