NC Healthcare.gov Insurance Options
Enroll in Affordable Health Coverage with Healthcare.gov
Whether you call it Healthcare.gov, The Affordable Care Act, Obamacare, or even the Marketplace, you can enroll in a plan when you have a qualifying event or during the annual open enrollment period. If you are eligible for a Healthcare.gov plan, any pre-existing health conditions are covered IMMEDIATELY, upon enrollment. You also may be eligible for federal tax credits that can reduce your monthly premium.
Request Healthcare.gov Quotes
Healthcare.gov Enrollment Windows
Annual Open Enrollment for Healthcare.gov — November 1st – January 15th of each year. Coverage always starts on the 1st day of your effective date.
Special Enrollment Periods — You have 63 days from the date you lost your health coverage due to the following special events to sign up for Healthcare.gov coverage. Special Enrollment Periods include:
- Getting Married or Divorced if you are currently on a health plan with your soon to be ex-spouse.
- Having a baby
- The primary subscriber passes away and you are covered under their health plan currently.
- You move to a new state or a new county that is serviced by your existing healthcare.gov carrier.
- You lose group health insurance, military benefits, or Medicaid coverage.
- Your COBRA or Medicaid coverage ends or your dependent turns 26.
Are You Eligible For Healthcare.gov Premium Tax Subsidies?
Depending on how many people are in your family, and your total annual Modified Adjusted Gross Income (MAGI), you may be eligible for federal tax credits that can reduce your Healthcare.gov monthly premium. You must estimate what your combined MAGI for next year will be when you apply. When you file next year's taxes, your estimate will be compared with your actual income — if your MAGI is higher than your estimate, you will need to pay back the premium tax subsidy funds you were not eligible for. Therefore, it is imperative that you calculate your estimated income carefully.
Health Insurance Marketplace Calculator
If your income is too high to qualify, you won't be able to receive federal subsidies that reduce your monthly premium. During the annual open enrollment period, or with a qualified special enrollment, you can still buy a plan but will not be eligible to receive subsidies.
If your income is below 100% of the federal poverty level based on the number of individuals on your tax return, you may qualify for NC Medicaid. You can submit an application on HC.gov and Medicaid will be notified of your eligibility, or you can apply directly. LSM Insurance Associates is not able to answer questions about Medicaid based on your application.
What else should you know?
In North Carolina, many of the Healthcare.gov health plans require you to use doctors that participate in a regional provider network. It is your responsibility to confirm whether your doctor participates in that network. If your plan has out of network benefits, please note that the out of network deductible is 5x the in-network deductible.
If you apply before the 15th of the month, your coverage can start as the FIRST of the NEXT month.
Advantages of Buying an Affordable Care Plan
NO PRE-EXISTING CONDITION EXCLUSIONS. The biggest benefit of purchasing an Affordable Healthcare (ACA) plan is that you can't be turned down if you have a pre-existing condition. As soon as your coverage starts you are eligible for any eligible medical expense and are covered for any medical condition including maternity or cancer.
FEDERAL TAX CREDITS COULD LOWER YOUR MONTHLY PREMIUM. Depending on your individual circumstances, you may qualify for a federal subsidy which will lower the monthly cost you pay. The subsidies are based on the number of people on your tax return and your income, on a sliding scale. Because you must estimate how much you will earn in the current year, your income may change — and when you file your taxes, the government will look at the income you applied with. If it is dramatically higher or lower, you could have to pay the federal subsidy back.
Determine If You Are Eligible For Subsidy
If you fall below 100% or above 400% of the federal poverty level (FPL), you aren't eligible for subsidies. Determine how many people will be included on your next tax return and see if your income falls within 100% to 400%.
Can I still buy an ACA plan if I make too much/too little?
You can still buy a plan during open enrollment or when you have a qualifying event if you don't qualify for federal subsidies. In these cases, you must pay 100% of the monthly premiums. We can send you quotes so you can determine the plans that work best for you.
Disadvantages Of Buying an ACA / Healthcare.gov Plan
The rates for these plans are based solely on your age. Men and women pay the same rate, which means the rates may be higher than you anticipated. Federal legislation allows insurance carriers to rate older individuals at 3x the rate for those in their 20's. Lastly, the plans will charge you 20% more if you are a smoker, defined as someone who has smoked cigarettes and/or vaped within the last 12 months.
Open Enrollment
If you don't join during open enrollment, you can only join if you have a special qualifying event. A Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period when you can sign up for health insurance without any waiting periods for pre-existing conditions. A special qualifying event includes:
- Lose EMPLOYER health coverage at work
- Move out of the state
- Get married, or divorced
- Lose your spouse to death
- Have a baby