Category: News

U.S. COURT RULING BLOCKS MARKETPLACE ACCESS FOR DACA RECIPIENTS, BUT NOT FOR THOSE WHO ARE NORTH CAROLINA RESIDENTS 

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Charlotte, N.C. – A Dec. 9, 2024, federal court decision blocked access to the Health Insurance Marketplace® for DACA recipients living in states that challenged a Biden administration ruling earlier this year making them eligible; the Dec. 9 court decision does not apply to N.C. This means that DACA recipients and other lawfully present immigrants who reside in N.C. can still access affordable health insurance via the HealthCare.gov Marketplace. The Charlotte Center for Legal Advocacy (Advocacy Center) is part of the NC Navigator Consortium; their health insurance navigators are standing by to help residents of Cabarrus, Mecklenburg and Union Counties get covered via HealthCare.gov or N.C. Medicaid.

“To reiterate, this ruling does not impact any eligible North Carolina resident who wants to use the Marketplace to find a high-quality health plan that is affordable,” said Natalie Marles, the health insurance navigator project manager for the Advocacy Center. She added that DACA recipients and eligible immigrant groups are also eligible for financial assistance and subsidies.

As for the future of the Affordable Care Act, Marles added, “Even though this recent ruling has national implications for the future, it will not affect North Carolina residents for this Open Enrollment period or the coverage that they have enrolled in or will secure for 2025.”

These groups are also eligible for a special enrollment period (SEP) that enables them to secure coverage quicker. According to the Centers for Medicare & Medicaid Services (CMS):

“Newly eligible individuals, including DACA recipients, will qualify for a special enrollment period to enroll in a QHP through the Marketplace during the 60 days following November 1, 2024 … Consumers who apply for coverage through a SEP during December 2024 can have their Marketplace coverage begin as early as January 1, 2025, if they meet all other eligibility requirements.” This means those who enroll by Dec. 31, 2024, can get coverage that starts Jan. 1, 2025, or Jan. 15, 2025, to start coverage in February 2025 or even beyond.

For those not included in the SEP, the current HealthCare.gov Open Enrollment period will run through Jan. 15, 2025. Those looking to start coverage on Jan. 1, 2025, will need to enroll before this Sunday, Dec. 15, 2024. 

During Open Enrollment, health insurance navigators at the Advocacy Center work directly with everyone eligible in Cabarrus, Mecklenburg and Union Counties to help them save money on high quality, affordable health insurance plans on the HealthCare.gov Health Insurance Marketplace. (Navigators also help those eligible enroll in NC Medicaid.) HealthCare.gov Open Enrollment will run Nov. 1, 2024, through Jan. 15, 2025. More information is available at charlottelegaladvocacy.org/getcovered.

As a member of the NC Navigator Consortium, Charlotte Center for Legal Advocacy navigators are available to provide free, unbiased advice to residents of Cabarrus, Mecklenburg and Union Counties. Navigators are federally certified and extensively trained in the insurance plan options offered by the Marketplace, in addition to cost-sharing reductions and premium tax credits eligibility. Additional assistance is provided to consumers who are disabled, do not speak English or are unfamiliar with health insurance.

Free appointments with a local navigator can be made using the statewide appointment hotline at 1-855-733-3711 or local at 980-256-3782 or online at charlottelegaladvocacy.org/getcovered. 

Charlotte Center for Legal Advocacy can provide those in need with information, advice and advocacy in consumer protection, home preservation, health care access and public benefits, immigration, tax assistance and more. Our mission is to pursue justice for those in need. Our vision is to build a just community, where all people are treated fairly and have access to legal representation to meet their basic human needs of safety, economic security and stability. Learn more: charlottelegaladvocacy.org. 

Started in 2014, the NC Navigator Consortium is the only federally funded Navigator entity in the state that serves all 100 counties across North Carolina. Learn more at ncnavigator.org, and follow us on Facebook, Twitter and Instagram. Members of the Consortium are Access East, Care Ring, CareReach, Charlotte Center for Legal Advocacy, Council on Aging of Buncombe County, Cumberland HealthNET, HealthNet Gaston, Kintegra Health, Mountain Projects, NC Field and Pisgah Legal Services. The Consortium is led by Legal Aid of North Carolina. 

Legal Aid of North Carolina is a statewide, nonprofit law firm that provides free legal services in civil matters to low-income people in order to ensure equal access to justice and to remove legal barriers to economic opportunity. Learn more at legalaidnc.org. Follow us on Facebook, Twitter, Instagram, LinkedIn and YouTube. 

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Prepare for Tax Season with Free Community Tax Talks

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With tax season around the corner, Charlotte Center for Legal Advocacy’s North Carolina Low-Income Taxpayer Clinic (Tax Clinic) is hosting a free community Winter Tax Talks series to help equip attendees with the knowledge and resources they need to navigate tax season with confidence. 

