Author Archives: jtdickerson

North Carolina newborn insurance coverage

2 Oct , 2014,
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North Carolina newborn insurance coverage

North Carolina newborn health insurance

We can help get your child covered!

Over the course of the year, we have received many inquiries from people wanting to know when a North Carolina newborn can get insurance coverage through the health insurance marketplace. As many people may be aware, most marketplace enrollments are effective the 1st day of the month following the date of enrollment.

However, for newborn children in North Carolina who need insurance coverage, a Special Enrollment Period or SEP is available that will provide coverage effective on the date of birth! This is great news for new parents worried about the hassle of getting a newly born child insured.

What is a a Special Enrollment Period? A special enrollment period is when you have a qualifying life event that allows you to enroll in coverage on or off of the marketplace, outside of open enrollment. Of course, giving birth to a child is one of the many life events that would qualify you for a Special Enrollment Period.

Below is the specific guidance, directly from CMS, that details how Special Enrollment Periods for Nouth Carolina newborn insurance coverage work:

Per 45 CFR §155.420, Special Enrollment Periods (SEPs) constitute periods outside the initial or annual
open enrollment when a QI may enroll in a QHP and QDP or a QI can elect to change a current QHP and
QDP selection as a result of a triggering event, such as birth/adoption, relocation, death, or loss of MEC.
It is the responsibility of the FFMs to determine whether a QI meets eligibility requirements for a SEP.
The FFMs determine eligibility for SEPs, which are described by regulation at 45 CFR §155.420(d). In the
individual market FFMs, Special Enrollment Periods generally last 60 days from the triggering event, per
45 CFR §155.420(c). In SHOPs, including FF-SHOPs, Special Enrollment Periods generally last 30 days
from the triggering event, although there are two exceptions, when an enrollee loses Medicaid or CHIP
coverage and when an enrollee becomes eligible for Medicaid or CHIP coverage For the Medicaid and
CHIP exceptions the SEP is 60 days. The start date of an SEP is based on the date of the triggering event.
Although certain SEPs adhere to the standard effective dates described earlier in section 1.2, there are
exceptions to this rule. For example, for birth, adoption, placement for adoption, or placement in foster
care, coverage is retroactive to the date of birth, adoption, placement for adoption, or placement in
foster care.

North Carolina Newborn Health Insurance Coverage enrollment example:

Example : An enrollee contacts the Marketplace on 09/25/2014 to inform the Marketplace of the birth of
twins on 09/01/2014. The Marketplace does a redetermination of the enrollment group. The Marketplace sends
an 834 change transaction to the selected Qualified Health Plan adding the newborn children with a coverage
effective date 09/01/2014.

Do you need help with North Carolina newborn insurance coverage?

Of course, if all of this sounds complicated, please call (843.882.7062) or email us directly. or leave a comment. We can HELP!


2015 Health Insurance Shopping Tips

30 Sep , 2014,
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Health insurance open enrollment starts November 15, 2014. It is important that everyone take some basic steps to ensure that they make an informed decision on their health insurance plan for 2015. Many things have changed since the last open enrollment, new plans, new pricing, new networks, and don’t forget, the penalty for not buying coverage in 2015 will

2015 NC health Insurance Shopping tips

increase to 2% of your income! At the end of this article we have presented a variety of helpful links for those of you who wish to do your own research. With that said, let’s take a look at we have assembled as our list of  2015 Health Insurance shopping tips for South Carolina residents:


1. GET HELP – Navigators, Health Insurance Agents, & Certified Application Counselors can all help you complete your health insurance enrollment for 2015. Of course, as an independent agent, I am biased towards recommending EVERYONE use an agent. Agents are licensed by their respective state, and are the only assisters that are legally allowed to discuss, compare, and give advice on health insurance plans. Agents are also available year round to help you navigate changes in circumstances which may affect your health plan eligibility. Of course, enrollment assistance is always FREE. It is illegal for anyone to charge you a fee for enrollment assistance. /insurance companies are not allowed to charge you more for enrolling thru an agent or navigator!


2. BE PREPARED – BASIC INFORMATION – You can get enrolled faster if you have all necessary personal information handy when you start shopping. Household income information, Social security numbers, dates of birth and full legal names of everyone applying is a MUST! Having reasonable estimation of your household income will help your agent or assister determine if you may qualify for a tax credit.


3. BE PREPARED – PRESCRIPTION INFORMATION – All health insurance plans have a formulary of covered drugs. A formulary is simply a list that states which drugs are covered by the plan, and what coverage tier each drug falls under. This helps determine your cost sharing when purchasing prescriptions.

