Category: Health Insurance

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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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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Health Insurance Marketplace Open Enrollment FAQ

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When is Open Enrollment for the Health Insurance Marketplace?

Open Enrollment for the Health Insurance Marketplace (Healthcare.gov) happens between November 1, 2024 and January 15, 2025.

Is there still a penalty for not having health insurance?

Effective January 1, 2019, there is no longer a penalty for not having health insurance.

Which health insurance companies will be offering plans in 2025 in Mecklenburg, Cabarrus, and Union counties?

The plans offered for Mecklenburg, Cabarrus, and Union Counties are Aetna, Ambetter, Blue Cross Blue Shield, Cigna, United Healthcare, and WellCare.

I already have coverage. How can I get ready to apply for 2025 Marketplace health coverage?

If you already have a Healthcare.gov account, make sure you are able to log in. If your household size or income has changed, gather supporting documentation such as tax returns from last year or recent pay stubs. You may be required to provide copies of these documents to the Marketplace. Please note plans have changed! You can schedule a free appointment with a Navigator to discuss your options and make sure you are enrolled in the best plan for you and your family.

What happens if I don’t sign up?

If you can afford health insurance but choose not to buy it, you may face high out-of-pocket costs if you have a medical emergency or need to visit a doctor. Use the window-shopping tool on Healthcare.gov to take a look at the plans offered in your area; financial assistance may be available for you and your family. Your premium may be less than you think!

Can I just wait and have my current plan automatically renewed?

Even if you’re happy with your plan and you don’t have any life changes to report (like moving to a new state or changes in your income or household), you should still go back through the application and make sure all your information is up to date to ensure that you are receiving all the financial assistance you are eligible for. You can also take a look at the health plans being offered in your area. You might benefit from a change, and you never know until you compare. You can do this yourself by logging into your Healthcare.gov account or by calling the Marketplace directly at 1-800-318-2596. You can also make an appointment with a navigator to go over your options, so call today!

When is my coverage going to start if I enroll or update my application after December 15, 2024?

If you enroll in a plan or update your application after December 15, 2024, your new coverage will start on February 1, 2025.

I no longer have coverage or lost my coverage during 2024; what are my options?

Even if you lost coverage this year, you may still qualify for financial assistance and can enroll in an affordable health plan for next year. You can log back into your Marketplace account, call the Marketplace, or meet with a navigator to start a new application for 2025.

I am eligible for health benefits at work, but I want to see if I can get a better deal on the Marketplace. Can I do that? 

Yes, you can always shop for coverage on  Healthcare.gov, assuming you meet other eligibility requirements. However, if you have access to affordable job-based coverage through your employer or your spouse’s employer, you may not qualify for financial assistance in the Marketplace. It is important to have information about your employer coverage offer when you complete a Marketplace application. The Employer-Sponsored Insurance Affordability threshold for 2025 is 9.02% of annual income for the Cost of Family coverage.

I have COBRA, but it’s too expensive. Can I drop it during Open Enrollment and enroll in a Marketplace plan instead?

During Open Enrollment, you can sign up for a Marketplace plan even if you already have COBRA. You will have to drop your COBRA coverage effective on the date your new Marketplace plan coverage begins. After Open Enrollment ends, however, if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment opportunity. You will have to wait until the next Open Enrollment period. Only exhaustion of your COBRA coverage triggers a special enrollment opportunity.

How can I find out if my doctor and/or prescription medication is in a health plan’s network? 

Each plan sold on Healthcare.gov provides a link to its health provider directory and prescription drug formulary so consumers can find out if their health providers and medications are included.

I am not currently working. Although I do not have income, should I still review my healthcare options for 2025?

YES! Although you are not currently working, the Marketplace application asks for information about your anticipated income for the following year. Therefore, you can estimate your potential income for 2025 even if you are not working right now. You can always update your income using the Marketplace application. Navigators can walk you through your options. Schedule a free appointment, in person or virtually, by calling 980-256-3782 or going online to ncnavigator.net.

You may also be now eligible for Medicaid under Medicaid Expansion in North Carolina. The Navigators will be able to assist you in understanding your eligibility and finding the best plan to fit your needs and protect you and your family. Click here to learn more.

What if I need help?

Navigators are available in your area and taking appointments, but we anticipate that appointments will fill up quickly! As always, appointments are free and available at convenient times. Appointments are available at over 20 convenient locations, including our office. Walk-in times are also available at our office Wednesdays 5:30pm-8:30pm and Saturdays 9:00am-3:00pm. Call 980-256-3782 or go online to ncnavigator.org to schedule an appointment today.

