Category: Client Resources

Still need health insurance? You may qualify for a Special Enrollment Period!

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What you need to know about Special Enrollment Periods

The Marketplace deadline to enroll in or change health insurance plans ended on January 15, 2022 for most people.  You still may qualify for a Special Enrollment Period to enroll in Marketplace coverage if you experience certain life changes.  You may also be eligible to enroll for coverage through Medicaid or the Children’s Health Insurance Program all year long.

Read more to learn who is eligible and contact a Health Insurance Navigator for help!

Frequently Asked Questions

What life changes may make you eligible for a Special Enrollment Period?

You may qualify if:

You or anyone in your household in the past 60 days:

  • Got married
  • Had a baby, adopted a child, or placed a child for foster care
  • Got divorced or legally separated and lost health insurance

You changed your residence:

  • Moved to a new home in a new ZIP code or county
  • Moved to the U.S. from a foreign country or United States territory
  • If you’re a student and moved to or from the place you attend school
  • If you’re a seasonal worker and moved to or from the place you both live and work
  • Moved to or from a shelter or other transitional housing

You lost your health insurance:

  • You or anyone in your household lost qualifying health coverage in the past 60 days
  • You or anyone in your household expects to lose coverage in the next 60 days
  • You lost health insurance since 1/1/2020

Important note: You only have 60 days to enroll in Marketplace coverage after one of these changes has occurred.

What is the new qualification for a Special Enrollment Period?

You may now qualify if your estimated annual household income is at or below 150% Federal Poverty Level (FPL).

If you are an immigrant not eligible for Medicaid due to your immigration status, you may still qualify for this Special Enrollment Period even if your income is below the 100% FPL. Household income limits will vary depending on the number of members of a household.

Who qualifies for the new Special Enrollment Period for low-income people?

To qualify, a person must have an annual projected income that is at or below 150% of the Federal Poverty Line: 

Number in HouseholdAnnual Household Income
1$19,320
2$26,130
3$32,940
4$39,750
5$46,560
6$53,370
7$60,180
8$66,990

If you are a household of one, and your projected income in 2022 is between $12,880 and $19,320, you may be eligible to enroll in Marketplace now or change plans if you are currently enrolled in a Marketplace plan.

If you are a household of four, and your projected income in 2022 is between $26,500 and $39,750, you may be eligible to enroll in Marketplace now or change plans if you are currently enrolled in a Marketplace plan.

If you are an immigrant not eligible for Medicaid due to your immigration status, and your income is below $19,320 (for a household of one), you may be eligible to enroll in Marketplace now or change plans if you are currently enrolled in a Marketplace plan.

When is the new Special Enrollment Period for low-income people available?

Beginning March 22, consumers are able to enroll through this Special Enrollment Period at HealthCare.gov or cuidadodesalud.gov or by calling the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) for enrollment help.

When does coverage begin for someone using a Special Enrollment Period?

A person who enrolls in Marketplace coverage using a Special Enrollment Period will be covered the first day of the month following plan selection, no matter what day you apply.

Who is eligible for Medicaid or the Children’s Health Insurance Program?

Medicaid: People with low income, including individuals, families and children, pregnant women, older adults, and people with disabilities, may qualify. If eligible, you can apply any time.

Children’s Health Insurance Program (North Carolina Health Choice for North Carolina residents): helps children in households that earn too much money to qualify for Medicaid, but not enough to buy private insurance.

Need help enrolling in a Special Enrollment Period, Medicaid, or the Children’s Health Insurance Program?

Health insurance navigators are ready to help!  Visit NCNavigator.net, call 855-733-3711, or 980-256-3782 in Mecklenburg, Cabarrus, or Union counties to schedule a free appointment!

Get Help

Healthcare.gov Premium Tax Credits and Filing Your 2021 Taxes

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If you currently do not have health insurance, we can help! Click here to learn more and make an appointment with a health insurance navigator today.

Health insurance on Healthcare.gov is affordable for many people because the government subsidizes your monthly premiums based on your income. These subsidies are called Premium Tax Credits. If you receive them each month during the year, they are called Advance Payments of the Premium Tax Credit (APTCs).  

If you receive these government subsidies, you need to reconcile these payments on your tax return each year. The IRS requires you to do this to make sure that you received the proper amount of subsidies based on your income. 

