Federal Insurance Marketplace
Open enrollment for 2017 in the federal Health Insurance Marketplace started Nov. 1, 2016 and ended Jan. 31, 2017. North Carolina enrolled 549,158 as of Jan. 31, 2017, which is 64,329 less than January 2016. North Carolinians enrolled or renewed online at Healthcare.gov. Blue Cross and Blue Shield of North Carolina was the only insurer to offer insurance plans in all NC counties on the Exchange in 2017. A 16-page analysis of North Carolina’s ACA market (release February 2017), researched and written by Wake Forest University law professor Mark Hall, is available here.
The North Carolina companion site, NCGetCovered.org, served as a statewide, go-to resource for reliable information on the Affordable Care Act to help North Carolinians identify the right coverage for their needs. The Get Covered Connector is an online scheduling tool that allows consumers to make an appointment with a free enrollment expert who can walk you through your options or schedule an appointment for enrollment assistance: connector.getcoveredamerica.org.
North Carolinians, including Spanish-speakers, also could call 855-733-3711 to schedule a meeting with an in-person assister in their county.
Need help enrolling?
There are four types of assisters available to help consumers apply for and enroll in health coverage:
The Navigator position was created by the ACA to provide helpers for people to enroll in coverage through the health insurance exchange, and refer or assist with Medicaid enrollment. Navigators are funded through by the exchanges. Regulations from the U.S. Department of Health and Human Services (HHS) are clear that anyone who gets payments from insurance companies cannot be a Navigator. Navigators also must meet cultural competency standards and go through training and certification. Starting in 2018, Navigators will provide more ongoing assistance to consumers after the enrollment process is complete.
In-Person Assisters (IPAs)
Like Navigators, Assisters must meet training and conflict-of-interest standards. They fill in gaps in areas that need more enrollment assistance, or provide outreach and education about the ACA to individuals who have not traditionally had access to health insurance coverage. In the federally-facilitated marketplace, non-Navigator assisters must complete the same training as Navigators.
Certified Application Counselors (CACs)
Hospitals can become certified application counselors (CACs) organizations. The certification process will ensure that CACs are qualified to help people apply for Medicaid, CHIP, and plans sold through the exchange (as well as premium tax credits and cost-sharing reductions).
CACs will not receive any public funding. CACs can be supported by organizations like hospitals, community health centers, private providers or local and regional funders...organizations trusted with protecting personally identifiable information.
Being certified as CACs enables organizations that would likely be engaged in application assistance anyway to help consumers in a more formal capacity. For example, although not all community health centers and community-based organizations will be chosen to serve as navigators or IPAs, they are well-positioned to provide application assistance because they are trusted messengers. The CAC designation will help expand the network of trained assistance that is available to consumers.
Agents and Brokers
Licensed agents and brokers can help consumers and small employers select and enroll in health plans offered through marketplaces/exchanges. Go to http://www.healthcarenc.org/ to find certified marketplace agents in your area. Search by Zip Code, County, or specific insurance companies.
Information for Business Owners
Small Business Health Options Program (SHOP)
Businesses with 50 employees or fewer can choose health and dental coverage options through the SHOP for their employees. Small businesses can begin offering SHOP coverage to employees any time of year. The SHOP provides a single point of entry for employers and their employees to apply for coverage. If your business has fewer than 25 employees, you may qualify for a Small Business Health Care Tax Credit worth up to 50% of your premium costs. To learn more, go to https://www.healthcare.gov/small-businesses/. There's also a government website dedicated to answering the questions of business owners at http://business.usa.gov/healthcare.
Small Business Health Options Program (SHOP) Application
Essential Community Providers (CAH, DSH and certain rural hospitals)
Under the Affordable Care Act, insurance plans offered through the Marketplace—known as Qualified Health Plans (QHPs)—are required to include some essential community providers (ECPs). ECPs are providers (CAH, DSH and certain rural hospitals) that serve predominately low-income medically underserved individuals.
On March 26, 2013, the Centers for Medicare and Medicaid Services Center for Consumer Information & Insurance Oversight posted a Non-Exhaustive List of Essential Community Providers to assist health insurance issuers in locating ECP: https://data.cms.gov/dataset/Non-Exhaustive-List-of-Essential-Community-Provide/ibqy-mswq. Insurers will be permitted to write in ECPs not on the list. If you are not on the list, when you contact insurers you should let them know you are an ECP and that they can write you in. QHPs are finalizing their networks in the next few months, but are not required to include all safety net providers in their networks. It is strongly recommended that direct service providers reach out to health insurers now if you want to get into their networks for 2014.
