Health Care

NORTH CAROLINA CONSUMER ASSISTANCE

The North Carolina Consumer Assistance Program provides residents with help regarding questions or problems related to health coverage. Assistance is available by phone, email, or in person.

Main Office

Health Insurance Smart NC
NC Department of Insurance
430 N. salisbury Street
Suite 108
Raleigh, NC 27603
Toll free: 877-885-0231
www.ncdoi.com/Smart/

Eastern Regional Office

Health Insurance Smart NC
NC Department of Insurance
1316 Unit A Commerce Drive
New Bern, NC 28562

Western Regional Office

Health Insurance Smart NC
NC Department of Insurance
537 College Street
Asheville, NC 28801

     AFFORDABLE CARE ACT     

As a result of the Affordable Care Act, families will soon be free from the constant worry that they will not be able to get health care when they need it the most.  But repealing the law would strip Americans of this new freedom and take us back to the days when big insurance companies had the power to decide what care residents of North Carolina could receive—allowing them to once again deny coverage to children with pre-existing conditions, cancel coverage when people get sick, and place limits on the amount of care people can get, even if they need it. 

Without the law, insurance companies could overcharge for insurance just to boost their profits, or use fine print to deny medical treatments that are covered under people’s policies. In addition, repealing the law would increase the national debt by at least a trillion dollars to the deficit, which Americans simply cannot afford.

This year, Americans will be able to enjoy a number of new benefits and protections under the Affordable Care Act including:

Bringing Down the Cost of Health Care Coverage. Health insurers, including grandfathered plans, must annually report on the share of premium dollars spent on medical care as opposed to profits or administration and provide consumer rebates where less than 80 to 85 percent of dollars are used for benefits.

Strengthening Community Health Centers and the Primary Care Workforce. Provides funds to build new and expand existing community health centers, and expands funding for scholarships and loan repayments for primary care practitioners working in underserved areas.

Increasing Reimbursement for Primary Care. Provides a 10 percent Medicare bonus payment for primary care physicians and general surgeons.

Increasing Training Support for Primary Care. Establishes a Graduate Medical Education policy allowing unused training slots to be re-distributed for purposes of increasing primary care training at other sites.

Improving Health Care Quality and Efficiency. Establishes a new Center for Medicare & Medicaid Innovation to test innovative payment and service delivery models to reduce health care costs and enhance the quality of care provided to individuals.

Improving Preventive Health Coverage. Provides a free, annual wellness visit and personalized prevention plan services for Medicare beneficiaries and requires new plans to cover preventive services with little to no cost sharing. Creates incentives for State Medicaid programs to cover evidence-based preventive services with no cost-sharing, and requires coverage of tobacco cessation services for pregnant women.

Improving Transitional Care for Medicare Beneficiaries. Establishes the Community Care Transitions Program to provide transition services to high-risk Medicare beneficiaries.

Expanding Primary Care, Nursing, and Public Health Workforce. Increases access to primary care by adjusting the Medicare Graduate Medical Education program. Primary care and nurse training programs are also expanded to increase the size of the primary care and nursing workforce. Ensures that public health challenges are adequately addressed.

Increasing Access to Home and Community Based Services. The new Community First Choice Option, which allows States to offer home and community based services to disabled individuals through Medicaid rather than institutional care, takes effect on October 1, 2011.

Transitioning to Reformed Payments in Medicare Advantage. Freezes 2011 Medicare Advantage payment benchmarks at 2010 levels to begin transition. Continues to reduce Medicare Advantage benchmarks in subsequent years relative to current levels. Benchmarks will vary from 95% of Medicare spending in high-cost areas to 115% of Medicare spending in low-cost areas. Changes are phased-in over 3, 5 or 7 years, depending on the level of payment reductions.

Discounts in the Part D “Donut Hole”: Provides a 50 percent discount on all brand-name drugs in the donut hole and begins phasing in additional discounts on brand-name and generic drugs to completely close the donut hole by 2020 for all Part D enrollees.

Reporting Health Coverage Costs on Form W-2: Requires employers to disclose the value of the benefit provided by the employer for each employee’s health insurance coverage on the employee’s annual Form W- 2.

Standardizing the Definition of Qualified Medical Expenses. Conforms the definition of qualified medical expenses for HSAs, FSAs, and HRAs to the definition used for the itemized deduction. An exception to this rule is included so that amounts paid for over-the-counter medicine with a prescription still qualify as medical expenses.

Increased Additional Tax for Withdrawals from Health Savings Accounts and Archer Medical Savings Account Funds for Non-Qualified Medical Expenses. Increases the additional tax for HSA withdrawals prior to age 65 that are not used for qualified medical expenses from 10 to 20 percent. The additional tax for Archer MSA withdrawals not used for qualified medical expenses would increase from 15 to 20 percent.

Cafeteria Plan Changes. Creates a Simple Cafeteria Plan to provide a vehicle through which small businesses can provide tax-free benefits to their employees. This would ease the small employer’s administrative burden of sponsoring a cafeteria plan. The provision also exempts employers who make contributions for employees under a simple cafeteria plan from nondiscrimination requirements applicable to highly compensated and key employees.

Pharmaceutical Manufacturers Fee. Imposes an annual, non-deductible fee on the pharmaceutical manufacturing industry allocated according to market share and not applying to companies with sales of branded pharmaceuticals of $5 million or less.

For more information about the specifics of the new law, please visit - http://www.healthcare.gov/