Use Form 8962 to see how much premium tax credit you qualify for based on your actual year-end income.  If your income at the end of the year is higher than you estimated on your Healthcare.gov application, you will need to pay back some of your subsidies. This is because you were given more subsidies than you were qualified for, based on your annual income.  

If your income at the end of the year is lower than you estimated on your Healthcare.gov application, you may be eligible for a refund.  Use form 8962 to claim the Premium Tax Credit. 

How do I know if I received APTCs?

If you enrolled yourself or a family member in a Healthcare.gov plan, you will receive Form 1095-A from the Health Insurance Marketplace. This form will show the months that you were covered by a Healthcare.gov plan and will show the amount of APTC that was paid to your health insurance company on your behalf. The Marketplace also provides this information to the IRS. 

Are there changes for filing taxes in 2021? What do I need to do? 

Last year the IRS announced individuals didn’t need to repay excess APTCs for tax year 2020.  This is not the case for 2021 tax return.  If you received excess APTCs in 2021, you will be required to pay these back when you file your tax return.  

If you find on Form 8962 that you received a smaller amount of subsidies than you qualify for based on your year-end income, you may claim the Premium Tax Credit on form 8962. 

As a reminder, this change applies only to tax year 2020. The deadline to file your 2021 federal income tax return is April 18, 2022. If you do not reconcile your APTCs by filing your 1095-A on your 2021 tax return, you run the risk of not being eligible for APTC in future years. 

More Resources

Filing your 2021 Federal Income Tax return: Child Tax Credit
Filing your 2021 Federal Income Tax return: Earned Income Tax Credit
Filing your 2021 Federal Income Tax return: Economic Impact Payment
Filing your 2021 Federal Income Tax return: Frauds & scams

Are you ready to file your 2021 Federal Income Tax return?

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Tax filing season for 2021 Federal tax returns opened January 24, 2022 and will run through April 18, 2022. With the expansion of the Child Tax Credit and Earned Income Tax Credit last year, there may be more money available to you than you realize! Here is what we think you need to know, links to frequently asked questions, and where to find more help. 

1. You may claim the Child Tax Credit even if you did not work or have income in 2021

You may claim the Refundable Child Tax Credit on your 2021 Federal income tax return even if you did not work or have any income. You must have lived in the United States for more than half of 2021 AND have a Qualifying Child with a valid Social Security Number. 

If you aren’t required to file taxes this year, you can visit GetYourRefund.org to get your tax credit.

Want to know more about the Child Tax Credit? Visit our Child Tax Credit help page. 

2. More people than ever before will qualify for the Earned Income Tax Credit

For the first time, workers 19-24 and 65 and older without kids at home now qualify for the tax credit, expanding eligibility to millions of additional workers nationwide.  Additionally, if you did not qualify in the past because your income was too high, you may now qualify.  Here’s what you need to know: 

  • You may qualify for a credit of more than $1,500 if you do not have children living with you.  
  • You may qualify for a credit up to $6,700 if you are raising children in your home.  
  • You may qualify if you make $27,380 or less without kids or $57,414 or less with kids. 

Want to know if you qualify?  Visit our Earned Income Tax Credit help page. 

3. The third Economic Impact Payment (“Stimulus Payment”) does not need to be included in your gross income on your 2021 Federal income tax return

This means when you file your tax return: 

  • You will not owe any tax on the Stimulus Payment you received. 
  • It will not reduce your refund.  

Note: The third Stimulus Payment will also not affect your income when determining your eligibility for federal government assistance or benefit programs. 

If the information reported on your 2021 Federal income tax return would cause you to have qualified for a lesser third Stimulus Payment (compared to your 2020 or 2019 tax information which was used to calculate the payment you received), you will not be required to pay any of it back.  

Missing your first, second, or third stimulus payments? Have more questions? Visit our stimulus payment help page. 

4. You may be eligible for free income tax return preparation

If your household income in 2021 was $58,000 or less, you could qualify to have your taxes prepared and submitted through the IRS Volunteer Tax Assistance (VITA) program. Local VITA Tax services will primarily be provided virtually this year, but a limited number of in-person sites are also available.   

