It’s Open Enrollment season — the time of year when families and individuals make important decisions about their health care insurance for the next 12 months.
For some, the choice will simple; they’ll choose from the options offered by their employers.
But for those without employer-provided health care insurance, the options can be a bit more complex.
To help demystify the Open Enrollment process, we asked Reginald Swann, Charlotte Center Manager with Blue Cross NC, to answers some common questions. (Blue Cross NC is the state’s largest health insurer, serving more than 3.8 million members statewide.)
Who is open enrollment for?
Open enrollment is for anyone who would like to change a current health insurance plan or get a new one.
What are the open enrollment dates?
If you are under the age of 65 and do not want a plan on the health insurance exchange, open enrollment starts Nov. 1 and ends Dec. 15. Plans purchased during this time will become effective January 1, 2022.
If you are buying a plan on the marketplace exchange, you have between Nov. 1 and Jan. 15. However, plans purchased after Dec. 15 will become effective February 1, 2022.
Enrollment for people age 65 and older who are interested in Medicare runs Oct. 15 through Dec. 7.
What kinds of plans does Blue Cross NC offer?
We offer individual and family health insurance plans, Medicare plans, dental plans and vision plans.
We have various options that can meet a customer’s needs. For example, our Blue Advantage plans are a good fit for people who need access to a broad network of medical providers.
Blue Value, however, is a great plan for members who are OK with being a part of a smaller network. Blue Home, with Novant, provides in-network benefits for members who use the Novant provider network and its affiliated doctors and hospitals. Blue Local,with Atrium, offers in-network benefits for members who use Atrium Health and its affiliated doctors and Hospitals. For more information, go here: Individual and Family Plans | Blue Cross NC
What if I want to buy an Affordable Care Act Plan through the marketplace or Exchange? Can a Blue Cross NC representative tell me what it will cost and whether I qualify for a government subsidy or tax credit?
We can show you the Blue Cross NC plans that are available on the Exchange.
We have many options for members to choose from that are on the Exchange. They are broken down into Bronze, Silver and Gold levels. The Gold plan offers the richest benefits (for example, a lower deductible and out-of-pocket costs) but has a higher premium. Bronze and Silver plans may have a lower premium but higher health care costs (such as higher deductibles and coinsurance amounts.)
If you give us your annual household income, we can provide an estimate of what the premium will be for an Exchange plan. We also can enroll people in a Blue Cross NC marketplace or Exchange plan. The federal government, however, will make the final determination about whether or not you qualify for a subsidy. After you are enrolled in a plan, the government will contact you regarding the premium payment.
What should people be thinking about before they enroll in a plan?
People should be thinking about what providers, including doctors and hospitals, fit their needs so that they can identify the best plan and coverage. In Charlotte, for example, people should think about whether they want to go to a Novant doctor or someone affiliated with Atrium Health System. We can help people figure out which plan considers their preferred medical providers as “in network,” which will bring considerable cost savings.
Do I have to pick only one hospital system with Blue Cross NC insurance? What if I go to a doctor that is not in my plan?
Most of our plans in the Charlotte region are specific to specific providers, meaning they have one hospital system and associated providers — mainly Novant and Atrium — considered as in network. We do offer Blue Advantage Plans that cover most statewide providers. If you go to a provider that is not covered as in-network under your plan, you would pay the out-of-network cost (which may include higher co-insurances and a higher deductible, among other costs), and you would not be eligible to use your in-network benefits.
What if a person (or family) makes too much money to qualify for a federal subsidy? Is there an advantage (or disadvantage) in going through the federal marketplace?
They can still go through the marketplace. However, plans will be limited. Going directly through BlueCross NC may provide more options.
Where can a person go to find out at what income levels federal subsidies kick in?
Customers can go to Healthcare.gov to identify income levels. Blue Cross NC also provides an estimated subsidy based off of provided income when providing a quote with a licensed sales agent or online(Free Rate Quote – Blue Cross and Blue Shield of North Carolina | BCBSNC)
When the Covid-19 pandemic began, the federal government raised the income limits to qualify for a subsidy. Will those higher limits be in effect for 2022?
Yes this will still be in affect going into 2022.
What if I qualify for a federal subsidy today but then my income rises (or falls) in the new year?
If your income rises or falls, you are to report that information to the marketplace, and they will guide you through next steps and expectations. They will determine any adjustments if any.
What if I lose my job, get married or have a baby during the new year? Can I adjust my coverage accordingly?
If you lose your job , get married or have a baby during the new year it is considered a “qualifying life event,” and you may make changes to your policy.
Can pre-existing medical conditions affect my insurance premium?
Pre-existing medical conditions do not affect your insurance premiums at this time.
How long does the enrollment process take?
The process typically takes 30 to 40 minutes to complete.
Where should people go for more information?
We have three Retail Centers that people can visit in person to get help.
Click this link to make an appointment. There will be an option to select Boone, Charlotte or Raleigh.
Or, to make an appointment by phone, call 1-888-275-7513. Press 1 for Raleigh; 2 for Charlotte; and 3 for Boone.
We also accept walk-ins between the hours of 9 am and 5 pm.
Charlotte Blue Cross Retail Center
5349 Ballantyne Commons Pkwy, Suite 950
Charlotte, NC 28277
Click here to learn more about Blue Cross NC plans.
Monday-Thursday, 8 a.m. – 6 p.m.
Fridays, 8 a.m. – 5 p.m.