Five things to know about enrolling under the Affordable Care Act

Oct. 31--Enrollment for health insurance under the Affordable Care Act, often known as Obamacare, opens Sunday. More changes are in store for Americans who buy insurance through the exchanges set up by the health care law. Here's what experts say you need to know:

1. You'll pay a bigger fine if you don't have coverage.

If you're not covered for at least 10 months of 2016, it will cost you at least $695 come tax time. The fine for remaining uninsured will more than double from this year's $325. The penalty shows up when a household files federal income tax, at a rate of $695 per uninsured person (with half that cost for children under 18) or 2.5 percent of household income, whichever is higher. The penalty is either deducted from the refund or added to the amount owed the IRS.

2. Already enrolled? Your subsidy or plan may have changed.

Insurers continue to join the Health Insurance Marketplace, and existing providers typically change the price of their plans each year. Since subsidies are tied to the price of certain plans, the amount of customers' subsidies is likely to change from year to year. This means the same plan could have a vastly different impact on a consumer's wallet from year to year.

In North Carolina, the average cost of plans has increased by 22.8 percent, according to the U.S. Department of Health & Human Services.

As the premium prices increase, so do the tax credits, which are tied to a particular benchmark plan.

Janel Lewis, a certified application counselor with Stedman-Wade Health Services, suggested customers seek in-person help to make sure they've updated their income, are getting the proper amount of tax credit and are buying health insurance that is appropriate for their needs.

"It's always helpful to see what your tax credit is," she said. "If it changes ... whether it's more or less, it will affect you in the end."

For marketplace customers who shopped for plans during last year's re-enrollment, it made a difference. In North Carolina, 31 percent of consumers switched plans during open enrollment last year, according to an HHS analysis released this week. Those who switched plans with the same level of coverage saved an average of $40 per month or $482 annually than what they would have paid if they had automatically re-enrolled in their previous plans. Across the state, that amounted to more than $27 million in savings for consumers last year.

This year, more than 8 in 10 marketplace customers can find a plan in the same metal level with lower premiums before tax credits by shopping around at HealthCare.gov, according to HHS.

Customers can already peruse plans and estimate the amount of their tax credits at HealthCare.gov. To have a new plan in place by Jan. 1, customers must make their selections by Dec. 15.

3. New to health coverage? Understand what you're buying.

Premiums, deductibles, copayments, networks. Health insurance can be confusing for people who have been using it for years, and it can be downright daunting for the recently covered, local experts say.

Chris Rey, the director of Cumberland HealthNET, said his agency has seen new enrollees become frustrated and "they cancel their policies a few months later because they have trouble navigating their health care."

Some new enrollees, he said, don't realize they need to find a primary care doctor to monitor their health and continue to access care the same way they always have: by going to the emergency room when they're sick. Then they get a hefty bill, "not realizing if they go to their doctors, their copays will be 20 bucks."

During this year's enrollment period, a new feature on HealthCare.gov may help people understand these additional costs. When viewing plans, the system now allows customers to estimate how much health care they will use in a given year and provides a rough estimate of how much they may spend on deductibles, copayments and other health care costs in addition to their monthly premiums for each plan.

"Until we improve health literacy for our counties, they don't understand what they're turning down," said Catherine Gaines, patient navigator for Southeastern Health's Supportive Care Services who is involved with the Affordable Health Care Coalition of Robeson County.

"It's a great thing for people to understand what does insurance buy me," she said, "particularly in the 18-34 age group, who don't think they'll need it."

As a cancer navigator, Gaines said she sees the power of insurance and how it can affect one's health long-term.

One of the biggest barriers to screenings, she said, is lack of insurance.

"I see what happens when people wait," she said.

"I want people to take good care of themselves, and I think insurance is an important way to make that happen."

4. Find in-person help completing your application

Several local organizations are partnering to offer enrollment assistance to residents.

Cape Fear Valley Health System has identified more than 17,000 patients from the past year who were uninsured, and has reached out to them to offer assistance during open enrollment.

The letters went out last Friday, and by Monday, more than 176 people had left voice mails for April Bratcher, patient access financial counselor supervisor for the system. Calls came all day.

"We want to take care of Cape Fear Valley patients who are uninsured ... but also reach out to the community," she said.

Five certified application counselors will see people from 8 a.m. to 5 p.m. Navigators and application counselors from Cumberland HealthNET and Stedman-Wade Health Services also will be on hand three days a week to help increase the number of people who can be seen.

Bratcher encourages people to call its new marketplace information line at 615-4700 to make an appointment for in-person assistance. Completing the enrollment process can take 60 to 90 minutes, depending on the number of family members enrolling in coverage, Batcher said. Without an appointment, it could mean long wait times.

Whether applying on your own or seeking help with a local nonprofit, customers should have a lengthy list of information within reach, including identification, tax documents, any current health insurance information, Social Security numbers, employment and financial information and home addresses for all members of the household. For the purposes of HealthCare.gov, a household includes those claimed on one's federal income tax return.

5. What if I don't qualify for marketplace coverage?

Completing an application through HealthCare.gov means that if you don't qualify for affordable insurance, you can secure an exemption from this year's higher penalty.

The system also estimates whether applicants may qualify for Medicaid in their state and suggests next steps.

Local enrollment experts say it's a good idea to come in and see what's available.

Many local hospitals offer indigent care programs for low-income patients, said Gaines, but typically, they now require patients have a denial letter from Medicaid and the marketplace before they qualify.

"Whatever their situation, we help them get connected to care, even if they don't qualify," said Stedman-Wade's Lewis.

"People leave with something, resources in the community that can help with their care. We make it worthwhile for them."

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