Facts that you need to know about DACA and the lawfully present final rule/Datos que necesita saber sobre DACA y el reglamento final sobre residentes legalmente presentes

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Medicaid and Medicaid Expansion in NC: Are you Eligible?

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Medicaid is a federal and state-funded health insurance program that provides full coverage for some vulnerable low-income North Carolinians. It improves access to healthcare and health outcomes for North Carolinians by increasing access to primary care providers, regular checkups, preventative care, and care for chronic conditions.

There are many different types or categories of Medicaid, each with its own income limits compared to the federal poverty line (FPL). Medicaid expansion is the newly implemented program in the state of North Carolina, covering adults aged 19-64 who meet the income requirements. This expands coverage to college students, working parents, childless adults, and more.

Have questions or think you may be eligible? Make a free appointment with a Health Insurance Navigator at Charlotte Center for Legal Advocacy Call 980-256-3782 or visit the website ncnavigator.org to schedule your free phone appointment today!

  • On March 27, 2023, Governor Cooper signed the Medicaid Expansion into law.
  • NC is the 41st state to expand Medicaid (Including the District of Columbia)
  • As July 2024, more than 500,000 people have enrolled in MXP

Who will be able to get health coverage through NC Medicaid?

Most people can get health care coverage through NC Medicaid if they meet the criteria below. If you were eligible before, you still are. Eligibility criteria:

  • You live in North Carolina
  • Age 19 through 64
  • You are a citizen (some non-U.S. citizens can get health coverage through NC Medicaid)
  • If your household income fits within the following chart:

Click here for a Medicaid PDF with more information.

El Centro de Apoyo recibe la expansión de Medicaid en Carolina del Norte

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La expansión de Medicaid finalmente es una realidad en Carolina del Norte, y el Centro de Apoyo Legal de Charlotte recibió el anuncio del estado, en el que comunicaron que se implementará este programa a partir del 1 de diciembre de este año. Celebramos que casi 600,000 habitantes de Carolina del Norte ahora tendrán acceso a coberturas de salud y ya no tendrán que vivir con miedo a tener enfermedades o accidentes. Al mismo tiempo, los defensores de nuestro Programa de Apoyo Familiar y Atención Médica están listos para monitorear de cerca la implementación del programa y asegurarse de que los residentes elegibles de Carolina del Norte reciban un acceso oportuno y significativo a la cobertura.

Para apoyar este nuevo capítulo de Medicaid en Carolina del Norte, el Centro de Apoyo organizará eventos de inscripción y nuestros navegadores de salud tendrán citas disponibles para toda la comunidad, tanto en persona como de forma virtual, para ayudar con el proceso de inscripción. Para mantenerse al tanto de todos los eventos que organizaremos, por favor siga nuestras redes sociales (Instagram, Facebook, X, LinkedIn) y visite regularmente nuestro sitio web. Creemos que estas iniciativas proporcionarán recursos y asistencia valiosa a quienes lo necesiten, y esperamos tener un impacto positivo en la vida de nuestros vecinos en el área metropolitana de Charlotte.

Advocacy Center welcomes Medicaid expansion in North Carolina

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Ver información en español

Medicaid Expansion is finally a reality in North Carolina, and Charlotte Center for Legal Advocacy welcomes the announcement that the state will implement this program beginning December 1st. We celebrate that nearly 600,000 North Carolinians will now have access to health coverage and will no longer have to live in fear of illness or accidents. At the same time, our Family Support and Health Care Program advocates stand ready to closely monitor the program’s implementation to ensure that eligible North Carolinians receive timely, meaningful access to coverage.

In support of this new chapter of Medicaid in North Carolina, the Advocacy Center will host enrollment events, and our navigators will have available appointments, both in person and virtually, throughout the community to assist with enrollment. To stay updated on all the events we will be hosting, please follow our social media channels (Instagram, Facebook, X, LinkedIn) and regularly visit our website. We believe that these initiatives will provide valuable resources and assistance to those in need, and we look forward to making a positive impact on the lives of our neighbors in the greater Charlotte area.

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

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Ver información en Inglés

¿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.

‘Unwinding’ could undermine Medicaid expansion in North Carolina

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By Jaymie Baxley

DHHS thinks 300,000 could lose coverage following the end of a federal mandate that protected enrollees during the COVID-19 pandemic.

When Medicaid expansion was signed into law earlier this year by Gov. Roy Cooper, it was widely heralded as a transformative event for uninsured people in North Carolina.

