Obamacare in North Carolina - Health Insurance Marketplace

Obamacare in NC

The Patient Protection and Affordable Care Act (ACA), often referred to as Obamacare, was signed into law in 2010, but many people still have questions about Obamacare and what is available to North Carolina residents.  The correct definitions for common terms and answers to frequently asked questions will help in better understanding the ACA or “Obamacare” and how it may impact you and your family.  

Important Terms

Individual Mandate- This is the law that requires everyone to obtain creditable health insurance coverage or pay a penalty.

Health Insurance Marketplace/Exchange- A government run website focused on the Affordable Care Act.  North Carolina did not elect to create its own state run Exchange and therefore operates on the Federal Exchange.  

Subsidy- Based on the income graph below, the federal government may help pay a portion of your health insurance costs.  Two types of subsidies include:

  • Advance Premium Tax Credit or APTC- Financial assistance provided by the federal government that is applied toward the monthly premium of a qualified health insurance plan.  To be eligible for a subsidy from the federal government, a person or family must earn between 100% and 400% of the Federal Poverty Level (see chart below).
  • Cost Sharing Reduction or CSR- Financial assistance provided by the federal government that is applied toward the annual deductibles, copayments and coinsurance of a qualified health insurance plan. The Cost Sharing Reduction, sometimes referred to as Enhanced Benefits, is only available to people who enroll in a Silver level plan and have an income between 100% and 250% of the Federal Poverty Level (see chart below).

Federal Poverty Level Guidelines for 2016

Poverty Level

Open or Annual Enrollment Period (OEP or AEP):  The yearly period when people can enroll in health insurance.  Open Enrollment for 2017 begins on Nov 1, 2016 and ends on Jan 31, 2017.  

Essential Health Benefits: The Affordable Care Act requires all qualified health plans to cover the ten essential health benefits.  These benefits include:

  • Ambulatory Services
  • Emergency Services
  • Hospitalization
  • Prescription Drugs
  • Laboratory Services
  • Maternity and Newborn Care
  • Rehabilitative Services
  • Preventive Services
  • Pediatric Services
  • Mental Health and Substance Abuse Services

FAQ’s

At NC Health Plans we are often asked questions about Obamacare in NC. Here are some of the questions we are asked most frequently along with our best answers:

  1. Do I have to have health insurance?  Yes you do.  Under the Affordable Care Act, you are required by law to carry health insurance or be subject to a tax penalty.
  2. How much is the penalty for not having insurance?  In 2016, the tax penalty is $695 per person or 2.5% of your income, whichever is higher.
  3. Can I be exempt from the penalty?  Yes.  Under certain circumstances, you may obtain a tax exemption.  We recommend talking with a licensed tax advisor about possible exemptions.
  4. Do I qualify for a federal subsidy?  You may.  Federal subsidies are based on your Modified Adjusted Gross Income and the number of people on your tax return.  For help determining whether or not you qualify, click the Get Quote button which includes a subsidy estimator or call 888-765-5400 to speak with a licensed agent.
  5. What if my income changes over the course of the year after enrolling in a subsidized plan?  You are required to update any income changes with the Federal Marketplace.  A failure to do so could result in you having to pay back a portion or all of your premium tax credit.
  6. Do I have to enroll through the federal Marketplace (Exchange)?  No; however, you do have to have an ACA compliant plan to avoid a tax penalty. You do not have to get your plan through the federal Marketplace and many private insurance companies offer plans both on and off the Federal Marketplace.

The Health Insurance arena is an ever-changing industry and understanding your options is more important than ever.  To speak with a licensed and professional agent who is current on the laws of the Affordable Care Act and Obamacare in NC, contact NC Health Plans at 888-765-5400.