Tips on enrolling in the Affordable Care Act

By: Kay Castillo of the NC Chapter of the National Association of Social Workers (a NCWU member) and Secretary of NCWU

The open enrollment period for the Affordable Care Act will close on March 31. Many organizations are working to educate consumers about new health care options because it is a significant personal decision. North Carolinians must keep in mind that the plan they choose today cannot be changed until the next open enrollment period; proposed at this time for November 14th, 2014. The only exception is in the event of a qualifying event such as a marriage, divorce, job change, or childbirth. In these circumstances, you may apply for a special enrollment period.

Leadership in North Carolina decided that the state will participate in the federal exchange, which offers four plan levels: platinum, gold, silver and bronze —each level corresponding to the portion of the health care costs that the plan covers, ranging from most generous to least generous. Although bronze plans may have the lowest premiums, they will have the highest deductibles and cost-sharing, whereas platinum plans have the highest premiums and lowest out-of-pocket costs. It is also significant to note that, while premium support for those between 100 percent and 400 percent of the federal poverty level applies to all plans, cost-sharing assistance is available only in silver level plans.

When evaluating the health plans, I recommend estimating your predictable health needs and expenses. There are a few things to keep in mind when choosing a plan through the health exchange. First, consider whether your doctor or hospital is in your plan. Access to doctors in a plan network —particularly specialists —may be limited in plans purchased on the health exchange. Knowing which providers are covered is vital for those who suffer from chronic diseases or who are engaged in therapy with a licensed provider. Losing your therapist can set you back in treatment if you are having to seek a new therapist in your health insurance network.

Next, consider how your prescription drugs will be affected —specifically, whether your prescription drugs will be carried on the preferred drug list, and what they will cost. Unfortunately, some plans may impose significant barriers to innovative medicines.

Third, find out what the covered benefits are under the plan and whether they include services that you know you and your family will need. Although plans offered under the health exchange cover certain key benefits, there will be some variation throughout the plans. Even though mental health and substance abuse services are essential benefits, do you have the level of coverage you may need?

Last, make sure that you understand your out-of-pocket expenses. These can include deductibles, co-pays, co-insurance and off-formulary prescription drug costs if the insurer has issued an exception.

There are many organizations out there with professionals to guide you through this process. If you are unsure which plan is best for you and your family, Navigators are available to help in person or over the phone. Navigators received over 20 hours of training to help consumers purchase insurance plans here in the state. They are ready to provide in-person assistance to anyone who may need it. Call 1-855-733-3711 Monday through Friday 9-5 or Tuesdays and Thursdays from 6-9. Enroll America‘s NC offices can also get you connected with help.