December Event: Reminders for Tax Season

The next community Tax Talks will be held on Dec. 4 and 5 and will provide information and resources to prepare attendees for tax season. Topics include: 

  • Preparing for tax season 
  • Avoiding tax scams 
  • Understanding filing requirements 
  • Accessing free tax-filing resources 

Event Details:

  • December 4 (in Spanish): 6 p.m. via Facebook Live on the Advocacy Center’s page 
  • December 5 (in English): 6 p.m. in-person (5535 Albemarle Road, Charlotte) and via Facebook Live on the Advocacy Center’s page 

This year, the Tax Clinic has delivered presentations and created resources to help inform North Carolinians about various tax-related topics, including self-employment taxes (November’s Tax Talk) and understanding the tax implications of online sports betting in North Carolina. 

The North Carolina Low-Income Taxpayer Clinic, a program of Charlotte Center for Legal Advocacy, provides free representation for low-income taxpayers in federal and state tax disputes while educating individuals about their rights and responsibilities as U.S. taxpayers. 

Charlotte Center for Legal Advocacy provides those in need with information, advice and advocacy in consumer protection, home preservation, health care access and public benefits, immigration, tax assistance and more. Our mission is to pursue justice for those in need. Our vision is to build a just community, where all people are treated fairly and have access to legal representation to meet their basic human needs of safety, economic security and stability. Learn more: charlottelegaladvocacy.org. 

Recent changes SSI program allows more people to keep their full benefits

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On September 30, 2024, three significant changes were made to the Supplemental Security Income (SSI) program, which will help thousands of people get more SSI benefits. 

Previously, the Social Security Administration (SSA) reduced SSI benefits for people who received help from friends, family, or others in certain situations. This is called In-Kind Support and Maintenance (ISM), which lowers the monthly income for people on SSI. 

However, SSA has made changes to ISM limitations to allow more people on SSI to get help with food and housing costs.  

As of September 30, 2024:

Update: SSI recipients will no longer face benefit reduction for getting help with food or groceries. 

Old rule: Previously, disabled people’s benefits could be cut by up to one-third if they received any kind of help with food—even for something as minor as a family member bringing them groceries. 

Update: SSI recipients will no longer face benefit reduction for receiving any discount to their housing cost, as long as they spend at least one-third of their monthly SSI payment on rent. 

Old rule: Previously, disabled people were penalized for renting a place that was cheaper than what Social Security considered the market rate. This included renting a place from a friend or family member who was charging only a small amount of rent. 

Update: SSI recipients who live in a household with any other person on certain public benefits, including SNAP (or food stamps), will not have their SSI benefits reduced for that reason. 

Old rule: Previously, disabled people were exempt from SSI benefit cuts if they lived in a “public assistance household,” which was a household where every person living there received certain public benefits like TANF cash assistance. SNAP was not previously included in the list of eligible public benefits. Now, if an SSI recipient lives with any other person receiving public benefits, including SNAP benefits, their SSI benefits will not be cut for that reason. 

Please note: The changes to SSI should be implemented automatically. If you encounter any issues or believe the new rules are not being applied correctly, please contact us at 704-376-1600 for assistance.

HealthCare.gov OPEN ENROLLMENT 2025 KICKOFF PRESS CONFERENCE HIGHLIGHTS NEW INSURANCE MARKETPLACE RULING FOR DACA RECIPIENTS

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Charlotte, N.C. – HealthCare.gov Open Enrollment 2025 kicked off today with a press conference in Charlotte hosted by Charlotte Center for Legal Advocacy (Advocacy Center) and the NC Navigator Consortium with experts who explained the final rule that allows DACA recipients and other immigrant groups to purchase health insurance through HealthCare.gov. The event also included guest speaker Endy Mendez who is a DACA recipient and health insurance navigator working for the NC Navigator Consortium in Winston-Salem, N.C. After the press conference, navigators helped consumers enroll in and update their HealthCare.gov plans.

During Open Enrollment, health insurance navigators at the Advocacy Center work directly with everyone eligible in Cabarrus, Mecklenburg and Union Counties to help them save money on high quality, affordable health insurance plans on the HealthCare.gov Health Insurance Marketplace®. (Navigators also help those eligible enroll in NC Medicaid.) HealthCare.gov Open Enrollment will run Nov. 1, 2024, through Jan. 15, 2025. More information is available at charlottelegaladvocacy.org/getcovered.

“November 1 marks an important milestone for DACA recipients and many more people who are called ‘lawfully present immigrants’,” said Natalie Marles, the health insurance navigator project manager for the Advocacy Center. “Not only will they have access to healthcare, they may qualify for premium tax credits and other savings on Marketplace plans.”

According to HealthCare.gov: “The term ‘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.
  • Legal status conferred by other laws (temporary resident status, LIFE Act, Family Unity individuals).”

“More than 20,000 DACA recipients reside in North Carolina according to U.S. Citizenship and Immigration Services, and because of the new rule, they are now eligible for Marketplace plans,” said Marles. “These North Carolinians are your friends, neighbors and coworkers.”

