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North Carolina Hospital Association

Serving North Carolina Hospitals & Health Systems


Federal Insurance Marketplace

Learn More about Health Insurance Market Place

Open enrollment in North Carolina's federally facilitated Health Insurance Marketplace has begun and runs through March 31, 2014. To enroll, go online at Healthcare.gov. Now is the time for North Carolinians needing insurance to become educated on the plans, consider which fit their budgets/health needs and then seek help if needed to enroll. Go to https://www.healthcare.gov/find-premium-estimates/ to get a preview of plan information in your area. 

How Can Consumers Get Help Enrolling in Health Coverage?

Individuals applying for insurance in the Federal Marketplace can go online to apply at http://www.healthcare.gov/index.html. Some consumers will need help with the new application and enrollment process. The national number for assistance is 1-800-318-2596. Local help can also be found at https://localhelp.healthcare.gov/. [Note: alternatively, a person can apply through the NC online application (ePASS) at https://epass.nc.gov/.]

There are four types of assisters that will help consumers apply for and enroll in health coverage:


All marketplaces are required to establish a navigator program. Navigators will conduct public education activities to raise awareness about the marketplace/exchange, help consumers understand the eligibility and enrollment process, and provide referrals to other consumer assistance resources. On Aug. 15, 2013, Health and Human Services Secretary Kathleen Sebelius announced four Navigator grant recipients in North Carolina:

  1. Randolph Hospital, Inc. (Anticipated grant amount: $352,320) — Randolph Hospital will use Navigator funds to serve a three county area in North Carolina (Randolph, Moore and Montgomery). Randolph Hospital plans on targeting specific geographic regions with high uninsured populations, and working with community organizations in those areas to leverage resources and reach the most people. Additionally, Randolph Hospital will work with hospital financial counselors that already work with uninsured hospital patients to inform those patients of their coverage options. For more information, contact Devin L. Griffith, Vice President of Care Continuum and Support Services, at 336-633- 7773 or dgriffith@randolphhospital.org.
  2. North Carolina Community Care Networks (Anticipated grant amount: $1,988,428) — North Carolina Community Care Networks are a consortia that total more than 100 organizations who will work to inform consumers statewide, with particular focus in areas where there is a higher concentration of uninsured. These networks will be serving to reach out, inform, educate and help enroll North Carolinians, and include organizations in the legal rights, faith-based, agricultural, and aging communities. The toll-free number for the central scheduling system for this navigator is now operational. The number is: 1-855-733-3711. Additional contact information is available for download above on the right. Partner organizations involved include Community Care of NC, Access East, Partnership for Community Care, Community Care of Wake and Johnston Counties, NC Med Assist, Council on Aging in Buncombe Co., NC Agromedicine, Benefit Bank, Legal Aid of NC, Legal Services Mountain Area and Legal Service Charlotte Area. CareShare Health Alliance is providing program leadership and management for the 11 funded partners. CCNC serves as the fiscal agent for the $1.9 million CCIIO Navigator grant.
  3. Mountain Projects, Inc. (Anticipated grant amount: $359,750) — Mountain Projects, Inc. is a non-profit Community Action Agency serving Haywood and Jackson counties in North Carolina. Mountain Projects plans on providing Navigator services to the seven western-most rural counties of North Carolina, including Haywood, Jackson, Macon, Swain, Graham, Clay, and Cherokee. They will leverage existing relationships in these rural communities with the goal of educating the uninsured and facilitating access to the new insurance options now available. For more information, go to http://www.mountainprojects.org/.
  4. Alcohol/Drug Council of North Carolina (Anticipated grant amount: $324,798) — The Alcohol/Drug Council of North Carolina plans on using Navigator grant funds to establish Project Jumpstart, implemented by a consortium formed to provide specialized navigation services to people in recovery from mental illness and/or substance abuse. A majority of people working on Project Jumpstart will have personal experience with mental illness, an addictive disorder, and/or a chronic disease, and will draw on these experiences to reach out to and help enroll this target population in new coverage options. For more information, go to http://alcoholdrughelp.org/.

In-Person Assisters (IPAs)

In-Person Assisters are similar to Navigators, except they can be funded with establishment grant funds. Health and Human Services Secretary Kathleen Sebelius recently announced new funding to help community health centers provide in-person enrollment assistance to uninsured individuals across the nation. For more information, contact E. Benjamin Money, Jr., MPH, President and CEO at 919-469-5701. North Carolina is eligible to receive 32 awards totaling $4,202,385. See what centers in NC are eligible for funding here:
Read the press release here:

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.

