NASW-NC Social Work Blog

Your source for the social work profession in North Carolina.

The Affordable Care Act: What Providers Should Know

With October 1st just around the corner, many people are scrambling to get information about the health insurance exchanges and what changes will happen. Open enrollment begins October 1st, 2013 and plans go into effect January 1st, 2014. Anyone can sign up for a plan before March 31st, 2014. You cannot be denied for preexisting conditions. Three insurance companies will be offering plans in NC:

Blue Cross Blue Shield of NC (BCBS of NC) will offer plans to residents in ALL 100 counties. BCBS of NC offers an online Blue Map to help find a plan that fits you best. Also see BCBS of NC’s announcement of offered plans as these will be what is available to NC citizens in every county. While the individuals plans are not released, you can get a snapshot of coverage.
Coventry Health Care of the Carolinas (Aetna) will offer plans in about 40 counties in the state and should release their plans soon.
FirstCarolinaCare will offer plans in  six counties in the state including Moore and the five surrounding counties. See offered plans and a subsidized chart here.

** Update: After this post went live, FirstCarolinaCare dropped out of the exchanges. Only TWO organizations will operate the exchanges. See more on this announcement here

All plans will be tiered- bronze, silver, gold, and platinum and will offer catastrophic categories. Not all carriers will offer plans at all levels but they must offer at least one silver level plan and one gold level plan. Though plans will vary from state to state, ALL plans must cover a basic level of care called essential health benefits, including: prevention and wellness, ambulatory (outpatient) care, laboratory services, emergency care, hospitalization, maternity and newborn care, pediatric care (medical, dental and vision), mental health and substance use disorder services, prescription medications, rehabilitation and habilitation. There will be subsidies available to help individuals paying for plans AND some employers will offer Health Reimbursement Arrangements (HRA) for those purchasing plans outside of their places of employment. To see what subsidies you are eligible for, use this calculator.

For people who are ensured by their employers, they do not need to do anything if they are happy with their coverage. It is the employer’s responsibility to ensure that their offered plans cover the basic essential benefits listed above.

5 Things Providers Should Know (from Enroll America)

  1. Inform yourself and your staff so you can discuss the new health insurance options with your patients. Visit www.cuidadodesalud.gov and www.healthcare.gov or call1-800-318-2596, TTY: 1-855-889-432
  2. Provide materials in your waiting room about how your patients can enroll with the Health Insurance Marketplace.
  3. Become a Certified Application Counselor Organization. Train staff to be Certified Application Counselors (CACs). For training and information, click here.
  4. Know where navigators and other CACs are located in your community so you can refer patients for assistance. For a list of NC organizations, click here
  5. Examine your own data to identify uninsured people in your community and inform them.

With so many changes on the horizon, be sure to turn to NASW for resources and questions!

NASW resources:
NASW Health Care Reform: Member Resources
NASW News: Open Enrollment Begins Oct. 1
NASW-NC resource (2012): The Affordable Care Act and Its Implications for Social Workers 

Other resources on understanding the Affordable Care Act:

Enroll America (with offices in Raleigh and Charlotte, NC)
The Arc: The Affordable Care Act: What Nonprofit Employers Need to Know
Health Insurance Marketplace: www.healthcare.gov
The Kaiser Family Foundation: www.kff.org

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3 comments on “The Affordable Care Act: What Providers Should Know

  1. Helen Adamopoulos (@BHR_Adamop)
    September 12, 2013

    Great post. In case you’re interested, HHS has also issued must-know lists for providers and patients concerning the ACA exchanges: http://bit.ly/19mddXb.

  2. naswnc
    September 13, 2013

    Thank you for this additional resource!

  3. Pingback: Affordable Care Act Facts | NASWNC

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This entry was posted on September 12, 2013 by in Advocacy and tagged , , , , , .

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