In late March, Morgan Childers, 30, of Cullowhee, logged onto the website, Healthcare.gov, and starred at the plans filling her screen.
Childers had never searched for insurance before, but things changed after she lost her job and employer-sponsored coverage from Western Carolina University. She has an autoimmune disorder and takes thousands-of-dollars-worth of medication every month.
Childers couldn’t afford to be uninsured.
She wasn’t alone in looking for insurance this spring. Nearly half of North Carolina residents get coverage through employers. As the state’s unemployment soared – from 3.6% in February to 12.8% in May – thousands became uninsured. Those fortunate to qualify for new plans were left, perhaps for the first time, to locate insurance on their own.
The COVID-19 pandemic took away health insurance from 238,000 North Carolinians this spring, according to a new study.
The nationwide analysis, from the consumer health care advocacy group Families USA, found a 24% increase in North Carolina workers who became uninsured from February to May. Overall, the state ranks fifth in the country with 1.2 million uninsured adults.
Yet most who lost insurance during the pandemic will face an array of options, each carrying varying costs and benefits.
People may be eligible for subsidized health plans through the federal Affordable Care Act (ACA) marketplace. Others may opt for COBRA, a federal program that lets laid-off workers retain their former employer-insurance at full cost. And those under 26 can join their parents’ plans.
Among the newly uninsured, some may land in the state’s “coverage gap” and struggle to access new plans. North Carolina remains one of 13 states to eschew Medicaid expansion under the federal ACA, commonly known as Obamacare.
Experts and advocates are available throughout the state to help people regain coverage, offering free meetings to go over the details, deadlines, and decisions of a system unfamiliar to many.
“Is it an easy process? No,” said Hyun Namkoong, policy advocate at the N.C. Justice Center. “We have to navigate it for a reason. It’s because our healthcare system and our health insurance system is so complex and convoluted.”
Childers found the process rushed and confusing.
Her income made her eligible for premium subsidies to be used toward private insurance plans, but Childers was unaware and instead picked a more expensive plan called COBRA, which let her keep her former insurance but at close to full cost.
“I probably could have gotten decently priced health insurance instead of paying $600 a month,” Childers said. “If I had known more about it, I definitely would have wanted someone to help walk me through it.”
Exploring the options
While the official ACA enrollment period starts in November, certain “qualifying life events” – like having a baby, getting divorced, or being laid off – triggers a 60-day special enrollment period. Miss the deadline and a person would have to wait until late fall to acquire subsidized healthcare through the federal marketplace.
COBRA ends after 18 months and can be cost prohibitive, with many participants having to pay full premiums without the benefit of a work income.
To determine their eligibility for different plans, individuals must accurately forecast their future earnings, including income and unemployment benefits. An incorrect estimate could close off care options.
Namkoong trains organizations to guide people through these choices. The federal government also connects insurance-seekers with nonprofit assisters and insurance brokers to explore the insurance marketplace together. (Both are free, though brokers receive small stipends from insurance companies for their services.)
“The questions on Healthcare.gov are worded in such a way that they’re not actually very clear and it’s almost like speak in double negatives,” said Geoffrey Ferland, owner of Hummingbird Insurance in Asheville. “It confuses a lot of folks.”
Spring and summer typically are quieter seasons, Ferland said, with fewer people looking for insurance on the federal marketplace.
But the coronavirus outbreak has altered the calendar.
“We saw an immediate uptick right there in March when everything really kind of hit the wall for a lot of people,” Ferland said.
Jaclyn Kiger of the Asheville-based nonprofit Pisgah Legal Services said her organization has had twice as many people reach out for insurance help this June compared to June 2019. Through virtual meetings, Pisgah staff walk clients through insurance jargon like advanced premium tax credits and income-based cost sharing reductions. While the services are specific to ACA, Kiger said Pisgah doesn’t pressure people to enroll in any particular plan.
“We really encourage people to just look at their options,” she said.
Fearing the coverage gaps
Beyond assisters and brokers, the ACA designated money for trained Navigators to help people understand their coverage options. Mark Van Arnam, director of the N.C. Navigator Consortium, said accurately estimating income is a common pitfall for many who misunderstand their eligibility.
“I really encourage them, instead of trying to do it on their own, to reach out to someone who really knows what’s going on,” he said.
Van Arnam estimated 500,000 North Carolina residents a year connect with his network of six nonprofits. He said determining eligibility in North Carolina is more difficult due to the lack of Medicaid expansion.
In recent years, Navigators have seen less assistance from the federal government. According to the Kaiser Family Foundation, Navigators in North Carolina received 85% less federal funding from 2016 to 2018 as the Trump administration reduced its support for Navigators nationwide.
“That significantly hampered our efforts in manpower and outreach, and you know in spreading the word,” Van Arnam said.
Health care advocates are concerned that many North Carolinians who can currently access plans will soon fall into coverage gaps once their unemployment benefits run out.
Morgan Childers is worried too. She fears she won’t be able to afford her COBRA plan if the $600-a-week federal unemployment bonus ends. She continues to look for jobs with health insurance, but has found the search challenging in rural Western North Carolina.
“If I don’t find a job, I’ll be using the rest of my savings to cover the next two months,” she said. “It’s hard to figure out what direction to go in when it comes to health care, but all the average person knows is, ‘I need health care to be available to me.’ ”
Reporter Brian Gordon can be reached at firstname.lastname@example.org.
• 46% of insurance increases during the pandemic were seen in 5 states: Calif., Texas, Fla., N.Y. and N.C.
• An estimated 20% of N.C. adults under 65 are uninsured, up from 16% in 2018.
• More than 1.2 million N.C. adults lacked health insurance in May 2020.
Source: Families USA