Local VITA appointments

National VITA Services:

English: GetYourRefund.org

En español: GetYourRefund.org en español

If your household income was $72,000 or less, IRS Free File also lets you prepare and file your FEDERAL income tax online using guided tax preparation, at an IRS partner site or Free File Fillable Forms. There are options available in English and Spanish: Free File: Do your Federal Taxes for Free | Internal Revenue Service (irs.gov)

5. Be aware of fraudulent tax preparers

The IRS doesn’t initiate contact with taxpayers by email, text messages or social media channels to request personal or financial information.

  • DON’T use tax preparers who promise higher returns
  • DO choose a tax preparer that has a valid IRS “Preparer Tax Identification Number” (PTIN). 
  • DON’T fall for flyers and advertisements promising you “free money” from the IRS.  There is no such thing as “free money” from the IRS!
  • DO review your return before you sign it and make sure your preparer signs it too.

Learn more about how to stay protected

6. BONUS TIP: We are here to help!

If you:

  • have trouble with the IRS
  • need assistance with an audit
  • disagree with a tax bill the IRS has sent but they are still taking money from your paycheck

We are here to help!

Charlotte Center for Legal Advocacy’s North Carolina Low-Income Taxpayer Clinic serves all of North Carolina by offering tax controversy services to low-income taxpayers. The Tax Clinic serves taxpayers who earn less than 250% of the federal poverty standard, including people who speak English as a second language. 

Contact us today: 980.202.7329 

Resources

Filing your 2021 Federal Income Tax return: Child Tax Credit
Filing your 2021 Federal Income Tax return: Earned Income Tax Credit
Filing your 2021 Federal Income Tax return: Economic Impact Payment
Filing your 2021 Federal Income Tax return: Frauds & scams
Healthcare.gov Premium Tax Credits and Filing Your 2021 Taxes
Owe taxes but cannot pay?
IRS Payment Options

Filing your 2021 Federal Income Tax return: Economic Impact Payment

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Economic Impact Payment (“Stimulus Payment”) FAQ

Have questions about how to handle your stimulus payments on your federal tax return?  Missing any of your payments?  We have answers!

Do I need to include the third economic payment (“stimulus payment”) on my federal tax return?

The third Economic Impact Payment (“Stimulus Payment”) is not includible in your gross income on your 2021 Federal income tax return.

This means when you file your tax return:

  • You will not owe any tax on the Stimulus Payment you received.
  • It will not reduce your refund. 

Note: The third Stimulus Payment will also not affect your income when determining your eligibility for federal government assistance or benefit programs.

If the information reported on your 2021 Federal income tax return would cause you to have qualified for a lesser third Stimulus Payment (compared to your 2020 or 2019 tax information which was used to calculate the payment you received), you will not be required to pay any of it back.

You are not required to report the third Stimulus Payment on your 2021 Federal income tax return, but you may need to provide information to your tax preparer showing whether you received the third Stimulus Payment.  Remember to keep any notices you receive from the IRS regarding the third Stimulus Payment and any additional payments with your 2021 tax records. The IRS mails these notices to each recipient’s address on file after the payment is made. This is generally the address on your most recent tax return or as updated through the United States Postal Service (USPS).

What if I am missing my third economic payment?

Missing third Stimulus Payments may only be claimed on a 2021 tax return.

People who are missing the third stimulus payment or got less than the full amount may be eligible to claim a Recovery Rebate Credit on their 2021 federal tax return.  Enter the stimulus payment amount in your tax preparation software or in the Form 1040 Recovery Rebate Credit Worksheet to calculate your credit.

Learn more: Recovery Rebate Credit | Internal Revenue Service (irs.gov)

What if I am missing my first and second economic payments?

All first and second economic impact payments (“stimulus payments’) have been sent out by the IRS.   Missing 1st and 2nd payments must be claimed on your 2020 tax return.  You can’t claim them on your 2021 tax return.

If you didn’t get a first and second Stimulus Payment or got less than the full amounts, you may be eligible to claim the Recovery Rebate Credit by filing a 2020 tax return if you have not filed yet or by amending your 2020 tax return if it’s already been processed.

How can I claim a Recovery Rebate Credit on my 2020 and 2021 federal tax return?

For 2021:

People who are missing the third stimulus payment or got less than the full amount may be eligible to claim a Recovery Rebate Credit on their 2021 federal tax return.  Enter the stimulus payment amount in your tax preparation software or in the Form 1040 Recovery Rebate Credit Worksheet to calculate your credit.