“I am a DACA recipient myself and am currently struggling with renal failure,” said Mendez, a dedicated advocate for the immigrant community in Forsyth and Guilford Counties, N.C. “The lack of access to (the Affordable Care Act) had a huge impact in my life last year.” Mendez has been a health insurance navigator since July 2024, helping others gain access to affordable health coverage. 

“There are still many subsidies and tax credits available through HealthCare.gov, and four out of five families can get coverage for less than $10 a month,” said Nicholas Riggs, director of the NC Navigator Consortium. “It’s important to remember that those who are eligible for NC Medicaid can also use our health insurance navigators to learn more and enroll.”

As a member of the North Carolina Navigator Consortium, Charlotte Center for Legal Advocacy navigators are available to provide free, unbiased advice to residents of Cabarrus, Mecklenburg and Union Counties. Navigators are federally certified and extensively trained in the insurance plan options offered by the Marketplace, in addition to cost-sharing reductions and premium tax credits eligibility. Additional assistance is provided to consumers who are disabled, do not speak English or are unfamiliar with health insurance.

Free appointments with a local navigator can be made using the statewide appointment hotline at 1-855-733-3711 or local at 980-256-3782 or online at charlottelegaladvocacy.org/getcovered. 

Charlotte Center for Legal Advocacy can provide those in need with information, advice and advocacy in consumer protection, home preservation, health care access and public benefits, immigration, tax assistance and more. Our mission is to pursue justice for those in need. Our vision is to build a just community, where all people are treated fairly and have access to legal representation to meet their basic human needs of safety, economic security and stability. Learn more: charlottelegaladvocacy.org.

Started in 2014, the NC Navigator Consortium is the only federally funded Navigator entity in the state that serves all 100 counties across North Carolina. Learn more at ncnavigator.org, and follow us on Facebook, Twitter and Instagram. Members of the Consortium are Access East, Care Ring, CareReach, Charlotte Center for Legal Advocacy, Council on Aging of Buncombe County, Cumberland HealthNET, HealthNet Gaston, Kintegra Health, Mountain Projects, NC Field and Pisgah Legal Services. The Consortium is led by Legal Aid of North Carolina. 

Legal Aid of North Carolina is a statewide, nonprofit law firm that provides free legal services in civil matters to low-income people in order to ensure equal access to justice and to remove legal barriers to economic opportunity. Learn more at legalaidnc.org. Follow us on Facebook, Twitter, Instagram, LinkedIn and YouTube. 

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Winter Tax Talk Series

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Join us this winter for our community Tax Talks Series, hosted by the Charlotte Center for Legal Advocacy’s North Carolina Low-Income Taxpayer Clinic! These sessions are designed to help you navigate various tax topics with confidence. Here’s what we have planned:

TAX TALKS

Participate in the following tax talks in-person at the Advocacy Center or tune in to the Facebook Live on the Advocacy Center Facebook page.

Tax Topics for Immigrants

January 16, 2025 at 6 pm

In this session, we’ll cover topics relevant to immigrant taxpayers, including:

  • ITINs vs. SSNs and how to merge the two
  • Eligibility for tax credits

Self-Employment Basics

This tax talk was on Nov. 7. Not able to attend? Click here to view this tax talk and click here to view the slides for this session.

If you’re an independent contractor, small business owner, or otherwise self-employed, this Tax Talk is for you! Topics covered at this tax talk will include:

  • Recordkeeping
  • Quarterly estimated tax payments

Reminders for Tax Season

Click here to view the slides for this session.

December 5, 2024 at 6 pm

This Tax Talk will cover essential tips and reminders for the upcoming tax season, including:

  • How to avoid tax scams
  • Filing requirements you need to know
  • Free resources for filing your taxes

CHARLAS SOBRE IMPUESTOS

Temas Impuestos para Inmigrantes

15 de enero de 2025

Conceptos Básicos del Trabajo por Cuenta Propia (6 de noviembre de 2024)

Haga clic aquí para ver la presentación.

Recordatorios para la Temporada de Impuestos (4 de diciembre de 2024)

Haga clic aquí para ver la presentación.

¿Le han robado sus Cupones de Alimentos?

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Una nueva estafa ha sido reportada, esta hace referencia a estafadores clonando las tarjetas EBT y robando la información de los beneficiarios del Programa de Cupones de Alimentos (FNS) en Carolina del Norte. Si usted ha sido afectado, es posible que pueda recibir un reemplazo y recuperar sus beneficios.

¡Los beneficios que le han sido robados podrán ser recuperados! Descubra los detalles:

Ciertos beneficios de Servicios de Alimentos y Nutrición (FNS) que han sido robados a través del esquema de tarjetas clonadas y otros métodos fraudulentos similares pueden ser reemplazados entre el 1 de octubre de 2022 y el 30 de septiembre de 2024.