More on CACs


Application to become a CAC Organization


CAC Training Materials




CAC Guidance



Agents and Brokers

Licensed agents and brokers can help consumers and small employers select and enroll in health plans offered through marketplaces/exchanges. Each marketplace will have the flexibility to determine the specific roles that agents and brokers will play in providing consumer assistance. Go to http://www.healthcarenc.org/ to find certified marketplace agents in your area. Search by Zip Code, County, or specific insurance companies.

Small Business Health Options Program (SHOP)

On July 3, 2013, the Obama administration announced they were delaying the "employer mandate" until 2015.  Small employers will be able to choose from a range of coverage options through the SHOP for their employees. The SHOP will offer a single point of entry for employers and their employees to apply for coverage, and if eligible, the employer may qualify for a tax credit worth up to 50 percent of the employer’s premium contribution. 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.

Printable Application Forms

 • Individual Short form (PDF - 668 KB)
 • Individual Short form instructions
 • Family (PDF - 820 KB)
 • Family instructions
 • Individual without Financial Assistance (PDF - 419 KB)
 • Individual without Financial Assistance instructions

 Small Business Health Options Program (SHOP) Application
 • Employee Application form (PDF - 60 KB)
 • Employer Application form (PDF - 142 KB)

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


NC Plans participating in the Health Insurance Marketplace

The N.C. Department of Insurance approved the insurance plans to be offered in the NC Marketplace this year with federal subsidies. Blue Cross Blue Shield of NC, which will offer 26 plans, is the only insurer offering subsidized coverage in all 100 NC counties. See a preview of BCBSNC's rates at http://mediacenter.bcbsnc.com/news/bcbsnc-announces-rate-information-for-individual-aca-health-plans. Coventry Health Care of the Carolinas, offering 25 plans, is expected to operate in 39 counties, mostly metropolitan areas. 

Helpful Web Resources

Healthcare.gov is the official U.S. government site provides ongoing news and information about the federal health insurance marketplace. This site is for consumers.

Marketplace.cms.gov provides the latest resources to help people apply, enroll, and get coverage in 2014. This site is for helpful for navigators, IPAs, CACs, agents/brokers, hospitals and other providers. This site will be a source for accessing marketing materials. You can sign up on this site for email updates.

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. Many of the following activities may qualify your hospital to be recognized by CMS as an official “Champion for Coverage” (apply online at http:// marketplace.cms.gov/help-us/champion-apply.html):

• Provide materials (posters, fact sheets and brochures) in your waiting room about how your patients can enroll with the Health Insurance Marketplace.

• Include a story about the Marketplace in your newsletter or other publication.

• Post the Marketplace widget/badges on your website that links to HealthCare.gov and/or CuidadoDeSalud.

• Share official Marketplace social media information with your community on Facebook and Twitter: Facebook.com/HealthCare.gov, Facebook.com/CuidadoDeSalud.gov, @HealthCareGov, @CuidadoDeSalud

• Record and send out a public service announcement about the Marketplace.

• Have your staff and community learn about the Marketplace in educational sessions.

• Provide space and a computer for certified counselors to help people enroll.

• Organize an enrollment event or fairs (ideally, with computers so people can check out the Marketplace

Health Insurance Marketplace Training Schedule
CMS Webinar Schedule on the Affordable Care Act and how the Health Insurance Marketplace will work.

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. As millions more Americans become eligible for Medicaid in the coming months, hospitals will be crucial partners in making sure these individuals enroll. We’ve created a toolkit designed to help hospitals learn more about presumptive eligibility and how to take advantage of a new opportunity to use it more broadly. Check out the toolkit at presumptiveforhospitals.org, and be sure to share it with your networks.

Affordable Care Act Tax Provisions
The Affordable Care Act contains some tax provisions that are in effect and more that will be implemented during the next several years. 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
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.

Get Covered America
Get Covered America is focused on educating the American public as health care consumers. Sign up here to be a Get Covered America volunteer.

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.

Blue Cross Blue Shield of NC has created a website with information on health reform for North Carolinians.

Coventry Health Care
The information on this site may help you learn more about federal health care reform and what it means to you. Connect to your local market website for state-specific information.

State Health Reform Assistance Network

The State Health Reform Assistance Network, funded by Robert Wood Johnson Foundation, offers best-practice and shared learning for state reform efforts.

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


AARP Health Law Answers


http://www.MiLeyDeSalud.org (Spanish version)


Brochure to Help Consumers Learn About the New Health Premium Tax Credit
Consumers Union, publisher of Consumer Reports, has developed a new brochure to help explain the new 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)

Videos on the Uninsured and the New Marketplace

North Carolina Web-Based Resources

The N.C. Department of Insurance has approved the insurance plans to be offered in the NC Marketplace this year with federal subsidies. Blue Cross Blue Shield of NC, which plans to offer 26 plans, is the only insurer offering subsidized coverage in all 100 NC counties. Coventry Health Care of the Carolinas, offering 25 plans, is expected to operate in major metropolitan areas.