For 2020:

  • If you did not file a 2020 tax return or successfully use the Child Tax Credit Non-Filer Sign-up Tool: File a 2020 tax return to claim the 2020 Recovery Rebate Credit even if you don’t usually file a tax return.
  • If you did file a 2020 tax return or successfully used the Child Tax Credit Non-Filer Sign-up Tool and did not claim a Recovery Rebate Credit: File an amended return to claim the credit.
  • If you filed a 2020 tax return or successfully used the Child Tax Credit Non-Filer Sign-up Tool and you received a letter from the IRS about your 2020 Recovery Rebate Credit:
    • If you agree with the changes the IRS made, you don’t need to reply. Keep the letter with your tax records.
    • If you disagree, call the IRS at the toll-free number listed on the top right corner of your notice. If you received a letter from the IRS about other issues relating to your tax return, you should follow the instructions in the letter.
  • If your 2020 return or information has not yet been processed do not file a second tax return. Some returns need special handling to correct errors or credit amounts, which can delay processing by up to 120 days. The IRS is having to correct significantly more errors on 2020 tax returns than in previous years. If they correct the credit claimed on your return, they will send you an explanation.

Learn more: Recovery Rebate Credit | Internal Revenue Service (irs.gov)

Where can I find my stimulus payment amounts?

Your Online Account: Securely access your individual tax information with an IRS online account to view your first, second and third Stimulus Payment amounts under the related tax year tab.

IRS Letters:  The IRS mailed these letters to the address they have on file.

  • Notice 1444: Shows the first Stimulus Payment advanced for tax year 2020
  • Notice 1444-B: Shows the second Stimulus Payment advanced for tax year 2020
  • Notice 1444-C: Shows the third Stimulus Payment advanced for tax year 2021

Filing your 2021 Federal Income Tax return: Child Tax Credit

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Nearly every family is eligible to receive the expanded Child Tax Credit, including families that haven’t filed a tax return previously and families that don’t have recent income.

Each qualifying household is eligible to receive up to $3,600 for each child under 6 years old, and $3,000 for each child between 6 and 17 years old. The credit is not a loan!

Since the American Rescue Plan expanded eligibility and increased the amount of this tax credit for children, almost all families qualify. Even families who have not filed a tax return before or do not have recent income are eligible for the full Child Tax Credit. Anyone who has a child with a Social Security number (SSN) can get it, even if they do not have an SSN themselves. 

All you must do is file a tax return this year. Families who received monthly payments last year will get the second half of the credit when they file taxes this year. If you missed out on payments during 2021, you will still get the full credit when you file your taxes this year.

If you are filing for the first time, or have additional questions, visit GetYourRefund.org, call 211 or make an appointment with your local Taxpayer Assistance Center to learn more about how to get your money!

I have children but didn’t work in 2021. Can I claim the Child Tax Credit?

You may claim the Refundable Child Tax Credit on your 2021 Federal income tax return even if you did not work or have any income. You must have lived in the United States for more than half of 2021 AND have a Qualifying Child with a valid Social Security Number.

Visit GetYourRefund.org to get your tax credit.

Remember: Any refund you receive because you claimed the Refundable Child Tax Credit is not counted as income when determining your eligibility for federal government assistance or benefit programs.

IRS Quick Info Guide

Do I have to repay my Advanced Child Tax Credit?

If you received an Advance Child Tax Credit payment in 2021 but had changes to your family, income, or living situations, then you may have to repay some or all the amount you received to the IRS. 

The amount of Advance Child Tax Credit payments sent in 2021 was based on an estimate of the amount of Child Tax Credits you could claim based on your:

  • Income
  • Filing status
  • Residence
  • Number of dependents.

If your situation changed after you received payments, then the IRS MAY have overpaid you and you may have to repay the IRS by reporting the overpayment on your 2021 tax return. 

Is there help for families & individuals who must repay the Advance Child Tax Credit?

The Repayment Protection Plan can help low-income families and taxpayers.  It is particularly beneficial to families and individuals who had a change in the number of qualifying children in 2021, such as divorced parents with children. 

To qualify for full Repayment Protection and not have to pay back any overpayments, you must meet the following requirements:

  • your main home was in the United States for more than half of 2021 AND
  • your modified adjusted gross income (AGI) for 2021 was:
    •  At or below $60,000 (married filing joint or qualifying widow or widower)
    • $50,000 (head of household)
    • $40,000 (single or married filing separate). 

