ACA enrollment starts Wednesday, and a lot has changed. Here’s what you need to know.

Oct. 30--Wednesday marks the beginning of Open Enrollment under the Affordable Care Act for Americans who buy their own health insurance.

More than a half-million people in North Carolina are expected to sign up for ACA health coverage in the coming weeks.

This is the fifth year that Americans will sign up for health coverage under the ACA and the first sign-up period under the Trump administration. Some are predicting problems not seen since 2013 when HealthCare.gov had so many problems that it took months for consumers to buy insurance.

That's because funding that paid for advertisement and navigators has been reduced and because the sign-up period is shorter this year.

Here are some important things you will need to know this year, along with some refreshers.

Q: When does ACA open enrollment start and end?

A: The first day is Wednesday, Nov. 1, and the final day is Dec. 15. Coverage starts Jan. 1.

Q: Aren't deadlines always extended? Can't I wait until the rush is over and sign up after Jan. 1?

A: Don't count on it this year. The Trump Administration is restricting ACA enrollment options. In fact, you should sign up as early as possible to avoid last minute problems that could result in a failure to obtain health insurance.

Q: How will the ACA open enrollment be different under the Trump Administration?

A: First, it will be available for just six weeks, rather than the 13 weeks of past years, giving the public much less time to sign up. Secondly, the enrollment website, healthcare.gov, will be shut down for maintenance more than 60 hours during open enrollment, including 12-hour maintenance blackouts on five consecutive Sundays.

Q: Does the ACA still pay financial subsidies to offset my cost of health insurance?

A: Yes, the subsidies are still part of the ACA. The ACA offers two types of subsidies, and both are available to individuals and families. Premium tax credits discount monthly premium payments for people whose household incomes are between 100 percent and 400 percent of the Federal Poverty Level. More than 90 percent of people in North Carolina insured through the ACA qualify for premium tax credits.

Cost sharing reductions are an additional subsidy available to people whose incomes are between 100 percent and 250 percent of the Federal Poverty Level; they discount out-of-pocket costs: deductibles, co-payments and coinsurance. About two-thirds of people in North Carolina insured through the ACA qualify for both subsidies, and those on the lower end of the income scale have most of their health insurance subsidized.

Q: Wait, didn't President Trump issue an executive order eliminating some subsidies?

A: Trump eliminated the cost sharing reduction reimbursements for health insurance companies, but the insurers are still bound by the ACA to offer these discounts to their customers. The effect on consumers is that health insurers raised 2018 rates to offset the loss of the subsidy. Congress is currently debating proposals to reinstate the cost sharing reductions for insurers.

Q: Could anything prevent me from getting my subsidy?

A: Yes, you may be denied premium tax credits in 2018 if you haven't filed your IRS Form 8962 with your 2016 federal income tax return. If you're among those who haven't filed, you still have time to file an amended return with the Form 8962.

Q: So who is supposed to sign up for ACA open enrollment? It's just some people, not everybody, right?

A: Anyone who buys individual health insurance directly from an insurance company, through an insurance agent or on healthcare.gov. Currently that's more than 500,000 people in North Carolina. ACA open enrollment does not apply to you if you buy health insurance through your employer or through a federal program like Medicare, Medicaid or Tricare. In past years, you could buy an individual health insurance policy off the ACA exchange, offering additional options for people who made too much money to qualify for subsidies, but those plans will not be available in 2018.

Q: Will "navigators" be available this year as in past years to explain health insurance and answer questions?

A: Yes in North Carolina, but not necessarily in other states. The Trump Administration cut the ACA advertising budget by 90 percent and navigator support by 41 percent nationwide. However, North Carolina's navigator budget was cut by just 10 percent, so that navigators here will be largely unaffected by the Trump funding cuts.

Q: Where can I find one of these navigators to help me? And how much does it cost?

A: Navigators are free -- they don't charge fees or commissions. Go to NCNavigator.net to find a planned public navigator event in your area, or to make an appointment. You can also call 1-855-733-3711.

Q: What if I'm insured now and may not need the ACA until later this year? Am I still bound by the Jan. 1 deadline?

A: You can sign up after open enrollment but only under special circumstances. Special enrollment is open to people who lose their jobs, lose their health insurance, get married or divorced, have a child, move to another state or another part of the state, or have some other "qualifying event" that is eligible for a special enrollment.

Q: What's the penalty if I don't sign up for health insurance?

A: The penalty will be the greater of two possible outcomes. The minimum penalty is $695 for an adult or up to $2,085 for a family. The maximum penalty is 2.5 percent of household income above the tax filing threshold, capped at $3,264 for single person, $6,528 for couple, $9,792 for three individuals, $13,056 for four people, and $16,320 for policy covering five or more people. You can apply for a penalty waiver if you meet certain hardship exemptions. Perhaps the biggest penalty, however, might be personal bankruptcy if you're hit by a catastrophic medical bill.

Q: Which insurers are selling ACA plans for 2018?

A: Blue Cross and Blue Shield is selling ACA plans in all 100 North Carolina counties. Cigna is selling ACA plans in five counties: Chatham, Johnston, Nash, Orange and Wake.

Q: Why should I sign up during open enrollment? Don't insurers automatically renew your coverage?

A: Insurers automatically renew your coverage by selecting a plan that their algorithm thinks most closely matches the plan you currently have. That may not be the plan you would choose for yourself. Plans and pricing change every year, so you should shop around and compare to make sure you are selecting the best plan that fits your needs and your budget.

Q: I fell behind on my bills this year and still owe money to my health insurer. Does that prevent me from signing up for ACA coverage?

A: Technically, yes. Under a new rule that went into effect June 19, insurers can require payment for past unpaid premiums before they issue coverage for 2018. Your insurer is expected to be flexible with this rule if you agree to set up a repayment plan for your unpaid 2017 premiums. You can get around this requirement if you switch insurers, from Blue Cross to Cigna or vice versa, but that option is available only in the five counties where Cigna sells ACA policies and would restrict your health insurance options.

Q: Can you explain all this business about Bronze, Silver and Gold plans?

A: The people who need to pay attention to the metal levels are those who qualify for cost sharing reductions (one of the two subsidies), which are available only on "Silver" plans. That's about two-thirds of all ACA customers in North Carolina. Otherwise, try not to worry too much about these terms. Look at the monthly premiums, annual deductible and the network to make sure your doctor is in-network and covered. The metal levels are based on the amount of out-of-pocket expenses the plans require on your part. Typically, "Bronze" plans have the highest deductibles and the lowest premiums, while "Gold" plans have the lowest deductibles and the highest premiums. But the plans may not follow a neat pattern, so follow the money, not the metallurgy.

Sources: Kaiser Family Foundation, Legal Aid of North Carolina, N.C. Justice Center, Georgetown University Health Policy Institute's Center on Health Insurance Reforms, Blue Cross and Blue Shield of North Carolina, Cigna

John Murawski: 919-829-8932, @johnmurawski

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