2015 health insurance shopping tips

Have your prescription info handy when enrolling! This can save time!

Having a list of your prescriptions handy when enrolling can be helpful when shopping for a plan.

4. BE PREPARED – PROVIDER INFORMATION – Having a list of you or your family’s doctors, specialists and preferred hospitals on hand can be VERY helpful. When I am helping enroll someone, I always take the time to see if your providers are in network. Simply having the doctor or facility’s name is usually sufficient for me to do a quick network search. I have run across many South Carolina residents that enrolled on their own without checking networks first. Many of these people were unhappy to find out a provider or hospital they use is not in their network. As an independent agent, I can quickly help you determine which plan is right for you based on the providers you prefer!

2015 Health Insurance shopping tips

Save time and headaches! A private exchange can help you get enrolled faster!

5. SAVE TIME – As anyone who watches the news knows, applying through could be a tedious process during the last open enrollment. A lengthy application process, combined with technical glitches and a website burdened by high traffic loads made the 2014 enrollment process difficult for everyone. For the 2015 open enrollment period, we have a couple of new enrollment options. First are issuer based pathways, where you can apply directly from an insurance company website. The downside to this is you can only enroll in plans sold by the insurance company website you are visiting. The second option are Web Broker Entities, also commonly referred to as “Private Exchanges”. You can view our private exchange HERE. A Private Exchange has all of the functionality of and lets you apply for tax credits and enroll in a plan without creating an account at The Private Exchange actually uses a secure connection to to confirm tax credits and plan enrollment. We like to refer to it as the faster, more efficient  “back door” to! Our private exchange system allows most people to enroll in under 10 minutes!

This concludes our 2015 health insurance shopping tips for today! Have a tip of your own or a question? Leave us a comment!

IRS releases 2015 HSA limits

24 Sep , 2014,
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2015 HSA limits

The IRS has updated 2015 HSA limits!

The IRS (Internal Revenue Service) has changed the HSA (Health Savings Account) deductible limit for 2015 from $1,250 to $1,300 for self-only coverage and from $2,500 to $2,600 for family and embedded deductible coverage. We anticipate that many North Carolina health plans will adjust deductible amounts to comply with these new deductible limits in 2015. You can view the new limits on the IRS website by clicking here.

Need more info? We can help!

IRS 2015 HSA limits – details:

Annual contribution limitation.

For calendar year 2015, the annual limitation on
deductions under § 223(b)(2)(A) for an individual with self-only coverage under a high
deductible health plan is $3,350. For calendar year 2015, the annual limitation on
deductions under § 223(b)(2)(B) for an individual with family coverage under a high
deductible health plan is $6,650.

High deductible health plan.

For calendar year 2015, a “high deductible health
plan” is defined under § 223(c)(2)(A) as a health plan with an annual deductible that is
not less than $1,300 for self-only coverage or $2,600 for family coverage, and the
annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not
premiums) do not exceed $6,450 for self-only coverage or $12,900 for family coverage.

IRS: New draft tax guidance for Affordable Care Act

Sep , 2014,
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As reported by Benefitsnews, the IRS (Internal Revenue Service) has released new draft instructions, notices and a publication to help taxpayers and tax preparers deal with the premium tax credits associated with the Affordable Care Act.

The draft instructions were released last week (week of September 15, 2014) for Form 8962, “Premium Tax Credit,” and Form 8965, “Health Coverage Exemptions.” The IRS had previously released draft versions of the forms themselves, both 8962 and8965, along with draft instructions for several other draft forms for the Affordable Care Act (see IRS Gears up for Impact of Health Care Reform on Tax Season).

Need help to see if you qualify for premium tax credits? Our 10 minute enrollment system can help you save time during the upcoming open enrollment! We can help!

Update: 2015 Unitedhealthcare North Carolina plan information!

11 Sep , 2014,
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We have recently discovered new information regarding UnitedHealthcare’s expansion into the North Carolina individual health insurance marketplace for 2015! Everything published below is available by searching the North Carolina Department of Insurance SERFF filing portal. As your North Carolina Obamacare agent,  we work hard to keep you informed on the latest ACA news for North Carolina residents.

The first piece of news is that UnitedHealthOne will not be marketing plans in geographic rating areas 12 & 16. Based on our research, this includes 19 counties that will not have UnitedHealthcare Individual health plans available on the Exchange for purchase in 2015. These counties include:

Rating Area 12


Rating Area 16


In addition, based on recent filings, it appears that Unitedhealthcare has lowered their rates in Geographic Rating area 9, due to a new hospital contract that was recently renegotiated. Rates in this area are expected to be approximately 16% less than what was originally forecasted. This is GREAT NEWS for NC residents of Richmond, Scotland, Robeson, Bladen, Sampson, Cumberland, Hoke, and Harnett counties!

