Relief for Rod in a Difficult Year for Health Insurance
Rod was faced with bad news. He had come to Pisgah Legal Services before for help enrolling in health insurance, but this year he was anxious. With rising premiums, the plans Rod saw were $400-$500 a month.
It would be impossible for him and his wife to afford on their combined Social Security income. Last year he paid less than $30 per month for insurance. Now, he was looking at more than 10 times the amount.
“I really don’t know what I would have done,” said Rod.
Finding Help in a Tough Year
Rod’s appointment was with longtime Pisgah Legal Services volunteer Jim Carillon, who has helped people enroll in the Affordable Care Act (ACA) plans since they began 13 years ago. This year looks very different, though.
A federal bill passed earlier in the year lowered many of the Advanced Premium Tax Credits (APTCs) that kept costs low for so many. That cut is causing people to see their rates double or triple what they paid last year, creating confusion and anxiety. Jim and the rest of the team at Pisgah Legal were prepared for just that.
“There is bad news that we have to help our clients deal with, but we’re able to help them work through it and find a solution that works best for them,” said Jim. “The staff and volunteers here are the perfect people to help them because we understand how it all works. With compassion and care, we can help them deal with the tough choices.”
A Rare Bright Spot
In a year of difficult choices, Rod’s situation turned out to be one of the exceptions. Because his wife qualifies for Medicare, he only needed insurance for himself, and their combined income falls into the narrow range that qualifies for the highest available tax credits.
With Jim’s help, Rod left the appointment with a zero deductible plan costing $82 per month. Although it’s still a jump from what he paid last year, the credits made it manageable. With it comes a sense of relief and peace of mind going into the new year.
“You never know what the day will bring,” said Rod. “Going in with insurance is a burden off my mind and off my heart just knowing that I am covered.”
Help and Hope from Experts Who Care
Rod’s outcome is not typical this enrollment season. To qualify for the highest tax credits, a household must fall between 138%-150% of the federal poverty level — $36,777-$39,975 for a family of three. Many families fall outside of this bracket and face drastic increases in premiums and the difficult decisions that follow. Jim says that even though that’s the case, people should not give up before asking for help. He’s helped many individuals find options that they didn’t realize were even available.
“My job is to help them understand what their options are and make the best choice under trying circumstances,” said Jim. “We have a really effective and compassionate group of people willing to help them find a solution that works for them.”
Jim doesn’t want the sticker shock people feel when browsing plans on their own to turn into hopelessness. Even if clients don’t qualify for the same level of savings that Rod did, Pisgah Legal can help them understand their range of options, navigate tough decisions, and maybe uncover solutions that were not as obvious at first glance. Rod is grateful that he had Jim to walk him through the changes and find something that worked.
“Come in with an open mind because there may be something suitable,” said Rod. “Come in willing to go through the process.”
To schedule a free appointment, visit pisgahlegal.org/health or call 828-210-3404.