North Carolina will receive a boost in federal funding this year to train and recruit “navigators” as the Affordable Care Act enters its third year and penalties surge for those who fail to enroll.
Four North Carolina organizations will receive $3.6 million in navigator grants, with $2.6 million designated for Legal Aid to lead 250 navigators at 14 health care, social service and legal aid organizations. The Legal Aid grant announced Wednesday is the second-largest navigator grant in the nation, behind a $5.9 million award to the University of South Florida.
North Carolina’s navigators have been among the nation’s most organized and most successful in enrolling uninsured people in health coverage under the ACA. The state tallied 492,014 enrollments as of March 31, with 458,738 of those receiving federal subsidies and paying an average $95 a month for health insurance.
Legal Aid and other navigator groups said Wednesday they will continue reaching out to the uninsured, but the organization will also advise those currently enrolled on buying health insurance for 2016. Insurance companies change their plans and prices every year, making it impractical – or impossible – for customers to automatically re-enroll in the same plan year after year.
“This year we’re stressing to consumers that even if you’re already enrolled in a plan, you should seek out a navigator who can help you figure out if your plan is still the best one for you, since new plans are available each year,” said Legal Aid spokesman Sean Driscoll.
For example, Blue Cross and Blue Shield, the state’s largest health insurer, has requested a 35 percent rate increase for ACA plans in North Carolina, and the company expects to eliminate plans that offer unrestricted access to hospitals and doctors.
Legal Aid said it will organize enroll-a-thons, presentations, one-on-one consultations and other outreach activities.
In all, the U.S. Centers for Medicare & Medicaid Services, the agency that administers the national health insurance program, awarded $67 million in navigator grants for 2015-16, up from $60 million a year ago.
ACA enrollment period runs from Nov. 1 through Jan. 31; those who want coverage by Jan. 1 must select a plan by Dec. 15. Enrollment is open year-round for special cases involving a change in household size and other circumstances.
The Affordable Care Act requires most Americans to obtain health insurance and prohibits insurance companies from turning away applicants with pre-existing conditions. Since most Americans get their health insurance through their employer or through a federal program like Medicare or Medicaid, the ACA primarily affects people who buy individual policies directly from insurers.
One factor that is likely to motivate enrollment from those who have not signed up is the higher federal penalty for failing to obtain health insurance.
In 2014, the penalty was the greatest of the following: $95 for individuals, up to $285 for families, or 1 percent of household income minus the federal tax filing threshold. In 2015, the penalty went up to $325 for individuals, up to $976 for families, or 2 percent of household income.
In January, the penalty will be much higher than in the ACA’s first two years: $695 for individuals, up to $2,085 for families, or 2.5 percent of household income.
The penalty will be taken out of tax refunds and can be rolled over into future years if the taxpayer doesn’t qualify for a refund that year.