Frequently Asked Questions on Essential Community Providers
Affordable Exchanges Guidance Re: Essential Community Providers
Helpful Websites for Consumers
Healthcare.gov is the official U.S. government site for consumers that provides ongoing news and information about the federal health insurance marketplace.
Marketplace.cms.gov is for helpful for navigators, IPAs, CACs, agents/brokers, hospitals and other providers.
North Carolina Department of Insurance: Health Insurance Smart NC
Hospitals can help promote the federal marketplace in a multitude of ways. Materials are online at http:// marketplace.cms.gov/ for your PR/Marketing staffs to utilize. Hospitals should consider:
- Providing materials (posters, fact sheets and brochures) in your waiting room about how your patients can enroll with the Health Insurance Marketplace.
- Including a story about the Marketplace in your newsletter or other publication.
- Posting the Marketplace widget/badges on your website that links to HealthCare.gov and/or CuidadoDeSalud.gov.
- Sharing official Marketplace social media information with your community on Facebook and Twitter: Facebook.com/HealthCare.gov, Facebook.com/CuidadoDeSalud.gov, @HealthCareGov, @CuidadoDeSalud
- Recording and sending out a public service announcement about the Marketplace.
- Having your staff and community learn about the Marketplace in educational sessions.
- Providing space and a computer for certified counselors to help people enroll.
- Organizing an enrollment event or fairs (ideally, with computers so people can check out the Marketplace online).
Understanding Health Insurance — Resources
Health insurance can be complicated. Hospitals can help promote health insurance literacy by filling in knowledge gaps to make consumers more likely to get covered and stay covered. Resources are available to use and share:
From Coverage to Care: A Roadmap to Better Care and Healthier You
This is an initiative from Healthcare.gov to help people with new health care coverage understand their benefits and connect to primary care and the preventive services that are right for them.
The same information is also available in YouTube videos at http://www.youtube.com/watch?v=_iVuAPlFjIM.
Blue Cross and Blue Shield of North Carolina also has developed a special site to help educate its new enrollees. BCBSNC’s Answer Spot provides information about accessing health care, managing your health insurance plan and staying healthy. http://www.bcbsnc.com/content/campaigns/answerspot/index.htm
Health Insurance Marketplace Training
Presumptive Eligibility Toolkit
Presumptive eligibility -- which allows entities like hospitals to temporarily enroll people in Medicaid if they appear to be eligible -- is an efficient, effective way for hospitals to connect their patients to health coverage. Check out the toolkit at presumptiveforhospitals.org, and be sure to share it with your networks.
Affordable Care Act Tax Provisions
This site provides a list of provisions for which the IRS has issued proposed and/or final guidance; additional information will be added to this page as it becomes available.
Enroll America is a collaborative organization, working with partners that span the gamut of health coverage stakeholders—health insurers, hospitals, doctors, pharmaceutical companies, employers, consumer groups, faith-based organizations, civic organizations, and philanthropies—to engage many different voices in support of an easy, accessible, and widely available enrollment process. You can sign up on this site for helpful updates.
The Center for Consumer Information & Insurance Oversight
The Center for Consumer Information and Insurance Oversight (CCIIO) is charged with helping implement many provisions of the Affordable Care Act. CCIIO oversees the implementation of the provisions related to private health insurance.
Connecting Kids to Coverage National Campaign. InsureKidsNow.gov provides information about Medicaid and CHIP services for families who need health insurance coverage. These programs are designed to be affordable for families who are not able to afford health insurance coverage in the private market or do not have coverage available to them.
The Kaiser Family Foundation
The Kaiser Family Foundation’s website provides in-depth information on health reform and state-by-state analysis.
Questions about insurance subsidies
Brochure to Help Consumers Learn About the Health Premium Tax Credit
Consumers Union, publisher of Consumer Reports, has developed a new brochure to help explain the health insurance premium tax credit to consumers. The brochure was tested with consumers to ensure that it provided information in a way that gave users a general picture of their eligibility and inspired them to apply if they did qualify. Tools like this brochure will be critical to educating the millions of Americans who still do not know about this opportunity to make health insurance affordable through the premium tax credit.
Open door forum—where states and stakeholders can engage with HHS on health care reform
Provider comparison information
Patient Protection and Affordable Care Act. Consolidated Bill Text
Congressional Budget Office. Selected CBO Publications Related to the Health Care Legislation.
US Census data (look at Historical Tables)