As enrollment starts for the Affordable Care Act, a guide to navigating Obamacare

| September 25, 2013
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Update, Oct. 1: www.healthcare.gov is the starting portal for North Carolinians shopping the exchange.

Update, Sept. 25, 9:37 a.m.: Mother Jones published a story late last night about the cost of premiums under Obamacare, as estimated by the Congressional Budget Office. Before tax credits, the cost of premiums will be an average of 16 percent less than projected.

Although the McCrory administration and state lawmakers have made it more difficult for North Carolinians to access information about the Affordable Care Act, an estimated 1.2 million North Carolinians will begin shopping for subsidized health insurance next week under the ACA, also known as Obamacare.

"The hope is a broad mix of people will sign up on the exchange, because health insurance is predicated on the fact that if you're healthy, you should buy it, because no one who is healthy knows when or if they'll become sick," said Adam Searing, director of the Heath Access Coalition, a branch of the N.C. Justice Center. "If you just have sick people who sign up, then the health insurance becomes very expensive because you're just taking care of sick people. Healthy people need to sign up too. That's why there are so many incentives in here for young people."

Earlier this year, Gov. McCrory and the Republican majority in the General Assembly rejected Medicaid expansion, keeping 500,000 low-income North Carolinians from applying for the federal health care program. State leaders also turned down $74 million in federal grants that would have been used to promote the system, upgrade computers and pay navigators to help people understand the program.

While county social service departments can allow navigators onsite, the educational role has largely fallen to nonprofits and local clinics, such as Lincoln Community Health Center in Durham, Piedmont Health Services in Orange and Chatham counties and Wake Health Services.

However, Benjamin Money, chief executive officer of the North Carolina Community Health Center Association, says some clinics might not have staff to help potential enrollees—a problem for those without reliable transportation—but "regionally, they will be accessible."

Enroll America, a nonprofit, nonpartisan group, is also helping people enroll.

Blue Cross Blue Shield of North Carolina and Coventry Health Care of the Carolinas are participating in the ACA.

In some states, such as California, insurance companies have sharply limited the number of doctors and hospitals in their network. That means ACA enrollees would pay high fees to visit a health care provider out of network.

However, Searing says that scenario is unlikely in North Carolina. "We have this already, with employers' health plans where you're in and out of networks. With the ACA, there are requirements about the adequacy of the network and the health care plan you are buying; the consumer protections are very good. It's not that you can always see any doctor in any hospital you want, but it is clear you should be able to get top-notch care regardless of where you live and what your condition is."

Darcie Dearth, communications specialist for Blue Cross Blue Shield, said the company is offering 26 plans to ACA enrollees, many with access to the full network. Other plans have limited providers. "There will always be some outliers, but most will accept your coverage."

In states that have chosen to expand Medicaid, additional people who meet the eligibility requirements will be fully covered. Searing is hopeful that North Carolina will opt into Medicaid expansion.

"You have more and more Republican governors and Republican states signing up," including most recently Michigan and Pennsylvania, Searing said, "because this is just such a good deal."

"There is this interesting contrast between the commitment of people on the ground, who are actually closest to the people who need the help (of Medicaid), and then the kind of chicken with its head cut off running around in the top leadership of the state health agency," Searing added. "I'm hopeful that kind of local commitment on the ground will translate into people getting signed up for something that will really help them."

This article appeared in print with the headline "In sickness and health."

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Great article! On the subject of getting enrolled, I would like to add that there is an alternative to going directly to an insurer, or using a navigator. Licensed health insurance agents can make recommendations on which plans to enroll in - something navigators are not permitted to do. In addition, going direct to an insurer means you will only see plans from that particular insurer. A licensed agent can compare multiple plans and insurers. In addition, experienced agents can help decipher the "nuts and bolts" of health plans - networks, formularies, copays, etc. As a licensed health insurance agent, my website has a quote engine that will calculate rates based on your exact age (unlike the current healthcare.gov calculator!), in addition, it will calculate any subsidies based on household income, as well! http://nchealthconnector.org/nc-health-exchange-rates/

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Posted by nchealthconnector.org on 10/29/2013 at 10:24 PM
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