The Repayment Protection amount is then phased out, or lowered, as your modified AGI gets higher.  If your modified AGI was at or above $120,000 (married filing joint or qualifying widow or widower), $100,000 (head of household), or $80,000 (single or married filing separate) then the Repayment Protection is capped, and you will have to pay back all excess payments. 

To find out more about Repayment Protection and the Advance Child Tax Credit, visit: https://www.irs.gov/credits-deductions/2021-child-tax-credit-and-advance-child-tax-credit-payments-frequently-asked-questions. 

Resources

The 2021 Child Tax Credit | Information About Payments & Eligibility
Determining Your Family’s Child Tax Credit Eligibility | Age & Income
Free Income Tax Preparation Resource: VITA Sites

Filing your 2021 Federal Income Tax return: Earned Income Tax Credit

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More people than ever before will qualify for the Earned Income Tax Credit this year.

For the first time, workers 19-24 and 65 and older without kids at home now qualify for the tax credit, expanding eligibility to millions of additional workers nationwide.  Additionally, if you did not qualify in the past because your income was too high, you may now qualify.  Here’s what you need to know: 

  • You may qualify for a credit of more than $1,500 if you do not have children living with you.  
  • You may qualify for a credit up to $6,700 if you are raising children in your home.  
  • You may qualify if you make $27,380 or less without kids or $57,414 or less with kids. 

To qualify for the federal Earned Income Tax Credit (EITC), you must: 

  • Earn money from a job or certain disability benefits 
  • Be 19-23 years old and not enrolled in school for more than 5 months in 2021 or be 24 years or older. (There is an exception for homeless and former foster youth. Homeless and former foster youth can be 18 or older and enrolled as a student and still qualify for this credit.) 
  • Make $27,380 or less without kids or $57,414 or less with kids in 2021 
  • Have a Social Security number for everyone listed on your tax return, including a spouse or child  

You can check your eligibility by using the EITC Qualification Assistant. 

Make sure to file your taxes by April 18, 2022, so you can claim your credit.  Visit GetYourRefund.org to find out more about how to get this tax credit and others like the Child Tax Credit. 

Earned Income Tax Credit FAQ

I’m between the ages of 19 and 24 without dependents.  Do I qualify?
  • Some 19-24-year-olds who earn less than about $21,000 could now get money back at tax time through an expanded tax credit, even if you don’t have kids and don’t normally file taxes.  
  • Workers who are 19-23 and were a full- or part-time student for more than 5 months in 2021 do not qualify. 
  • Homeless youth and former foster youth ages 18+ who work are eligible, even if they are a student.  
  • You may qualify for a credit of more than $1,500 if you don’t have children living with you. 
  • If you support yourself financially, you can file your own taxes, even if your parents claimed you as a dependent on their taxes in previous years. 
  • Visit GetYourRefund.org to find out more about how to get this tax credit. 

I’m over the age of 65 without dependents.  Do I qualify?
  • If you’re 65 years old or older, you can now qualify for the Earned Income Tax Credit even if you are retired or aren’t caring for any kids in your home.  
  • You may qualify for a credit of more than $1,500 if you don’t have children living with you. 
  • To qualify, you need to have earned income from a job or certain disability benefits, whether you are retired or not.  
  • Social Security benefits and pensions do not count as income for this tax credit.  
  • Don’t miss out on the Earned Income Tax Credit! File your taxes before April 18, 2022.  
  • Visit GetYourRefund.org or call 211 to find out more about how to get this tax credit or to get connected with local IRS-certified free tax filing assistance. You can also connect with AARP Tax-Aide assistance by calling 888-227-7699. 

I’m an immigrant.  Do I qualify?
  • You must be a U.S. Citizen or non-resident alien for all of 2021. 
  • If you have a Social Security number (valid for employment and Issued before the due date of the tax return (including extensions)), you can qualify for the Earned Income Tax Credit when you file your taxes. 
  • You may qualify for a credit of more than $1,500 if you don’t have children living with you or up to $6,700 if you have three or more children. 
  • If you don’t have a Social Security number and your children do, you could get a Child Tax Credit worth up to $3,600 per child when you file a tax return with an Individual Taxpayer Identification Number (ITIN). 
  • Visit GetYourRefund.org to find out more about how to get this tax credit. 

