Open enrollment opens Nov. 1 for insurance under the Affordable Care Act, and there is help available in negotiating the various levels of coverage and pricing.
“We met with Blue Cross Blue Shield this past Friday, and they gave us an overview of the plan,” said Cynthia Solesbee, a certified application counselor serving Macon County.
Solesbee came home with some good news: Policyholders in Western North Carolina can expect to see average premium costs decrease by about 3 percent for 2020.
Statewide, the average reduction is 5.5 percent, according to Blue Cross Blue Shield of North Carolina. Premiums declined statewide by an average of 4 percent for 2019.
Otherwise, there are few changes the ACA, also known as Obamacare.
Residents of Western North Carolina have just one ACA carrier, Blue Cross Blue Shield of North Carolina
“Overall, people are really happy with this insurance,” Solesbee said.
The ACA still does not allow insurance companies to deny coverage or charge more for a pre-existing condition.
“All plans cover the same benefits, the 10 essential benefits,” Solesbee said.
Those include preventive and wellness visits; maternity and newborn care; mental and behavioral health treatment; services and devices to help people with injuries, disabilities or chronic conditions; lab tests; pediatric care; prescription drugs; outpatient care; emergency room services; and hospitalization.
One change this year is that the Silver plans, the most popular, will have no tiers of coverage. Bronze plans cover about 60 percent; Silver plans cover about 70 percent; and Gold plans cover about 80 percent.
Solesbee’s job has been made more difficult after two years of funding cuts to provide navigators like her to help people get insurance under the Affordable Care Act. The Trump Administration has also slashed advertising for the Affordable Care Act.
“We found private funding, so we’re good to go,” Solesbee said. “We’re excited about that.”
Nationally, there was a 20 percent decrease in enrollment for 2019.
Last year the administration eliminated the penalty for having no insurance. People who paid that penalty in 2017 or 2018 can get a refund.
Residents of Macon, Jackson and Haywood counties have recouped about $1.5 million in penalties. But getting that money back is not automatic. An application is required, and Solesbee is also ready to help with that.
“We’re here to guide people through the whole process, and to be an advocate,” Solesbee said.
People with “qualifying life events” such as divorce or loss of a job can enroll anytime with help from Solesbee and other navigators.
“We also help people if they have a problem with their insurance, help them file an appeal,” she said.
Open enrollment opens Nov. 1 and runs through Dec. 15.
For more information, call Linda Fitzsimmons, Swain & Graham rep, at 828-550-7908.