The NC Institute of Medicine estimates that NC has 1.5 million uninsured residents under age 65. Estimates range from 300,000 to 700,000 for the number of uninsured North Carolinians that potentially could enroll for health insurance during the federal open enrollment period. For uninsured residents between 100% and 400% of the federal poverty level, ACA provides tax credits that reduce premium costs. Uninsured residents with incomes up to 250% of the federal poverty level are eligible for reduced cost sharing (e.g., health insurance with lower deductibles and copayments). The premium tax credits and cost-sharing assistance are integral to the open enrollment period in 2014.

NC County-Level Estimates of Non-Elderly Uninsured: http://nciom.org/wp-content/uploads/2010/08/County-Level_Estimates_10-11.pdf

County-Level Estimates of the Number of Individuals in North Carolina Who Would Be Eligible for Coverage Under the Affordable Care Act’s Expanded Insurance Options


North Carolina Dashboard on Health Care Quality Compared to All States
Agency for Healthcare Research and Quality


Ushering in a New Era in Health Care. North Carolina Medical Journal. July/August 2013.

Implementation of the Affordable Care Act in North Carolina.

Implementation of the Affordable Care Act in North Carolina. NCMJ, May/June 2011;72(2):155-159.


What Does Health Reform Mean for North Carolina? NCMJ, May/June 2010;71:3 


NCIOM: North Carolina data on the uninsured

North Carolina Department of Insurance: Health Insurance Smart NC

Healthy NC 2020

North Carolina State Center for Health Statistics HealthStats (see also Community Snapshot Reports for information for specific counties)


Relevant postings from NCHA's weekly NewsLine:

HHS Reports on Plan Choices in Health Insurance Marketplaces; Delays Announced
9/27/13  A new report released this week by the U.S. Department of Health and Human Services finds that in North Carolina consumers will be able to choose between 22 qualified health plans in the federally facilitated health insurance marketplace, less than the national average of 53 plans. Premiums are generally lower in states with more insurers participating, the agency said. NC only has two insurers participating, Blue Cross Blue Shield of NC and Coventry Health Care of the Carolinas. For more on the national report, see the press release online at http://www.hhs.gov/news/press/2013pres/09/20130925a.html. The Issue Brief on Health Insurance Marketplace Premiums for 2014 is online at http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/ib_marketplace_premiums.cfm. NC specific data can be found in this press release and at http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/datasheet_home.cfm and http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/longdesc/nc.htm. Also this week, the Obama Administration announced a delay for online Obamacare enrollment for small businesses in federally operated healthcare exchanges until Nov. 1, one month later than planned. Also, the Spanish-language version of the federal marketplace's main website, CuidadoDeSalud.gov, is not ready to process applications online. Spanish-speakers wanting to complete the process can apply over the phone or with an in-person counselor.

Update on the NC FAST System for Medicaid and NC Health Choice Enrollment
9/27/13 An update on the NC FAST system was provided at a recent meeting of stakeholders involved in North Carolina's Health Insurance Marketplace outreach and enrollment efforts. NC FAST is the state's system that will ultimately have the capacity to determine eligibility for all of NC Department of Health and Human Service's programs, including SNAP (formerly called Food Stamps), Medicaid, NC Health Choice, Temporary Assistance to Needy Families, Low Income Energy Assistance Program and child care subsidies. Under the Affordable Care Act, a consumer can file a single application in the federal marketplace which will determine eligibility for subsidies to purchase private health insurance coverage through the marketplace and will link to NC DHHS's eligibility system to determine eligibility for Medicaid or NC Health Choice. The attached document provides background information on NC FAST and Federal Marketplace.

Social Services Encouraged to Assist North Carolinians with Marketplace
9/27/13 The NC Division of Social Services recently sent a memo to county social services directors and public health directors supporting their involvement in assisting North Carolinians seeking help with the Health Insurance Marketplace. When the open-enrollment period begins on Oct. 1, many North Carolinians will look to their county departments of social services for assistance and answers. The memo, attached to today's CEO email, also encourages social services to allow navigators to work onsite if the local facility can accommodate them. This will provide valuable assistance to those who are interested in purchasing a plan through the federal marketplace.

CMS issues provider-focused Health Insurance Marketplace publications
9/06/13  Two new publications from the CMS answer questions that health care providers and patients may have about the Health Insurance Marketplace where individuals and small businesses may purchase health coverage beginning Oct. 1. For details, see "10 Things Providers Need to Know" and "10 Things to Tell Your Patients" about the Health Insurance Marketplace.





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