Consejos para que le ayudarán a proteger su información:

  • Revise regularmente su cuenta EBT en busca de cargos no autorizados.
  • Cambie el PIN de la tarjeta EBT regularmente, utilizando un número nuevo cada vez.
  • Seleccione un PIN difícil.
  • Revise regularmente las máquinas lectoras de las tarjetas en busca de dispositivos que adulteran las máquinas.

Para obtener más información sobre estos consejos, visite aquí.

Lea a continuación para conocer más información sobre sus derechos y cómo solicitar beneficios de reemplazo:

  • ¿Fueron robados sus beneficios de EBT/Cupones de Alimentos desde el 1 de octubre de 2022 y hasta el 25 de agosto de 2023?

Si informó el robo de sus beneficios de EBT o Cupones de Alimentos durante esas fechas al Centro de Llamadas de EBT, debería haber recibido un aviso, una carta de presentación y una declaración juramentada en blanco. Debe enviar esa declaración jurada antes del 27 de septiembre de 2023 al DSS por correo, fax, en persona o por teléfono. Si no tiene la declaración jurada, puede encontrar copias en la oficina de DSS.

  • ¿Qué es una declaración juramentada?

Una declaración juramentada es una declaración juramentada voluntaria, que se utilizará como verificación de que está diciendo la verdad con respecto a los beneficios de EBT o Cupones de Alimentos robados.

  • ¿Descubrió el robo durante el 1 de octubre de 2022 y el 25 de agosto de 2023 pero no lo informó al centro de llamadas de EBT?

Deberá enviar una declaración juramentada firmada antes del 27 de septiembre de 2023. Puede hacer clic en los enlaces a continuación para obtener el formulario de la declaración juramentada o visitar su oficina de DSS del condado para solicitar ayuda. Debe completar, firmar y enviar la declaración juramentada por correo, fax, en persona o por teléfono.

  • Haga clic aquí para obtener el formato de la declaración juramentada en español.
  • Haga clic aquí para obtener el formato de la declaración juramentada en inglés.

  • ¿Descubrió el robo desde el 26 de agosto de 2023 y hasta el 30 de septiembre de 2024?

Tiene 30 días para presentar una declaración juramentada desde la fecha en la que descubrió dicho robo.

  • ¿Cómo presentar un reclamo?

Deberá completar una declaración juramentada firmada y presentarla por correo, fax, en persona o por teléfono con una firma telefónica en DSS. Carolina del Norte tiene 30 días para revisar su declaración juramentada para aprobarla o denegarla. Si se deniega la declaración juramentada tiene derecho a una audiencia.

  • ¿Cuánto recibiré de vuelta?

Es posible que no reciba todos los beneficios que le robaron. El beneficio de reemplazo será menor que la cantidad robada del hogar o igual a dos meses de la asignación mensual del hogar inmediatamente anterior a la fecha en que se robaron los beneficios.

  • ¿Cuántas veces puedo presentar un reclamo?

Solo podrá solicitar que se reemplacen sus beneficios dos veces durante un año fiscal federal, que es del 1 de octubre al 30 de septiembre.

  • ¿Qué beneficios se pueden reemplazar?

Los siguientes beneficios pueden ser reemplazados: Servicios Regulares de Alimentos y Nutrición, Programa de Asistencia Nutricional Simplificada (SNAP), Programa de Asistencia Nutricional de Desastres Suplementarios (D-SNAP) y Asignaciones de Emergencia (EA).

Más información:

Si tiene preguntas, necesita más información o ha sido víctima de esta estafa y se encuentra en el condado de Mecklenburg, llame a nuestra línea de ayuda para clientes al 704-376-1600 (inglés) o al 800-247-1931 (español), deje un mensaje de voz y nuestro equipo de admisión de Cupones de Alimentos se pondrá en contacto.

Food Stamp Benefits Stolen? 

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Ver información en español

A new EBT card scam has data thieves stealing information on EBT cards. Scammers are skimming and cloning EBT cards and are stealing benefits from Food Stamp (FNS) recipients in North Carolina. If you’ve been affected, you may be able to receive a replacement for your benefits.  

Stolen Benefits Can Now Be Replaced! 

Certain Food and Nutrition Services (FNS) benefits can receive replacement for benefits stolen between October 1st, 2022 through September 30th, 2024 through card skimming, card cloning, and other similar fraudulent methods. 

Tips to Protect Your Information

  • Check your EBT account regularly for unauthorized charges. 
  • Change the PIN to the EBT card regularly, using a new number each time. 
  • Select a “difficult” PIN. 
  • Regularly check card reading machines for skimming devices. 

To learn more about these tips please visit here.

Read below to learn more about your rights and how to request replacement benefits: 

  • Were your EBT benefits/Food Stamps stolen from October 01, 2022 through August 25, 2023? 

