Navigating the Affordable Care Act


It’s the policy change that sparked Capitol Hill debate rarely seen – the Patient Protection and Affordable Care Act.

Starting in 2014, the Affordable Care Act will extend health coverage to millions of Americans. This development will be done, in part, by offering tax credits to help low- and middle-income Americans afford private coverage. These new tax credits, which will offset a portion of the cost of health insurance premiums, will soon become a reality, allowing many previously uninsured North Carolinians to purchase quality health coverage.

Here in North Carolina, a report prepared by Families USA indicated the vast majority of North Carolinians who will be eligible for premium tax credits – about 89 percent – will be in families.

The report says that statewide, nearly 773,000 people, the majority of North Carolinians who will be eligible for premium tax credits, will be in families with a worker who is employed, either full- or part-time.

There are four levels of coverage:

  • Bronze: 60 percent coinsurance
  • Silver: 70 percent coinsurance
  • Gold: 80 percent coinsurance
  • Platinum: 90 percent coinsurance

Under ACA, individuals who purchase insurance after Jan. 1 through an Exchange will be eligible for subsidies for health insurance premiums and cost-sharing if their income is less than 400 percent of the federal poverty level, which for a family of four would be $94,200.

Tax credits to subsidize the cost of health insurance premiums are based on four factors:

  • The number of persons in the household.
  • The Federal Poverty Level.
  • The cost of the Second-lowest “Silver” plan available in North Carolina. In these plans 70 percent of expenses are covered by insurance, and consumers pay the remainder out of pocket.
  • A defined percentage of household income related to the Federal Poverty Level.

“No partnership is better equipped to successfully navigate health care reform than the partnership between North Carolina Farm Bureau and Blue Cross Blue Shield of North Carolina. Our qualified and professional agents are well-positioned to provide answers to your questions,” NCFB President Larry Wooten says.

Health Care Reform FAQs

What is the Affordable Care Act (ACA)?
The law intended to address issues with our health care system by increasing access to health insurance, introducing reform and improving quality. Also referred to as the Patient Protection and Affordable care Act (PPACA).

When can I enroll?
Open enrollment is Oct. 1, 2013, through March 31, 2014.

Can I still enroll if I have a pre-existing condition?
Yes, being sick does not keep you from getting coverage. Insurance companies can no longer rate or decline you based on health.

Why should I have coverage?
Health insurance not only helps you when you get sick, it also offers benefits such as first dollar preventive care for 10 minimum essential benefits. It also covers some health screenings, vaccines and regular check-ups.

2014 Compliant Plans must include these 10 health benefits:

  • Ambulatory patient services
  • Emergency Services
  • Hospitalization
  • Maternity and newborn care
  • Increased benefits for mental health and substance use disorder services including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

What if I can’t afford health insurance?
There are two different types of government subsidies to help you pay for health insurance in 2014. Contact a local agent for help in determining if you qualify.

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