Please keep in mind that all information presented above is based solely on public filings made available by the NC Department of Insurance and may be subject to change. If you need help finding a health insurance plan in North Carolina, please contact us now!

UnitedHealthcare to enter North Carolina Health exchange for 2015!

14 Jul , 2014,
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Great news for North Carolina residents! As reported by the News & Observer recently, UnitedHealthcare has filed with the North Carolina Department of Insurance to sell health plans on the North Carolina health insurance Exchange for 2015. Currently, North Carolina has only 2 health insurers on the exchange for 2014: BCBS-NC and Coventry Healthcare. Currently, many North Carolina residents only have one choice of insurer on the exchange as Coventry currently does not have a plan in every North Carolina county.

North Carolina Health Exchange Rates

NC residents will have more health plan options in 2015!

The addition of UnitedHealthcare  to the North Carolina Health Insurance Exchange could have a huge benefit to North Carolinas residents! As an independent health insurance agent, we at believe that competition among health insurance companies is a POSITIVE! As an independent health insurance agent, we have worked with UnitedHealthcare for nearly a decade, and look forward to offering UnitedHealthcare plans on the North Carolina health insurance exchange for 2015!

Who is UnitedHealthcare? UnitedHealthcare is an operating division of UnitedHealth Group, the largest single health carrier in the United States.

From UnitedHealthcare:

As a recognized leader in the health and well-being industry, we strive to:
Improve the quality and effectiveness of health care for all Americans
Enhance access to health benefits
Create products and services that make health care more affordable
Use technology to make the health care system easier to navigate
Our family of companies delivers innovative products and services to approximately 70 million Americans. UnitedHealthcare’s nationwide network includes 751,609 physicians and health care professionals, 80,000 dentists and 5,629 hospitals. Our pharmaceutical management programs provide more affordable access to drugs for 13 million people.

We’re committed to the delivery of quality care and its continual improvement. In fact, UnitedHealth Group made significant investments in research and development, technology and business process improvements – nearly $3 billion in the past five years. These investments led to changes that are improving the way care is delivered and administered across the entire industry.

Need more information? Contact us TODAY!





Get Obamacare North Carolina

9 Jan , 2014,
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Get Obamacare North Carolina: We can help!

If you need to get Obamacare in North Carolina during the 2013-2014 open enrollment season, we can help! Our new video series will help you complete the initial steps needed to get Obamacare North Carolina and get enrolled in a 2014 health insurance plan on Our team at can help you with your Obamacare enrollment from start to finish via our remote meeting service! As a certified South Carolina Obamacare agent and North Carolina Obamacare agent, we can help you in ways that Navigators cannot. As a marketplace certified agent, we can make recommendations and comparisons regarding your health plan options. Having been licensed in the health insurance agency for over 10 years, we have the experience to help you make the right choice when you decide to get Obamacare in 2014.

Get Obamacare North Carolina: Subsidy eligibility

When you log in to, the first step to complete your enrollment is to complete the subsidy application process. This process will determine if you are eligible for either of 2 types of health insurance subsidies. The first subsidy, known as Advanced Premium Tax Credits (APTC for short) is a subsidy that may reduce the monthly cost of your insurance. The second type of subsidy is known as a cost sharing reduction subsidy (or CSR for short). The CSR comes in 3 different “flavors” and may reduce your out of pocket costs on health care services such as doctor and hospital visits, as well as prescription drug costs. It is IMPORTANT to note, that if you qualify for a CSR, YOU MUST ENROLL IN A CSR ELIGIBLE PLAN to receive your CSR subsidy! If you need help determining which North Carolina Obamacare plans are CSR eligible, please feel free to contact us for help!

Get Obamacare North Carolina: Choosing a Plan

Once you have completed the subsidy eligibility process, it is time to choose a plan! At this point we recommend you contact us directly for assistance.

Get Obamacare North Carolina

As many people are well aware, the cheapest health insurance plan may not be the best plan for your specific health care needs. We can help you determine which plan best suits your individual needs, whether you need a higher deductible with lower costs, more comprehensive coverage, or coverage that includes specific doctor and hospital systems as in network providers. Need access to the Duke Medical Center in Raleigh/Durham or Carolinas Medical Center in the Charlotte area? We can help you select a plan with Duke and/or CMC in network! Worried about the hospital in your neighborhood being covered by your plan? Let us help you do a network provider search! Need a plan with out of network benefits? We can help!

