Special Enrollment Period Options
ACA Marketplace Plans
You may qualify for a Special Enrollment Period!
You qualify for a Special Enrollment Period if you’ve had certain life events including:
- Losing health coverage at your job
- Losing other health insurance coverage
- Moving to a new state and need health coverage
- Getting married
- Having a baby, or adopting a child
- Turning 26 years old
- If your household income is below a certain amount.
ACA Health Insurance aka Obamacare with ppo options and dental insurance are available.
Special Enrollment Period
Open enrollment begins November 1st, but have you had a qualifying life change? You don't have to wait for open enrollment.
Health Insurance Plan Levels
Bronze 60/40 plan
Bronze 60/40 plan
Bronze 60/40 plan
- Most affordable monthly cost
- Highest costs when you use the insurance
- Preventive Care doctor visits are free and do not require coinsurance or copays in many cases.
Silver 70/30 plan
Bronze 60/40 plan
Bronze 60/40 plan
- If you qualify for cost-sharing reductions in addition to your advanced premium tax credit subsidy, you must pick a Silver plan to get the extra savings. You can save hundreds or even thousands of dollars per year if you go to the doctor.
- Moderate monthly premium
- Moderate decuctible costs
Gold 80/20 plan
Bronze 60/40 plan
Gold 80/20 plan
- High monthly premium
- Low costs when you need care
- Deductibles — the amount of medical costs you pay yourself before your plan pays are usually low.
REAL LIFE example of a $0 plan!
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Your healthcare needs and budget are as unique as you are. That’s why we offer North Carolina plans across a range of price levels. We can help you find a plan that’s right for you, whether you’re an individual who only needs emergency coverage or part of a large family with more extensive healthcare needs. Plus, if your income is between 100% and 400% above the Federal Poverty Level , you could qualify for a government subsidy to help pay your health insurance.
What does that mean? If you're single and make at least $15,060 per year, you could qualify! For a family of 3, you need to make at least $25,820 and a family of 4 would need to make $31,200 per year to qualify for government subsidies. Here are the HHS Poverty Guidelines.
Among those who qualify for subsidies, the average cost of health insurance in North Carolina is $68.00 per month. However, rates vary based on income, and the cost can be as low as $0 per month! ACA Health Insurance aka Obamacare with PPO options and dental insurance are available.
Advanced Premium Tax Credit & Cost-Sharing Reductions
If you don’t have health coverage through an employer and you’re not eligible for Medicare or Medicaid, you may qualify for a health care subsidy. Established by the Affordable Care Act (ACA), this federal assistance covers some of the premium and out-of-pocket costs of health coverage. There are two types of subsidies offered:
Advanced Premium Tax Credit (APTC): This subsidy helps lower your monthly insurance premiums. It’s based on the cost of health coverage in your state, your estimated income and your household size, which includes you, your spouse and any tax dependents.
Cost-Sharing Reductions (CSRs): This subsidy offers extra savings that reduce out-of-pocket costs by decreasing deductibles, coinsurance, copays and out-of-pocket max. If you qualify for CSRs based on your income, you must enroll in a plan that falls in the Silver ACA level to enjoy these extra health insurance savings.
The best part is you may be eligible for both types of subsidies, which can dramatically lower your annual health insurance costs.
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What is an Affordable Care Act (ACA) subsidy?
The Affordable Care Act (ACA) subsidies are tax credits that allow you to pay less for a health insurance plan purchased on an ACA marketplace.
- How it works: When you use the subsidies, the cost of private health insurance is reduced based on the size of your family and your household income. Subsidies can be applied throughout the year to lower your monthly bill, or the lump sum can be taken as a deduction when you file income taxes.
- Who can sign up: Health insurance subsidies are available for those whose income falls in a certain range, depending on family size, and who buy insurance on HealthCare.gov or a state-run health insurance marketplace.
- Which insurance plans qualify: ACA subsidies can be used to lower the cost of insurance from any company, and the discount can be applied to four levels of coverage: Bronze, Silver, Gold and Platinum. They can't be used for the cheapest options: Catastrophic plans, Medicaid, the Children's Health Insurance Program (CHIP) or coverage offered by your employer.
Health Insurance Options
ACA Marketplace Plans
What prescriptions are covered by my plan?
- Your plan will help pay the cost of certain prescriptions.
- Your plan’s list of covered drugs is called a "formulary."
- Visit your plan’s website, call their Member Services, or review your Summary of Benefits and Coverage for a list of covered drugs.
How can I find a doctor in my plan?
- Most plans give you the best price on services when you go to an "in-network" health care provider who has a contract with the plan.
- You may be able to visit doctors who aren’t in your plan’s network, but you may pay more.
- Learn how to find a doctor in your plan's network.
How do I use my coverage?
- Learn how to stay healthy and get the care you need (PDF, 698 KB). You’ll find tips on where to go for care, how to find a provider, and more.
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