What income do I use to calculate my Earned Income Tax Credit?

You can now elect to use your 2019 earned income to calculate your 2021 Earned Income Tax Credit.   

  • If your 2019 income was higher than your 2021 income, you may enter the amount of your 2019 earned income on your tax return to calculate your 2021 EITC.  This is particularly beneficial for individuals and families whose employment or work was impacted in 2021 by the global pandemic or other factors.   
  • Note: You may not use your 2020 earned income to calculate the 2021 EITC.  You may only use your 2019 earned income. 

More Resources

Find out more about the 2021 Earned Income Credit by visiting: https://www.irs.gov/credits-deductions/individuals/earned-income-tax-credit-eitc 

IRS Earned Income Tax Credit FAQ (English)

IRS Earned Income Tax Credit FAQ (en español)

Wage Theft During the Holiday Season

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The holiday season is busy and stressful for many workers, especially hourly workers in the retail, food service, and delivery sectors. During this busy time, employers are less likely to pay workers for all hours worked or to pay overtime rates. It is important for workers to understand common practices that result in unpaid wages and incorrect hourly rates, also referred to as wage theft.

What to look out for

According to the US Department of Labor, common employment law violations during the holiday season include:

  • Misclassifying employees as independent contractors to evade liability under employment laws
  • Failing to pay salespeople and cashiers for time spent prepping or closing out registers
  • Requiring stock room and warehouse workers to work through breaks without pay
  • Requiring workers to clean or perform closing duties after they have clocked out
  • Failing to pay promised holiday rates or overtime rates

Who is at risk

Temporary holiday and seasonal workers are particularly vulnerable to wage theft. Employers count on these temporary workers to be unfamiliar with their employment rights and too busy to keep careful track of hours worked. Many temporary or seasonal workers are hired through subcontracted companies or temporary staffing firms, making it even more difficult to track down unpaid wages after the holiday rush is over.

What to do

If you think that your employer isn’t paying you proper wages for all hours worked, it is important to keep records of your pay and hours. Make sure to keep any records of agreed upon pay rates, paystubs, and actual hours worked. It is also a good idea to keep records of any communication with your employer, manager, or supervisor regarding your schedule, hours worked, and pay rates. Pay close attention to any differences between promised overtime or holiday pay and the amount you are actually paid.

The US Department of Labor has a free smartphone app to help workers track their hours.

Learn more

You can learn more about your workplace rights in North Carolina by calling the North Carolina Department of Labor’s Wage and Hour Bureau at 1-800-625-2267 (1-800-NC-LABOR). You can also file a Wage Complaint with the Wage and Hour Bureau; more information is available on the NCDOL website.

If you would like to discuss possible unpaid wages, call us at 704-376-1600.

Open Enrollment 2021: FAQ Videos

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Open Enrollment for the Health Insurance Marketplace (AKA Healthcare.gov) will open Nov. 1, 2021, and last until Jan. 15, 2022. 

Our federally trained Navigators answer your top health care coverage questions and share important information on where to find help during this year’s Open Enrollment. Siga el enlace para videos en español.

Frequently Asked Questions

Let’s go over some Open Enrollment vocabulary: ACA, Obamacare, Healthcare.gov, Marketplace
What are the benefits of health care coverage from the Marketplace?
Who qualifies for health care coverage, how do you apply, & why do you need to re-enroll?
What programs are available to help people pay for health care?
What is the Medicaid gap or coverage gap? What are some resources for people in the Medicaid gap?
What are the rules on health care coverage for immigrants?

Where can I get help learning about health care coverage and how to enroll?

Preguntas frecuentes en español

Revisemos algunos conceptos importantes sobre el período de inscripción abierta: ACA, Obamacare, Mercado de seguros y www.cuidadodesalud.gov

¿Cuáles son los beneficios de obtener Seguro de salud en el Mercado de Salud?
¿Quiénes califican para Seguro médico, cómo aplicar y por qué necesita reinscribirse?
¿Qué programas de asistencia financiera están disponibles para asistencia de Seguro médico?
¿Qué es el gap de cobertura de Medicaid?¿Cuáles son las opciones para las personas en el gap de cobertura de Medicaid?
¿Cuáles son las reglas para que los inmigrantes puedan acceder a Seguro de salud?
¿Dónde puedo encontrar más ayuda disponible sobre temas de Seguro de salud?

