FAQs

No one wants to get sick or hurt, but health insurance helps protect against the unexpected and high medical costs. Through protections required by the Affordable Care Act, all health plans on the Health Insurance Marketplace must cover essential health benefits like regular doctor visits, prescription drugs, emergency services, hospitalization, pregnancy and maternity care, mental health care, rehabilitative and habilitative services, laboratory services, preventive services, and pediatric services.

Health insurance Navigators give peace of mind to those seeking free, unbiased help finding quality, affordable health insurance with no pressure. While they are federally certified in navigating the Marketplace on HealthCare.gov, our health insurance Navigators are located in North Carolina. Our Navigators offer experienced counsel to help by:

• Taking time with consumers and helping them avoid mistakes
• Showing consumers all their options and ensuring their providers are in-network
• Explaining terminology and processes, increasing health insurance literacy
• Assisting consumers with estimating their income for the year ahead

Our health insurance Navigators work year-round, not just during Open Enrollment, to answer your questions and address other issues that come up, like qualifying life events and income adjustments. Click here to learn more about the NC Navigator Consortium.

There are a few different documents and pieces of information you need to have to create an account on HealthCare.gov. The following items are required by the Health Insurance Marketplace® to create an account, verify your identity, estimate your income, and see how much financial assistance you qualify for:

• Previous year’s Marketplace enrollment information and HealthCare.gov username and password (if applicable)
• Your best estimate of what your household income will be this year, including employer and income information for every member of your household (for example, from pay stubs, income verification letter from employer, or W-2 forms/tax returns)
• Home and/or mailing address for everyone applying for coverage
• Information about everyone applying for coverage, like Social Security numbers and birth dates
• List of current doctors/providers and medications (if applicable)
• Immigration documents (I-94, green card) (if applicable)

If you are offered job-based coverage, you might be able to enroll in a Marketplace plan, but you probably won’t qualify for financial assistance or other savings as long as the job-based plan is considered affordable and meets minimum standards. Most job-based plans meet these standards.

The Affordable Care Act is the comprehensive healthcare reform law enacted in March 2010 to make affordable health coverage available to more people. (It is sometimes called the ACA or “Obamacare.”) To this end, the Health Insurance Marketplace® was created so consumers could directly enroll in health insurance policies via the HealthCare.gov website. All of these changes have increased access to health insurance coverage for millions, but trying to enroll or update one’s coverage through the Marketplace can be confusing and overwhelming. That’s where health insurance Navigators step in, giving peace of mind to those seeking free, unbiased help finding quality, affordable health insurance with no pressure.

For 2022 coverage, the Health Insurance Marketplace defines affordable job-based coverage as 9.83% or less of an employee’s household income (which may fluctuate each year). Currently, this applies only to the employee and not his or her family. This means that if employer-based coverage is considered affordable for just the employee, it is considered affordable for the whole family, regardless of additional costs. If coverage is considered affordable, family members can either pay full price in the individual market or pay the amount the employer requires to cover the family on the employer’s plan.

The Marketplace uses an income number called modified adjusted gross income (MAGI) to determine eligibility for financial assistance.

An excellent way to estimate your MAGI is to find your household’s previous adjusted gross income (AGI) from your most recent federal income tax return, which can be found on line 7 of IRS Form 1040. From there, you can add any tax-exempt foreign income, tax-exempt Social Security benefits (don’t include Supplemental Security Income (SSI)), and tax-exempt interest. Make sure you adjust your income for any possible changes, like expected raises, changes in employment, or changes in household size.

When estimating your income for Marketplace coverage, it’s important to remember that income is counted for you, your spouse, and everyone you’ll claim as a tax dependent on your federal tax return if the dependents are required to file. Include their income even if they don’t need health coverage.

Click here for a more detailed explanation of estimating your expected income when applying for Marketplace coverage.

Yes. When you submit your application on HealthCare.gov, you’re asked to estimate your annual income, which determines the amount of premium tax credit you receive to help pay for coverage. If your actual income ends up being less than your estimate, you may get a larger refund when you file your taxes. If your actual income ends up being more than your estimate, you may owe money when you file your taxes. The Marketplace will send you a tax form called a 1095-A, and you’ll use the information on that form to reconcile your premium tax credit using IRS Form 8962.

Open Enrollment is from November 1 to January 15. If you miss the Open Enrollment window, you may still be eligible to enroll in Marketplace coverage if you experience specific life changes that qualify you for a Special Enrollment Period. These life changes can include getting married, having a child, having a change in income, or moving could qualify you to enroll outside the open enrollment window. Click here to learn more about qualifying life events.

For more information on Special Enrollment Periods, click here.

Once you’ve submitted your application to the Marketplace, you must pay your premiums to your health insurance company. Premiums must be paid each month to ensure your coverage isn’t canceled.

If you’re having issues with the online payment option, or if you have payment or general questions, you can contact your insurance company over the phone:

Aetna – (800) 872-3862

Ambetter – (833) 863-1310

AmeriHealth Caritas – (833) 613-2262

Blue Cross Blue Shield – (800) 324-4973

CareSource – (833) 230-2099

Cigna – (866) 494-2111

Oscar – (855) 672-2788

United – (800) 980-5213

WellCare – (833) 925-2861

If you are a lawfully present immigrant, yes, you can. Click here to see a list of eligible immigration statuses. If you are a lawfully present immigrant who has been denied Medicaid because you’ve been in the country less than five years, you may be able to get help paying for your coverage even if you don’t meet the income requirements.