Thousands In WNC Without Insurance Face Penalties, But One Mountain Group Says They Don’t Have To

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By Davin Eldridge–Staff Writer

Last year when Mission Health and insurance company Blue Cross and Blue Shield grappled over who was going to pay for what, the often rocky terrain of the insurance maze became even more confusing. Even when the two entities came to an agreement in early December, consumers were still left wondering where they stood and if the insurance plan they purchased would be honored barring further disputes. 

That outlook carried over at the start of the new year, when the number of North Carolinians who signed up for the Affordable Care Act this dropped from previous years—from just over 549,000 in 2017, to 523,989 people this year, according to federal figures. That’s a 4.6 percent drop in ACA enrollments.

That decrease translates to sluggish growth at the local level. According to the Centers for Medicare & Medicaid Services (CMS), the total number of Macon County residents that selected an exchange plan this year was 2,322. Only 527 of them were considered new customers, meaning a grand total of 1,795 people in the county re-enrolled in ACA plans—just over five percent of the population.

This has left many in the mountains unsure of the consequences they’ll face as a result of not having health insurance—a penalty under “Obamacare.” Meanwhile it’s left many more, who are aware of the repercussions, seeking any kind of relief they can get in the form of tax exemptions.

Fortunately, there is hope. It was recently found in the form of a completely free event held at the Macon County Public Library.

“The people we’ve helped are very excited and appreciative that we are helping them get the process started so they will get the money back they paid as a penalty for having no insurance,” said Cynthia Solesbee, of Mountain Projects—a regional social services group that’s provided healthcare navigation services since 2013. “Throughout the years, as part of our job, we’ve helped people apply for exemptions from the penalty for not having health insurance.”

If a person experienced some sort of hardship throughout the year, such as having their utilities shut-off, Solesbee said such situations constitute an exemption from the penalty.

New exemptions were announced this year through a Department of Health & Human Services memo dated April 9, and as a result, Solesbee said the group has kept steadily busy raising public awareness of them.

“Nearly everyone will qualify for them if they live in Western North Carolina,” she said. “These new exemptions are effective back to the tax years 2016 and 2017, and this year, 2018.”

The event was just one of many regularly scheduled throughout the mountains. Mountain Projects is planning to hold future events in each county to get the word out.

“However, to be clear, we are available to assist people with exemption applications anytime, not just at these events,” said Solesbee. “This is part of our job, and because we have Navigators in every western county, we are able to assist people during the week, at our offices, depending on a time that is convenient for a person.”

According to Mountain Projects Director Jan Plummer, the group has received no shortage of phone calls from the public about where it stands.

“We’ve heard from a lot of folks who’ve been worried about the penalty,” said Plummer, adding that her group helped more than 6,000 people sign up for health insurance last year, since the beginning of ACA. Many residents throughout the region got their plan through Blue Cross Blue Shield—a provider that, until last winter, wasn’t sure if it would continue to offer coverage to Mission Health. After a widely unpopular contract dispute last year, the two entities reached an agreement in December. BCBS is one of the last remaining

Insurance providers active in the mountains.

The number of exemptions Mountain Projects has assisted locals in applying for indicates a growing awareness . Since April 9, the group has helped mountain residents complete 126 exemption applications who have paid in excess of roughly $42,000 in penalties. Since the beginning of open enrollment on Nov. 1 of last year, the group assisted with 511 exemptions.

“Some people apply for an exemption for multiple tax years,” said Solesbee. “This is a two-step process. First, the tax filer must apply for the hardship exemption for anyone in their tax household who was uninsured and fined. Second, after the exemption is approved, the tax filer will need to file an amended tax return with their exemption certificate number (ECN) for 2016 or 2017, or both.”

Solesbee said the ECN will also prevent the tax filer from being penalized for the current tax year. She stressed that Navigators do not assist with tax preparation, so the tax filer would need to return to their tax preparer to amend their past returns.

“The public seems to be very enthusiastic about the opportunity to get back the money they’ve paid for having no insurance. The penalty could be substantial each year: $695 per adult and $347.50 per child, or 2.5% of your income — whichever is higher. We’re trying to get the word out so people can get their money back as soon as possible.”

The group has gleaned a great deal from the public regarding its own standing in the ACA.

“What we’ve seen is that people aren’t aware of how much they paid in penalties for no insurance,” said Solesbee. “That’s probably because, for the most part, the penalty is netted against their refund when a person files their taxes, and therefore it may not be clear just how much they paid.”

Solesbee said it’s probably a good idea for taxpayers to review their tax returns from previous years to determine exactly how much they paid in penalties.

“It could be a substantial amount,” she said, adding that taxpayers will need an exemption for 2018, because the penalty is still in effect until … after Dec. 31 of this year.”

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