If you reported your stolen EBT or Food Stamp benefits during those dates to the EBT Call Center, you should have received a notice, a cover letter, and a blank affidavit. You must submit that affidavit by September 27, 2023 to DSS by mail, fax, in person, or over the phone. If you do not have the affidavit, copies can be found at the DSS office. 

  • What is an affidavit?  

An affidavit is a voluntary sworn statement made under oath, which will be used as verification that you are telling the truth regarding stolen EBT or Food Stamp benefits.  

  • Did you discover the theft during October 01, 2022 – August 25, 2023 but did not report to the EBT call center?  

You must also submit a signed affidavit by September 27, 2023. You can click on the links below to obtain the affidavit or visit your county DSS to request assistance. You must fill out, sign and submit the affidavit via mail, fax, in person or over the phone. 

Click here for fillable affidavit in Spanish.

Click here for fillable affidavit in English.

  • Did you discover the theft from August 26, 2023 – September 30, 2024?  

You have 30 days to file an affidavit from the date of discovery. How do I file a claim? An affidavit will need to be filed out which you sign and submit via mail, fax, in person, or over the phone with a telephonic signature at DSS. North Carolina has 30 days to look over your affidavit and approve/deny. If the affidavit is denied you have the right to a hearing.  

  • How much will I get back?  

You may not get back all of the benefits that were stolen. The replacement benefit will be the lesser of the amount stolen from the household or the amount equal to two months of the monthly allotment of the household immediately prior to the date on which the benefits were stolen.  

  • How many times can I submit a claim?  

You can only ask for your benefits to be replaced two times in a federal fiscal year, which is October 1st – September 30th.  

  • What benefits can be replaced?  

The following benefits can be replaced: regular Food and Nutrition Services, simplified nutritional assistance program (SNAP), Disaster Supplemental Nutrition Assistance Program (D-SNAP), and Emergency Allotments (EA). 

For any issues or questions in Mecklenburg County, call our client helpline at 704-376-1600 (English) or 800-247-1931 (Spanish) to leave a voicemail for our Food Stamps intake.  

What Should I do if Someone Signed me up for Health Insurance Marketplace Coverage Without my Consent?

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Page last updated on Feb. 7, 2024

Ver información en Español 

Did your federal income tax return for last year indicate that you had health insurance coverage through the Marketplace (also referred to as Obamacare, Healthcare.gov and Affordable Care Act) and/or you owe IRS a repayment of premium tax credit, but you did not sign up for coverage?

If you were enrolled in a health plan in the Marketplace by another person (an insurance agent or broker) without your consent and knowledge, you should report this to the Marketplace and submit the claim for agent fraud.

On this page, you can find information on the following topics:

North Carolina residents, if you would like assistance with this process, our Health Insurance Navigators can provide you with free help.

Mecklenburg, Cabarrus and Union Co. residents, please call 980-256-3782

North Carolina residents in other counties, please call 1-855-733-3711

Visit ncnavigator.net

Next steps to follow if you were enrolled in a plan on the Health Insurance Marketplace without your consent

  1. Call the Health Insurance Marketplace (aka Obamacare) Call Center at 1-800-318-2596 to find the status of your enrollment. Even if you did not sign up of your own will, you may owe the IRS money back for premium tax credits you received.
  2. If the Marketplace reports you did not have coverage in 2022 and/or 2023, there is nothing else you need to do.
  3. If the Marketplace confirms you had coverage that you did not consent to AND you did not use this coverage for your doctor or hospital visits, follow these steps:
  • Ask the Marketplace representative to cancel/terminate any current active coverage you were fraudulently enrolled in, so that you do not continue receiving premium tax credits that you may not be eligible for.
  • Contact an Affordable Care Act Health Insurance Navigator to assist you with reporting your enrollment without a consent to the Center for Medicaid and Medicare, the federal government agency overseeing Marketplace, and to submit an agent fraud claim so that your coverage may be terminated retroactively (which would allow you to cancel your entire coverage from the original issue date). To receive assistance from a Health Insurance Navigator, call 980-256-3782 (Mecklenburg, Cabarrus and Union Co. residents) or 1-855-733-3711 (NC residents in other counties) for free assistance.
  • Next, the Marketplace Complex Case Help Center will investigate your claim. Only Navigators can submit this form, but both you and your Navigator will receive a call as part of this investigation in the days after submitting the agent/broker fraud. Upon investigation, you will be informed of the outcome and the next steps. 
  • Depending on the fraud claim outcome, you may receive an amended 1095A tax form that you may need to file with your federal income tax return. Make sure the Marketplace has the correct mailing address for you. Charlotte Center for Legal Advocacy Low-Income Taxpayer Clinic may be able to provide guidance with tax questions regarding your 1095A form. You can contact the clinic at 980-202-7329.
  • It is recommended that you file an agent fraud claim with the NC Department of Insurance as well. Visit ncdoi.gov or call 919-807-6840 (Toll-Free 888-680-7684). Your Navigator can assist you with this process. 
  • If you believe your identity has been stolen, you should report it to IdentityTheft.gov.
  • If you have questions about this process, want assistance or just want to understand your options for health coverage, Affordable Care Act Health Insurance Navigators can help. Call 980-256-3782 (Mecklenburg, Cabarrus and Union Co. residents) or 1-855-733-3711 (NC residents in other counties) for free assistance.

