Where credit is due

Western North Carolina residents who want to change the health insurance they receive through the Affordable Care Act, or who want to sign up for a plan through the health insurance marketplace, can do so during a special enrollment period ending Sunday, Aug. 15.

And local nonprofits urge people to explore their options for potentially saving hundreds of dollars a month. “People who were already getting the tax credits and reductions can now get more,” explains Shannon Cornelius, health justice program director at Pisgah Legal Services.

The special enrollment period, opened in July as part of the federal American Rescue Plan coronavirus relief package, includes two new enrollee benefits. One is a premium tax credit, or increased subsidy, which will bring down the premium a customer pays each month.

Previously, eligibility for this tax credit was capped at 400% of the federal poverty limit, which varies based on the number of persons in a household. Now, those over that threshold will receive the credits if their insurance expense would exceed 8.5% of their household income.

For a household of four, the income limit works out to $104,000, which some dual-income households exceed, Cornelius explains. The increased subsidy allows higher-income residents to qualify for help: A couple jointly earning $100,000 per year would not pay more than $700 a month in health insurance premiums, she says, noting that families in that income bracket paid as much as $2,000 a month before the new benefit.

The second new tax credit is the zero-dollar benchmark plan. A household is eligible if it is below 150% the federal poverty limit or contains anyone who received unemployment compensation during 2021 for one week or more. Under this plan, a person may have doctor co-pays as low as $5, says Cornelius.

Helping hands

Several local organizations have been certified as “assisters” for navigating the at-times confusing health care maze: PLS; the Council on Aging of Buncombe County; Blue Ridge Community Health Services; Legal Aid of North Carolina; Mountain Projects Inc.; and Western Carolina Medical Society. These unbiased assisters offer confidential, free help for residents who need to select an insurance plan, troubleshoot issues and communicate with insurance companies if necessary.

“We have plenty of appointments left that we can still fill before Aug. 15,” says Susan Wilson, Affordable Care Act program director at the Council on Aging of Buncombe County. There is no age limitation or cap on the income bracket for residents that the nonprofit will assist.

A tool on www.PisgahLegal.org/ACA is a centralized scheduling location each assisting nonprofit is using. The tool will search for a free 90-minute appointment via ZIP code. While appointments are primarily being conducted over the phone, some organizations offer in-person appointments.

Residents can visit NCnavigator.net for more information about plans or call 855-733-3711, the statewide number for scheduling appointments. Those who are considering enrollment or a change to their existing plan can research 2021 health insurance plans by searching their ZIP code on HealthCare.gov.

Popular plans

Wilson and Cornelius say their nonprofits have both experienced an uptick in WNC residents seeking information about health insurance plans in 2021 compared to the previous year.

That uptick is reflected statewide as well. The Centers for Medicare and Medicaid Services at the federal Department of Health and Human Services, which issues data on the number of health insurance plans selected each year, reported that North Carolina residents selected 32,697 plans from Feb. 15 to June 30, 2020.

During that same period in 2021, 91,166 plans were selected across the state This nearly threefold increase “speaks to the fact that if you make health insurance more accessible, people are going to get it,” Cornelius says.

The COVID-19 pandemic and its associated job losses are likely driving the higher sign-up rates, Cornelius suggests.

“We know during COVID is a really important time to have coverage, even if it’s ‘just in case,’” she continues, citing a Kaiser Family Foundation brief that estimates more than 3 million people ages 18 and older in North Carolina are at higher risk of serious illness from COVID-19.

Six percent of working-age adults in the United States reported that they lost employer health coverage because of COVID-19, according to a July 16 study by The Commonwealth Fund, a foundation dedicated to health care. Of those, 67% reported that they gained other coverage.

“We are excited that so many people are taking advantage of the increased subsidies available and we hope that people evaluate if they can get health insurance if they want it and reach out for assistance,” says Cornelius. “Now is the time.”