Amid the bipartisan celebration, there was little mention of the hundreds of thousands of existing enrollees who are expected to lose Medicaid coverage before expansion goes into effect. Few of the revelers acknowledged the less-than-ideal timing of the legislation, which passed just days before the expiration of a federal mandate that had prevented states from kicking Medicaid beneficiaries who became eligible for coverage during the COVID-19 pandemic off of the rolls.

Known as the continuous coverage requirement, the three-year-long mandate ended on April 1, the same week expansion became law. The so-called unwinding of this continuous coverage rule means the state must redetermine the eligibility of more than 2.9 million people who are currently receiving Medicaid. It’s an unprecedented undertaking that some health care advocates fear will trigger a wave of unwarranted terminations.

Before the pandemic, Medicaid recipients usually experienced an annual or semiannual review to verify that they continued to qualify for coverage. But many of the state’s more recent enrollees, who gained coverage during the public health emergency, have never gone through the process. Statewide enrollment grew 36 percent during the pandemic, with over 797,000 people newly qualifying for coverage from March 2020 until April of this year.

Read more at: https://www.northcarolinahealthnews.org/

Las reglas en Medicaid cambiaron

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Con algunas excepciones, los beneficiarios de Medicaid no habían estado en riesgo de perder su cobertura desde marzo de 2020.  Sin embargo, a partir del 1 de abril de 2023, su Departamento de Servicios Sociales (DSS) local comenzará a verificar si aún es elegible para Medicaid.  Esto se conoce como redeterminación.

DSS comenzará a reducir o cancelar el servicio de Medicaid para aquellos que ya no son elegibles.  También podrían terminar la cobertura de quienes no devuelvan la información necesaria para determinar su elegibilidad.

Por esta razón, debe asegurarse de que DSS tenga su información de contacto actual (dirección, número de teléfono, etc.) y que responda de inmediato a las llamadas o mensajes que reciba sobre su Medicaid. Las redeterminaciones estarán vigentes hasta el 31 de mayo de 2024. DSS se comunicará con usted entre el 1 de abril de 2023 y el 31 de mayo de 2024 para determinar su elegibilidad.

¿Qué debo hacer?

  • Comuníquese con su oficina local de DSS para asegurarse de que tengan su dirección, número de teléfono, correo electrónico y otra información de contacto.
    • Local DSS Offices:
      • Condado de Mecklenburg
        • 704-336-3000
        • Wallace H. Kuralt Centre, 301 Billingsley Road, Charlotte, NC 28211
        • Centro de Recursos Comunitarios, Community Resource Center, 3205 Freedom Drive, Charlotte, NC 28208
      • Condado de Union
        • 704-296-4300
        • 2330 Concord Avenue Monroe, NC 28110
      • Condado de Cabarrus
        • 704-920-1400
        • 1303 S. Cannon Blvd. Kannapolis, NC 28083
  • Esté atento al correo electrónico, mensajes de texto o llamadas telefónicas que reciba del DSS y responda de inmediato.
  • Cree una cuenta ePass mejorada (https://epass.nc.gov):
    • Vea sus beneficios,
    • Cargue los documentos que respalden cualquier cambio, como ingresos o tamaño del hogar,
    • Actualice su información en línea.

Tiene derecho a:

¿Qué pasa si pierdo mi cobertura de Medicaid?

Tiene derecho a apelar

Si cree que ha habido un error, puede apelar esa decisión. Tiene 60 días (aproximadamente 2 meses) a partir de la fecha del aviso para solicitar una apelación. Si lo hace dentro de los siguientes 10 días hábiles, puede pedir que su Medicaid continúe mientras se revisa la apelación. Llame al 704-376-1600 y marque la opción 2 para obtener más información.

Los períodos especiales de inscripción (SEP por sus siglas en inglés) están disponibles para la cobertura de Medicare y del Mercado.

Personas que ya no son elegibles para Medicaid pueden ser elegibles para inscribirse en la cobertura de Medicare o del Mercado con un Período de Inscripción Especial.

Navegadores de Seguro Médico

Programa de Información de Seguro Médico para adultos mayores de Carolina del Norte (SHIIP por sus siglas en inglés)

  • Los consejeros de SHIIP ofrecen información gratuita e imparcial sobre los productos de atención médica y la elegibilidad de Medicare.
  • Llame a 1-855-408-1212

Asistencia legal gratuita disponible

Si cree que su Medicaid fue reducido o terminado injustamente, llame al 800-247-1931.

Para consultar más recursos que lo ayudarán en este proceso visite NCMedHelp.org.