Who are Health Insurance Navigators and how can they help me with this process?

Health Insurance Navigators are licensed by the Center for Medicaid and Medicare, a federal agency that also administers Health Insurance Marketplace. Their services are FREE for everyone, and they do not get any financial incentives for their assistance. They help consumers understand what health options they are eligible for and assist with enrollment in Medicaid and Marketplace coverage. They cannot choose a health plan for you but can help answer questions about health coverage and guide a consumer through the enrollment process. Navigator services include reasonable accommodations for non-English speaking consumers or consumers with visual, hearing, or other impairments with no cost to consumers.

No, Health Insurance Navigators are not an insurance agent or broker. Navigators are federally licensed and provide free, unbiased help to consumers to help individuals understand their health options eligibility and assist with enrollment in Medicaid and Marketplace coverage. Navigators can also assist with processes concerning the Health Insurance Marketplace, such as enrollment in a plan without consent. Navigators receive no direct compensation for assisting an individual with the Health Insurance Marketplace or Medicaid.

Why is it important to report fraudulent enrollment in Marketplace coverage?

Every time someone applies for coverage through Marketplace, they are also applying for government financial assistance through advance premium tax credit to help lower your monthly health insurance payment (or “premium”). Advance Premium Tax Credit is approved based on the estimate of your expected income, the tax filing status, and other criteria for the year you will have coverage. This is reported on your Marketplace application.

If you qualify for a premium tax credit based on your estimate, tax filing status, and ineligibility for other health coverage, you can use it to lower the cost of your monthly premium for the plan you enrolled in.

You are legally required to file a federal income tax return for the year you had Marketplace coverage and reconcile the advance premium tax credit with your actual income for that year:

  • If at the end of the year you have received more premium tax credit than you are due based on your final income, you will have to pay back the excess when you file your federal tax return.
  • If you have received less than you qualify for, you will get the difference back.

If you were eligible for premium tax credits when you had coverage on Marketplace and you received the correct amount, all you need to do is submit this information with your tax return.

There are several reasons someone is not eligible for premium tax credits, for example you may not have an eligible immigration status, or you had an offer of or enrolled in an employer sponsored insurance (some exceptions apply). If you were eligible/ enrolled in Medicaid, Medicare, or other health coverage that meets the minimum essential coverage requirement, you WERE NOT eligible for premium tax credits.

What is not a fraudulent enrollment?

You cannot claim that you were fraudulently enrolled in a Marketplace health plan if:

  1. You agreed to be enrolled in Marketplace plan after you talked to a health insurance agent or broker.
  2. You willingly enrolled into the Marketplace plan with the help of an agent/broker, but later changed your mind and decided you do not want this coverage.
  3. You used your Marketplace health plan at any point to cover the cost of any medical services provided during the coverage year to you or any other tax household member listed on your Marketplace application.
  4. Your health plan premium cost was not fully subsidized (you were paying a portion of the premium).

What If I was enrolled in health coverage on Marketplace without my consent, but now I want to keep it?

If you have been enrolled without consent to a Marketplace health plan for 2024 and you decide that you may want to keep that plan, you should:

  1. Ask the Marketplace representative for the details of the plan (monthly premium, deductible amount, copays amount, out-of-maximum amount for 2024) so that you can understand the cost of this coverage and make an informed decision.
  2. Ask the representative to update your 2024 application to make sure you report any offer of insurance elsewhere (employer sponsored insurance, Medicare, Medicaid, TRICARE or VA Healthcare, etc..), your accurate tax filing status and your income for coverage year to make sure you will receive an accurate premium tax credit to lower you monthly premium. *Please note that if you are legally married you will need to include your spouse’s income on the Marketplace application and file jointly with your spouse for the year you had coverage, even if you do not live with your spouse. Some exceptions apply.
  3. If your employer offers health insurance, you are not eligible to be on Marketplace and receive premium tax credit unless the lowest premium cost of the plan your employer offers is more than 8.39% of your income.
  4. If you already enrolled in health insurance offered by your employer (or are eligible for any other minimum essential coverage, e.g., Medicaid, Medicare, or TRICARE), you are NOT eligible for Marketplace coverage and you should immediately cancel the Marketplace plan you were enrolled in for 2023. Otherwise, you may have to re-pay your premium tax credit when you file taxes.
  5. Make sure Marketplace has correct contact information to mail you your 1095A for 2024 coverage.
  6. Use your 1095A to reconcile any premium tax credits you received on your federal tax return.

