Affordable Care Act

Obamacare in North Carolina FAQs

With an even shorter Open enrollment period this year than last you will want to be informed of the ins and outs of the Affordable Care Act before you apply for a health insurance plan.

Open enrollment begins on November 1st, 2015 and ends on January 31, 2016.

After, January 31st you won’t be able to secure health insurance coverage until January 1, 2017.

10 Things You Should Know About the Affordable Care Act in North Carolina

Navigating your way through the Affordable Care Act and the health insurance laws in North Carolina can be confusing. We’ve got the answers to the most frequently asked questions when it comes to the ACA.

1. Will the Affordable Care Act cause my North Carolina health insurance to increase?

The short answer, it depends on your situation and the changing Affordable Care Act rules and regulations.

Employer-Sponsored Insurance:

Do you already have health insurance from your employer? If you already receive coverage from your employer in North Carolina, you may see the cost of your plan rise. Many businesses are trying to pass along healthcare costs onto employees in the form of higher deductibles and copays. The overall goal of the Affordable Care Act is to lower healthcare costs. The healthcare reform puts some new limits on the amount insurers in North Carolina can charge as well as some other structural changes to the healthcare system and coverage requirements. Policy requirements for health insurance plans in the health insurance exchange will affect employee sponsored health insurance as well.

For some businesses, dropping small business health insurance benefits could help small business owners and employees save money by opening up eligibility for subsidies and other options.


In 2013, North Carolina voted not to expand Medicaid within the state to bridge the gap between health insurance subsidies provided by the Affordable Care Act and Medicaid coverage.

Middle Class:

Do you think you make too much to qualify for subsidies? Many people qualify for cost-saving subsidies in North Carolina but don’t realize it. Subsidy tax credits are available to people earning up to $97,000 per year for a family of four. Cost share reduction plans are available to families making 250% of the Federal Poverty Level, or $60,625 for a family of four. To receive subsidies or enroll in cost share reduction plans, you must purchase health insurance through the online health insurance exchange. Be careful, make just one mistake on, and you could miss out on subsidies that you deserve. Learn how to get help navigating

2. What is a health insurance exchange? How will the exchange work in North Carolina?

The health insurance exchange is an online collective where individuals, families and small businesses in North Carolina will be able to purchase health insurance. States can choose to use the federal health insurance exchange, a state-federal partnership exchange, or a state-based exchange.

While North Carolina originally planned to set up a state-federal partnership exchange, the legislature decided on a purely federally run exchange. Overall, the exchange will work to help lower the cost of health insurance for individuals and small businesses in North Carolina by giving them more buying power.

“Ronee was by far the most professional and attentive agent we have had the good fortune to deal with. We were especially pleased with how efficiently she worked our way thru the new affordable healthcare act. The time we spent getting new and affordable coverage was really time well spent.” – Bill & Sarah Riddle

Health insurance plans in the exchange will be offered in four different coverage levels: bronze, silver, gold, and platinum. All of these plans are required to cover ten essential health benefits. Changes in requirements for insurance plans offered through the exchange will have a direct impact on the requirements for private health insurance purchased outside the exchange. Even if you do not buy health insurance through the health insurance exchange in North Carolina, costs and coverage of your current plan may change. Visit our blog or contact us for more information on how your health insurance plan may be affected.

3. What 2016 dates should I know about in North Carolina?

  • November 1, 2015 – Open enrollment begins
  • January 31, 2016 – Open enrollment ends and the special enrollment begins

4. Who gets penalized for not having insurance and what are the penalties?

The individual mandate in the Affordable Care Act healthcare plan says that every American must have health insurance. A tax will be levied against those who fail to purchase insurance starting in 2014. This tax, which is based on household income and family size, will increase annually for the next several years. For many families who qualify for subsidies, purchasing health insurance will be cheaper than paying the tax penalty.

However, there are some exceptions from the health care tax, including:

People between jobs with no insurance for up to three months

  • Those with religious objections
  • Illegal immigrants
  • Inmates
  • Members of Indian tribes

Tax Penalties for People Without Health Insurance


5. How does the Affordable Care Act affect Medicaid and Medicare?

Medicaid: Medicaid provides healthcare to low-income Americans and is being expanded on a federal level under the Affordable Care Act . Each state had the option to opt-out of the Medicaid expansion and both North and South Carolina have voted not to expand Medicaid coverage within the state. This means that Medicaid qualifications will stay the same within North Carolina, and those who currently qualify will continue to receive benefits.

Medicare: Some cuts have been made to Medicare in North Carolina, but they are mainly aimed at eliminating Medicare fraud and reducing payments made to the Medicare Advantage programs offered by private insurance companies in NC. The overall cuts to the plan will be about $716 billion, but the Affordable Care Act aims to fill the coverage gap in the Medicare prescription drug benefit.

6. What is a grandfathered plan?

A grandfathered plan is a health insurance plan that was purchased on or before March 23, 2010. If the plan has covered at least one person continually from that day forward, then it may be exempt from the Affordable Care Act changes until a new policy year begins.

Under the Affordable Care Act, all health insurance plans are required to cover ten essential health benefits, but some of these are not included in North Carolina grandfathered insurance plans. These essential health benefits include coverage options like maternity care, ambulatory care, and prescription drugs. The essential health benefits will be determined on a state by state basis, but grandfathered plans will not have to include the essential benefits until the plan starts a new policy year. If you received a cancelation letter or your grandfathered individual, family or small group insurance plan is coming to an end, contact us and we can help you take the next steps.

7. Health care reform, the Affordable Care Act and Obamacare. What’s the difference?

Many of the buzz words you read when picking up the paper or watching the news are all referring to the same thing. Health care reform, the Affordable Care Act and Obamacare are all names that refer to the health care changes initiated by the Obama administration. The Affordable Care Act is the official name for the Obama administration’s healthcare reform, and the Affordable Care Act is an unofficial name that the public has adopted to refer to the plan. We know all of the health insurance and policy changes can be confusing, but we work hard to stay up to date and we’re always here to help.

8. What are the “essential health benefits”?

The essential health benefits are specific services or benefits that must be included in any health plan sold to individuals or businesses in North Carolina. These benefits include coverage for things like maternity, newborn care, hospitalization, ambulatory care and prescription drugs. Each state will decide which benefits will be essential for health insurance plans within that state. In North Carolina, insurance companies must include a minimum of 10 essential benefits in all health insurance plans.

9. Can I get free health insurance?

There are many subsidies and savings available when purchasing health insurance in North Carolina. Depending on income, some North Carolina residents have qualified for fully subsidized and now have health insurance plans that cost them $0. If you do not qualify for one of those programs, you may still be eligible for partial health care subsidies or cost share reduction plans based on your income level. Americans with an annual income ranging from 100% to 400% of the federal poverty level will be eligible for some subsidy. For more information and to find out if you qualify for a subsidy, please contact us!

10. Do I need to have health insurance?

Yes, under the Affordable Care Act, nearly all Americans are required to have health insurance. Some situations qualify for exceptions, such as:

People between jobs with no insurance for up to three months
Those with religious objections
Illegal immigrants
Members of Indian tribes.

Ready to get started?

We have years of experience meeting the health insurance needs of individuals, families, and small business throughout North Carolina. When you work with us, you can rest assured that you will have the coverage you need and that we will always be here to answer your questions, all year long.

Contact us here or learn more about us on our North Carolina health insurance blog.