DACA, others now eligible for federal health insurance exchange Federal health insurance marketplace includes DACA participants for first time

The annual open enrollment period for the federal health insurance exchange began Friday in North Carolina with newly eligible participants including a potential 22,010 DACA recipients and other immigrant groups.

Those include 2,050 in the Winston-Salem metro area and 1,770 in the Greensboro-High Point metro, according to U.S. Citizenship and Immigration Services.

Meanwhile, HealthCare.gov officials in North Carolina are projecting the state could surpass the 1 million threshold for the second time during the 2025 enrollment period that runs through Jan. 15. That would more than double the yearly enrollee count of 2020.

The marketplace is a high-profile component of the federal Affordable Care Act, also known as "Obamacare."

The fate of the marketplace, as well as the ACA itself, beyond 2025 is a key public healthcare issue in the presidential race between Democrat Vice President Kamala Harris and former Republican President Donald Trump.

DACA is the acronym for the federal Deferred Action for Childhood Arrivals Act.

The act protects from deportation eligible immigrants, also known as Dreamers, who came to the United States when they were children, as well as provides them with a work permit.

Among the newly eligible recipients is Endy Mendez from Winston-Salem, who began working in July as a health insurance navigator for the N.C. Navigator Consortium in Forsyth and Guilford counties. The consortium is a statewide network of federally qualified health insurance navigators.

Mendez said she is pursing an associate's degree at Guilford Technical Community College.

Originally from Mexico City, Mendez has led numerous cultural and sports projects, focusing on advocating for issues that impact immigrant populations.

"I am a DACA recipient myself and a dialysis patient currently struggling with renal failure, so this is actually life-or-death," Mendez said. "The lack of access to (the Affordable Care Act) had a huge impact in my life last year, so I have been waiting for this opportunity."

Mendez said having access to marketplace health insurance "means an opportunity to try to get a transplant to become a bigger part of my kid's life and to be healthier."

According to U.S. Citizenship and Immigration Services, North Carolina has the sixth-largest number of DACA individuals with 5,250 DACA individuals in the Charlotte metro area, 3,270 in the Raleigh-Cary metro and 1,540 in the Durham-Chapel Hill metro.

The new rule "marks an important milestone," said Nicholas Riggs, the consortium's director.

"DACA recipients now join other lawfully present immigrants in being eligible for Marketplace plans, and may qualify for premium tax credits and other savings."

According to HealthCare.gov, "lawfully present" includes immigrants who have:

• 'Qualified non-citizen' immigration status;

• Humanitarian statuses or circumstances (including temporary protected status, special juvenile status, asylum applicants, convention against torture, and victims of trafficking);

• Valid non-immigrant visas; and

• Legal status conferred by other laws (temporary resident status, LIFE Act, family unity individuals."

Enrollment information can be found at ncnavigator.org.

Marketplace details

Marketplace enrollment in N.C. set a record of 1.03 million in 2024, fifth most trailing (in order) Florida, Texas, Georgia and California.

For those who enroll before Dec. 16, their coverage starts on Jan. 1. Those who enroll before Jan. 15 will start on Feb. 1.

Many enrollees in a health plan through the marketplace are eligible for savings.

According to marketplace officials, 4 out of every 5 enrollees can find a plan for $10 or less per month with financial help.

Individual rates vary based on location, age, subsidy amount and plan. Subsidies are available for customers with household incomes between 100% and 400% of the federal poverty level.

During 2024, there were 987,666 North Carolina residents enrolled in a marketplace plan - an 118% increase since 2020.

The increase has been due in part due to higher subsidies from the federal American Rescue Plan.

Blue Cross NC, by far the largest provider to date, typically is the only ACA insurer to provide coverage in all 100 counties. Also providing marketplace insurance plans in N.C. are Aetna, Ambetter, AmeriHealth Caritas, CareSource, Cigna, Oscar, UnitedHealthcare and Wellcare.

Consumers who do not actively select a plan by Dec. 15 will be automatically re-enrolled into the same plan they had in 2024, or a suggested alternate plan for 2025.

After Dec. 15, the marketplace sends a notice to consumers who were automatically re-enrolled. Consumers who prefer to select a new plan actively can return to the marketplace to do so before the Jan. 15 close.

The state Insurance Department encouraged N.C. citizens to sign up for health insurance if they meet one of the following conditions.

• They have current qualifying ACA coverage, but may want to change their plan for 2025;

• They don't have health insurance through their employer or their spouse's employer;

• They don't have government coverage, such as veterans, Medicare and Medicaid; or

• They are older than age 26 and can no longer be on a parent's health insurance.

Also, short-term health plans can be sold in North Carolina with initial plan terms up to 364 days.

Outside the open enrollment period, North Carolinians who buy health insurance from the ACA may enroll in an insurance plan only if they qualify for a special enrollment period because of life events, such as having or adopting a child, losing health coverage or moving to a different service area.

[email protected]@rcraverWSJ