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.