Get Obamacare: Video Tutorial Series

16 Dec , 2013,
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Do you need help with We can show you how to get Obamacare NOW! Today we begin the first in a series of videos designed to help you get started with the enrollment process at Today’s video will show you the process used to create your account at and verify your identity at


As your #1 North Carolina Obamacare Agent we are committed to helping North Carolina residents find the best, most affordable coverage for your unique situation. As a licensed health insurance agent/broker for over 10 years, we have the experience needed to help you make the right decision. Many North Carolina residents will qualify for lower costs on their health insurance premiums through The first step to finding your health insurance coverage for 2014 is to create an account at create an account at healthcare.govcreate an account at Not sure which plan to choose? Contact us today, and we can help you determine if you may qualify for a health insurance tax credit to lower your costs!

Why create your account at

By creating your account at, you are just minutes away from determining if you qualify for a premium tax credit to help get Obamacare. Many North Carolina residents who apply through may also qualify for cost sharing subsidies. These tax credits and cost sharing reductions are only available for health insurance plans purchased through We can help you with the process! Get started today by watching our video and create your account!

 Is it safe to get Obamacare at

After the SC Department of Revenue breach to our south in 2012, it is understandable that many NC residents are wary of their online privacy. While many people are worried about the security of their information at, we would like to point out that identity theft happens all over the internet. If you use popular services such as Facebook, Google, or online banking, chances are your information is already readily available on the internet. We recommend everyone who uses the internet on a daily basis be wary of their personal information safeguards, use strong passwords, clear your browser cache regularly and use 2-step authentication where possible. As an online health insurance agent, I use a variety of security methods such as encryption, 2 step authentication, virus protection and strong passwords to ensure HIPPA compliance and my own personal data security.

North Carolina Marketplace Update – December 10, 2013

10 Dec , 2013,
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This is simply a quick update, as we are BUSY helping people get enrolled! The health insurance exchange has been functioning fairly reliably over the past couple of weeks. Noticeable improvements to occurred in the December 1st, 2013 update. These improvements included many new features that allow us, acting as your North Carolina Obamacare Agent, to resolve many of the glitches previously experienced on If you have tried to complete an application and received errors, CALL US TODAY at 843-367-8372 – we can help!

Last Friday, I was able to enroll a single person, with premium subsidies and cost sharing subsidies in UNDER 25 minutes! Health Insurance APPROVEDToday, I helped a Wake county resident save over almost $400 a month with a new 2014 plan. However, TIME IS RUNNING OUT if you need new insurance effective January 1st, 2014. Please call or email us ASAP if you need January 1st coverage. As we get closer to the December 23rd and December 15th deadlines, the Exchange Marketplace website is getting busier. This morning was very busy, with wait times up to 15 minutes just to get in. Thankfully, we also have the issuer-based pathway, AKA the “backdoor” access to the Federal Exchange Marketplace. Thankfully, the “backdoor” has not been subject to the long wait times experienced on the front end of

Carrier direct policy subsidies?

27 Nov , 2013,
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We recently receive news of another possible workaround for the problem plagued website. Last week I learned that the National Association of Health Underwriters (NAHU) has requested clarification from the IRS on the subject of subsidy eligibility for consumers who purchase a Qualified Health Plan (QHP) directly from an insurer. Specifically, it was asked if subsidy determination could be made at a later date, for example, at the time of 2014 tax filing. Currently, as the law stands, coverage must be purchased through the Federal Marketplace to be subsidy eligible. However, a change in this interpretation of the law could open the door for many more consumers to get enrolled, without the burden of applying through The downside, however, is that consumers would have to finance the entire unsubsidized cost of the premium up front. Considering the median household income in North Carolina is roughly $45,000 per year, this could present a financial challenge for many residents who are already struggling with high premiums. However, we view any additional enrollment options as a move in the right direction! See below for the full NAHU update on the subject of carrier direct policy subsidies:

Finally, NAHU is seeking clarification from the IRS on a subsidy issue, which if resolved could also facilitate enrollment more directly. We have requested immediate clarification if individuals who can afford to advance the premium on their own monthly but might also be subsidy eligible could by an exchange offered QHP directly from a carrier “off the marketplace” and with out getting a marketplace subsidy determination. We have asked if it would be permissible for those individuals to obtain a subsidy determination and advance premium credits later, when the marketplace is working better, or simply claim the credit on their 2014 taxes with an exchange-based determination. As soon as we get resolution to this issue, we will let the membership know.

Stay tuned to your North Carolina Obamacare Agent for the latest breaking news regarding healthplan subsidies for NC residents