Qué hacer si fui inscrito en la cobertura de salud en el Mercado (Obamacare) sin mi consentimiento

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¿Su declaración federal de impuestos del año pasado indicó que tenía cobertura de salud a través del Mercado (Obamacare) y/o que debe un reembolso del crédito fiscal premium al IRS, pero usted no se inscribió en la cobertura?

Si alguien más (un agente o corredor de seguros) lo inscribió en un plan de salud del Mercado sin su consentimiento y conocimiento, debe informar esto al Mercado y presentar una reclamación por fraude de agente.

Por favor, siga estos pasos:

  1. Comuníquese al Centro de Llamadas del Mercado de Seguros Médicos (también conocido como Obamacare)  al 1-800-318-2596 para conocer el estado de su inscripción. Es posible que deba realizar un reembolso al IRS si se le otorgó un crédito tributario de prima para el que no era elegible.
  2. Si le informan que no tuvo cobertura en 2022 y/o 2023, no debe hacer nada más.
  3. Si el Mercado confirma que usted tenía cobertura sin consentimiento y no utilizó esta cobertura para visitas al médico y/u hospital, siga estos pasos:
  • Informe sobre su inscripción sin consentimiento y presente una reclamación por fraude de agente para que su cobertura sea cancelada retroactivamente. Pida al Mercado que cancele cualquier cobertura activa actual en la que lo inscribieron fraudulentamente, para que no siga recibiendo créditos fiscales premium para los cuales puede no ser elegible.
  • A continuación, el Mercado investigará su reclamación. Esto tomará al menos 30 días, pero puede tomar más tiempo. Tras la investigación, recibirá una carta con la resolución de la reclamación por fraude. Si no recibe noticias de ellos en un plazo de 30 días, puede llamar al Mercado para verificar el estado de la reclamación.
  • Según el resultado de la reclamación por fraude, es posible que reciba el formulario fiscal de impuestos 1095A enmendado que deberá ser presentado con su declaración de impuestos federales. La Clínica de Contribuyentes de Bajos Ingresos del Centro de Apoyo Legal de Charlotte puede responder preguntas relacionadas con el formulario 1095A. Si lo requiere puede contactarse al: 980-202-7329.
  • Se recomienda que presente una reclamación por fraude de agente ante el Departamento de Seguros de Carolina del Norte también. Visite ncdoi.gov o llame al 919-807-6840 (Llamada gratuita 888-680-7684).
  • Si cree que su identidad ha sido robada, debe informarlo en IdentityTheft.gov.
  • Si tiene preguntas sobre este proceso o sus opciones de cobertura de salud, los Navegadores de Seguros de Salud de la Ley de Cuidado de Salud a Bajo Precio pueden ayudarlo. Llame al 980-256-3782 para obtener asistencia gratuita.

Los Navegadores de Seguros de Salud pueden ayudarlo con este proceso. Puede llamar al 980-256-3782 para obtener asistencia gratuita.

Los Navegadores de Seguros de Salud están licenciados por el Centro de Medicaid y Medicare, una agencia federal que también administra el Mercado de Seguros de Salud. Sus servicios son gratuitos para todos, y no reciben incentivos financieros al ofrecer su ayuda. Ayudan a los consumidores a comprender las opciones de salud para las que son elegibles y los asisten en la inscripción en Medicaid y en la cobertura del Mercado. No pueden elegir un plan de salud por usted, pero pueden ayudarlo a responder preguntas sobre la cobertura de salud y guiar al consumidor a través del proceso de inscripción. Los servicios del Navegador incluyen adaptaciones razonables para consumidores que no hablan inglés o que tienen discapacidades visuales, auditivas u otras discapacidades sin costo para los consumidores.

¿Por qué es importante informar la inscripción fraudulenta en la cobertura del Mercado?

Cada vez que alguien solicita cobertura a través del Mercado, también está solicitando asistencia financiera gubernamental a través del crédito fiscal premium por adelantado para ayudar a reducir su pago mensual del seguro de salud (o “prima”). El Crédito Fiscal Premium por Adelantado se aprueba en función de la estimación de sus ingresos esperados, el estado civil para efectos de declaración de impuestos y otros criterios para el año en que tendrá la cobertura. Esto se informa en su solicitud al Mercado.

Si califica para un crédito fiscal premium en función de su estimación, estado civil para efectos de declaración de impuestos y la falta de elegibilidad para otra cobertura de salud, puede utilizarlo para reducir el costo de su prima mensual del plan en el que se inscribió.

Está legalmente obligado a presentar una declaración de impuestos federales del año en que tuvo cobertura del Mercado y conciliar el crédito fiscal premium por adelantado con sus ingresos reales de ese año:

  • Si al final del año ha recibido más crédito fiscal premium del que le corresponde según sus ingresos finales, deberá devolver el excedente cuando presente su declaración de impuestos federales.
  • Si ha recibido menos de lo que califica, recibirá la diferencia.

