License to insure: Affordable Care Act enrollment begins Tuesday

Published 7:06 pm Saturday, September 28, 2013



The Affordable Care Act’s first major phase goes into effect Tuesday as the health care marketplace is launched nationwide. But with the massive plan to get every American insured comes a lot of confusion as to who needs to do what, and when.

To that end, local health insurers and ACA application counselors are reaching out to Beaufort County residents to arm them with the information they need to know.

Monday night, Agape Community Health Center will host an Affordable Care Act information session from 7 p.m. to 9 p.m. at Metropolitan A.M.E. Zion Church in Washington. The event is open to the public.

“People have heard of the Affordable Care Act, but we need to provide a little bit of education,” said Claudia Stokes, director of the ACA program at Agape. “We’ll try to answer as many questions as we can.”

Paige Harris, co-owner of Coastal Insurance Services in Washington, has spent the past year training for the changes ACA will bring to the insurance industry. According to Harris, not everyone will be affected by this first round of ACA implementation: those 65 and older already insured by Medicare, as well as employees under a large group policy, will likely see no changes — but they still need to check. However, those with individual policies, those with no insurance and those who have insurance under a small group policy — for example, employees insured through a small business — need to take action, Harris said.

“People need to be proactive and call somebody who can help them,” Harris said, explaining that navigating the Federally Facilitated Marketplace website, known as the exchange, can be tricky.

That’s because enrollment will not only offer up the many insurance plans to choose from in North Carolina, but will also determine what’s called the advanced premium tax credit. Harris explained the tax credit as, essentially, a subsidy that helps pay insurance premiums. Since it’s based on household income, a great majority of Beaufort County residents will qualify for the credit, she said.

In North Carolina, any household with total income falling between 100 and 400 percent of the federal poverty level will qualify — in real numbers, that means any household with income below $94,200. Those making less than 250 percent of the federal poverty level will likely also qualify for “cost sharing:” the potential for a better plan without additional cost.

While enrollment is offered online, Harris said people enrolling should seek help to navigate the system. Starting Tuesday, Agape will also be facilitating enrollment during normal business hours for those who need guidance, Stokes said.

“Basically, the law is now saying that every American needs to be covered (by insurance),” Stokes said. “I think people need to take this very seriously because if they don’t, they will be penalized.”

Those penalties will be felt at tax time if North Carolinians aren’t enrolled, covered by their employer or Medicare, by Jan. 1, 2014. The way it breaks down is this: in 2014, the penalties measure out to a flat fee of $95 per adult and $47.50 per child, up to $285 per household, or 1 percent of family income, whichever is greater. But those penalties will rise in the following years: by 2016, the flat fee will be $695 per adult and $347.50 per child up to $2,085 per household or 2.5 percent of family income, whichever is greater.

Whether or not a person or family has insurance will be monitored: on 2014 federal income tax returns, taxpayers can expect to see a requirement to provide information of health insurance; penalties may be taken from income tax returns.

As for the benefits of the Affordable Care Act, Harris said it’s a mixed bag.

“For the average person who does not have group coverage, they are now eligible for insurance regardless of health status. That’s a big deal if you have any kind of preexisting condition. … I think the negative is it’s going to cost people more,” Harris said, adding that insurance premiums for younger people in North Carolina will be going up.

But the new law is a step toward getting people to be responsible for their own health, she noted.

“It can be beneficial to some and hurt some,” Stokes said. “It’s going to make us or break us, one.”

Metropolitan A.M.E. Zion Church is located at 102 W. Martin Luther King Jr. Drive in Washington. For more information about the ACA information session, call 252-946-5634 or 252-702-8337. For more information about the Affordable Care Act or to enroll, visit