Health insurance deadline looms

Jan. 28--SANFORD -- Those who don't obtain health insurance by Sunday's deadline could face larger penalties this year than in years past under the Affordable Care Act.

The Open Enrollment period -- during which customers can sign up for new coverage through either the government-regulated online marketplace or through third-party insurers -- ends Sunday. Purchasing insurance for 2016 after this date will not be possible unless a customer has a qualifying life event, such as a divorce, marriage, job loss or relocation, according to Kathy Norman, an individual advisor with Digital Benefit Advisors in Sanford.

A penalty, known as the individual shared responsibility payment, could be imposed for not having minimal essential coverage. This year, that penalty will be $695 per adult and $347.50 per child, or 2.5 percent of household income that's above the yearly tax filing threshold, whichever is greater, according to Norman. The penalty will be paid while filing tax returns for the year without health coverage.

For example, if an uninsured individual earns $30,000 this year, the penalty when he or she files taxes in April 2017 would be $750, which is 2.5 percent of the person's income. In 2015, the penalty was $325 per uninsured adult ($162.50 per child) or 2 percent of household income. Based on the $30,000 annual income, the charge would be $600 when the individual files tax returns this April.

"You're on a very short fuse at this point," said Tom Snell, principal at Digital Benefit Advisors in Sanford and a specialist in the ACA, also known as Obamacare. "You have to find someone who can help you."

Snell encouraged those who are uninsured to shop around before they make a decision and to use an insurance agent for help, explaining that an agent's services do not increase the price of coverage. He added that it was a bit late in the enrollment period to begin shopping for coverage.

The Open Enrollment period to purchase health insurance for 2016 began on Nov. 1, 2015.

According to Norman, some individuals will be exempt from paying the fee. Customers are allowed 60 days without insurance before the penalty is applied. Those making below the federal poverty level -- many of whom qualify for Medicaid -- are also not required to have insurance, Snell said.

"The clock is ticking," said U.S. Secretary for Health and Human Services, Sylvia Burwell, in a statement. "We are focused on making sure people know that financial help is available, the deadline is fast approaching and that we're here to help them enroll."

More than 575,000 North Carolinians already have enrolled or re-enrolled for 2016 health insurance through HealthCare.gov, including 154,176 in Raleigh, Durham, Fayetteville and surrounding areas, according to DHHS.

Snell added that he believes 30,000 people in the state are still without health insurance, down from 40,000 since the ACA was passed in 2010.

The federally operated marketplace, HealthCare.gov, offers subsidized health insurance from private insurers to those who earn between one to four times the federal poverty level, according to Norman. Those who qualify for Medicare, Medicaid or other affordable employer-sponsored insurance are not eligible for federal subsidies.

Snell said there will be some individuals who don't make enough to qualify for the federal subsidies who also don't qualify for Medicaid. Since the ACA was passed, N.C. governors have opted not to expand Medicaid within the state.

The largest private healthcare insurer in North Carolina is Blue Cross Blue Shield, according to Snell. BCBS of North Carolina serves more than 3.9 million customers, the company said.

Yet BCBSNC experienced a turbulent start to the year, with some customers having found their coverage suddenly was dropped or changed, or that payments were billed incorrectly, according to the company's website. The insurer since has said that all issues have been resolved and that no gaps in coverage happened because of the problems.

"Resolving our customers' challenges is our top priority," said BCBSNC spokesperson Ryan Vulcan. "We are redeploying staff and expanding customer service hours, our website and phone capacity. We are working tirelessly to address the situation and making progress every day, and we are truly sorry for this experience."

BCBSNC only offers its Blue Value plan to Lee County residents, the company says, which offers access to a limited number of popular healthcare providers, including UNC Health Care, Rex, and WakeMed. This plan is available both through the federal marketplace and off the exchange.

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