Si fue elegible para créditos fiscales premium cuando tenía cobertura en el Mercado y recibió la cantidad correcta, todo lo que necesita hacer es presentar esta información con su declaración de impuestos.

Hay varias razones por las que alguien no es elegible para créditos fiscales premium, por ejemplo, es posible que no tenga un estatus migratorio elegible o que haya recibido una oferta o se haya inscrito en un seguro patrocinado por el empleador (con algunas excepciones). Si fue elegible/inscrito en Medicaid, Medicare u otra cobertura de salud que cumple con el requisito de cobertura esencial mínima, NO será elegible para créditos fiscales premium.

¿Qué no es una inscripción fraudulenta?

No puede afirmar que fue inscrito fraudulentamente en un plan de salud del Mercado si:

  1. Aceptó ser inscrito en un plan del Mercado después de hablar con un agente o corredor de seguros de salud.
  2. Se inscribió voluntariamente en el plan del Mercado con la ayuda de un agente/corredor, pero luego cambió de opinión y decidió que no desea esta cobertura.
  3. Utilizó su plan de salud del Mercado en algún momento para cubrir el costo de cualquier servicio médico proporcionado durante el año de su cobertura o si cualquier otro miembro del hogar fiscal mencionado en su solicitud al Mercado hizo uso de este servicio.
  4. El costo de la prima de su plan de salud no estaba completamente subsidiado (usted estaba pagando una parte de la prima).

¿Qué sucede si fui inscrito en cobertura de salud en el Mercado sin mi consentimiento, pero ahora quiero mantenerla?

Si fue inscrito sin consentimiento en un plan de salud del Mercado para 2023 y decide que podría querer mantener ese plan, deberá:

  1. Solicitar al representante del Mercado los detalles del plan (prima mensual, monto del deducible, monto de copagos, monto máximo fuera de bolsillo para 2023) para que pueda comprender el costo de esta cobertura y tomar una decisión informada.
  2. Solicitar al representante que actualice su solicitud de 2023 para asegurarse de informar cualquier oferta de seguro en otro lugar (seguro patrocinado por el empleador, Medicare, Medicaid, TRICARE o VA Healthcare, etc.), su estado civil y sus ingresos exactos para el año de cobertura, para asegurarse de que reciba un crédito fiscal premium preciso para reducir su prima mensual. *Tenga en cuenta que si está legalmente casado, deberá incluir los ingresos de su cónyuge en la solicitud del Mercado y presentar una declaración conjunta con su cónyuge para el año en que tuvo cobertura, incluso si no vive con su cónyuge. Se aplican algunas excepciones.
  3. Si su empleador ofrece seguro de salud, no es elegible para estar en el Mercado y recibir créditos fiscales premium a menos que el costo de la prima más bajo del plan que ofrece su empleador sea superior al 9,12% de sus ingresos.
  4. Si ya se inscribió en un seguro de salud ofrecido por su empleador (o es elegible para cualquier otra cobertura esencial mínima, como Medicaid, Medicare o TRICARE), NO es elegible para la cobertura del Mercado y debe cancelar inmediatamente el plan del Mercado en el que se inscribió para 2023. De lo contrario, es posible que deba reembolsar el crédito fiscal premium cuando presente sus impuestos.
  5. Asegúrese de que el Mercado tenga la información de contacto correcta para enviarle su formulario 1095A para la cobertura de 2023.
  6. Use su formulario 1095A para conciliar cualquier crédito fiscal premium que haya recibido en su declaración de impuestos federales.

El mercado de salud y los impuestos

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By Equipo Buenas Finanzas

Durante la temporada de impuestos VITA Latino 2023 varios clientes compartieron su interés en conocer más sobre el acceso a un seguro auspiciado por el Mercado de Salud (www.HealthCare.gov o www.cuidadodesalud.gov ) y como puede afectar sus impuestos.

Dada la importancia de contar con un seguro médico en los Estados Unidos, además de cumplir con el deber ciudadano de pagar impuestos, decidimos consultar con los expertos del programa de acceso a la salud, “Health Insurance Navigator”, en el Centro de Apoyo Legal de Charlotte.

En el siguiente video, entrevistamos a Natalie Marles, supervisora del programa de Navegadores de Salud. Ella responde a preguntas como: ¿Qué es el mercado de seguros y quiénes califican?, ¿Cómo afecta mi seguro médico a mis impuestos? Y más importante, ¿debo tener alguna precaución al adquirir mi seguro médico?

Algunos de los puntos más importantes a destacar son:

  • Las personas pueden calificar para un seguro médico asequible teniendo en cuenta el número de miembros de su familia, el ingreso que la familia reciba y si son fumadores o no.
  • Las personas que califican deben tener algún estado migratorio legible (proceso de visa, residentes legales, etc.) y no deben tener cobertura médica bajo ningún otro programa medico (como Medicare o Medicaid).

Read more at: El mercado de salud y los impuestos