Basic Health Insurance Terms

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Need to enroll in a health insurance policy or update the one you have?

Open Enrollment for the Health Insurance Marketplace (Healthcare.gov) is Nov. 1, 2022, to Jan. 15, 2023.

GET COVERED

There are a lot of special terms in the health insurance world, and they can be difficult to understand. We’re here to help you make sense of terms you see on Healthcare.gov.

Watch the video and scroll down for more terms defined.

Learn more about how to get covered, or call 980-256-3782 to reach a Health Insurance Navigator for free assistance. You can leave a message with a quick question or schedule a longer phone appointment.

Catastrophic Health Plan
The premium amount you pay each month for healthcare is generally lower than for other plans, but the out-of-pocket costs for deductibles, copayments and coinsurance (see terms defined below) are generally higher. To qualify for a Catastrophic plan, you must be under 30 years old OR get a “hardship exemption” or “affordability exemption” (the Marketplace determines that you are unable to afford health coverage because of the cost of the health insurance plan offered to you is too expensive or you have a financial hardship circumstance).

COBRA
A federal law that may allow you to temporarily keep health coverage after your employment ends. If you choose COBRA coverage, you pay 100% of the premiums, including the portion that your employer used to pay, plus a small administrative fee.

Coinsurance
Like a copayment (see next term), but in the form of a percentage of the cost of a healthcare service (e.g. you pay 20% of the cost of a visit or procedure).

Copayment
A set amount that you pay for a medical service or item, like a doctor’s visit. The insurance company covers the rest.

Deductible
The amount you have to pay for covered health care services (e.g. doctor and hospital visits, labs, etc.) before your health insurance or plan begins to pay. Often, the health insurance company will only pay a percentage of the costs after you reach your deductible. If you think you will need a lot of healthcare services in a year, you should look for plans with a low deductible.

Metal Categories of Health Plans
In addition to catastrophic plans, Healthcare.gov plans come in four metal categories: Bronze, Silver, Gold and Platinum. Bronze plans are usually best for individuals who have few health needs but want to be prepared in case of an emergency. Bronze plans have the lowest monthly premiums, but they have a high deductible. Gold and Platinum plans are often best for people who use a lot of health services. They have the highest monthly premiums, but each visit to the doctor and each prescription will have a low copay/coinsurance. Plans in all metal categories provide free preventive care (for example, a yearly wellness visit to your doctor).

Silver plans are ideal for individuals/families with income less than 250% FPL. If you select a Silver plan, you will receive cost sharing reductions, which means your out of pocket costs (deductible, coinsurance and copays) are also subsidized and may be very low.

Network
The doctors, hospitals and suppliers your health insurer has contracted with to deliver health care services to their members. Ask a healthcare provider if they accept your insurance before you visit. If you go out of network, your care will be more expensive.

Out-of-pocket Maximum
Usually a larger number than your deductible. This is the absolute maximum amount of money you will have to spend in the year on healthcare costs. After you reach this amount, the health insurance company will cover all services 100%.

Plans and Prices Tool: https://www.healthcare.gov/see-plans/#/ 
Saves you time! This tool allows you to see what plans are available in your area and how much financial assistance you qualify for before you fill out an application. 

Pre-existing Conditions
A health problem, like asthma, diabetes, or cancer, that you had before the date that new health coverage starts. Insurance companies can’t refuse to cover treatment for your pre-existing condition or charge you more.

Premium
The amount you pay for your plan each month.

Premium Tax Credit
The “subsidies” that lower the cost of your monthly premiums. You can take the premium tax credits in advance to lower your monthly cost, or you can take them as a refund at tax time.

To look up more key terms, visit the Healthcare.gov glossary.

NC Medicaid Managed Care – FAQs

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North Carolina Medicaid Managed Care- What is it and how does it affect my Medicaid coverage?

North Carolina has undergone a change in how Medicaid benefits are set-up. This change, called the Medicaid Transformation, has caused many Medicaid-eligible individuals to be switched from the traditional Medicaid Direct, managed by the state of North Carolina, to new health plans that are managed by private companies instead. This change took place officially July 1, 2021, but many people are still left with questions about how the changes affect them. Answers to some common questions are below, as well as guidance on where to go for help.