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Affordable Care Act enrollment is open for 2022. Here's what NC residents should know

In this 2020 photograph, captured inside a clinical setting, a health care provider and patient, consult on influenza vaccine options.

It’s time to sign up for Affordable Care Act — aka Obamacare — coverage for 2021. Open enrollment lasts until Jan. 15, although you need to sign up by Dec. 15 if you want coverage starting Jan. 1.

Those who sign up for coverage are in for some changes. Ten companies now offer plans in North Carolina. Five years ago, only one company, Blue Cross Blue Shield, offered policies in all 100 counties.

And if you’re uninsured, you may be in for a big surprise. More than 360,000 North Carolinians will be able to get free or low-cost coverage this year, including many people who haven’t been eligible for subsidies in years past.

We'll go over a few things you need to know about enrolling this year.

Obamacare policies are less expensive

Coverage is less expensive because government subsidies are larger. The Centers for Medicare and Medicaid says premiums are at a record low, and 4 out of 5 people will be able to get coverage for $10 a month or less.

Subsidies are higher because Congress included a temporary expansion of Obamacare assistance in last year’s COVID-19 stimulus bill. It also increased the number of people eligible for those subsidies.

At least 369,000 North Carolinians became eligible for no-cost premium policies last year, according to estimates by the Kaiser Family Foundation. They’ll be able to get those policies again this year. That includes many who haven’t been eligible for ACA coverage at all in the past.

You may be eligible for coverage this year, even though you haven’t been in years past

Up until last year, anyone who made less than 138% of the poverty level — that’s $17,774 a year for an individual — couldn’t get an ACA policy because they’re supposed to be covered through expansion of the Medicaid program. Most states went ahead and expanded, but North Carolina hasn’t.

Now some North Carolinians in that coverage gap can get zero-premium policies. These are people who earn between 100% and 138% of poverty. That’s about $12,880 to $17,774 a year.

You may be eligible for a subsidy this year, even though you earned too much to qualify previously

Some higher earners will qualify for subsidies this year. Under the COVID stimulus bill, no one will have to spend more than 8.5% of their income on premiums regardless of their income level. And people who earn between 400% and 600% of the poverty level — that’s $51,520 to $77,280 a year — now qualify for subsidies for the first time. The Kaiser Family Foundation estimates that group will save an average of $213 a month for a Silver Plan.

uninsured individuals aca zero premium kff.jpg
Kaiser Family Foundation

It's worth checking whether you qualify for a lower-cost plan

Only 124,000 North Carolinians signed up for new coverage during the special enrollment period last year after Congress passed the stimulus. That means that thousands of people who qualified for the no-cost premium plans missed out.

A lot of people just didn’t know about the changes. Mark Van Arnam, who heads the group that helps people enroll in plans — the North Carolina Navigators —says some people think the ACA was struck down. And some people haven’t signed up because they’re politically opposed to Obamacare.

Part of the problem may be that funding for outreach was cut during the Trump administration. But the Navigators are getting more funding this year, and they’ve been advertising.

Chris Telesca is one of the people who would have been eligible for zero-premium coverage last year. The Raleigh resident says he didn’t sign up because he’d tried to get a policy shortly after the ACA went into effect and got discouraged, so he didn’t want to try again.

“I signed up for the Obamacare website years ago,” he said. “It’s difficult to navigate. It was not a very well-designed web page. I got in there. I got to a page. I clicked on the link. Nothing happened.”

But the website is working fine this year. And you can contact a Navigator if you need help figuring out your choices.

You may have more plan choices this year

Ten companies are offering ACA policies in North Carolina this year, up from six last year. Arnam says that’s creating competition, and that’s another reason premiums are lower. National estimates find ACA premiums are declining in states with more plans.

The new subsidies are temporary

The expanded subsidies run out at the end of the 2022. They could be extended again. The subsidies are part of the large funding bill congressional Democrats are trying to pass.

But Van Arnam says that even if the subsidies go away at the end of next year, at least people can get lower cost coverage now. He’s encouraging people to sign up and get as much preventative and primary care as they can.

Where do I go for more information?

You can learn about Affordable Care Act coverage at healthcare.gov.

You can learn how to speak with a Navigator at ncnavigator.net.

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Dana Miller Ervin is the Holly and Paul Freestone Health Care Reporting fellow at WFAE, examining the U.S. health care system.