Orange County NC Website
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o Hospital services; professional services; prescription drugs; rehabilitation and <br /> habilitative services; mental health and substance use disorders; and maternity <br /> care <br /> o Well-baby, well-child care, oral health and vision services for children under age <br /> 21 <br /> o Recommended preventive services with no cost-sharing and all recommended <br /> immunizations <br /> o Mental health parity law applies to qualified health plans <br /> Individual Mandate <br /> - Citizens and legal immigrants will be required to pay penalty if they do not have <br /> qualified health insurance, unless exempt. <br /> Subsidies to Individuals <br /> - Refundable, advanceable premium credits will be available to individuals with incomes <br /> up to 400% FPL on a sliding scale basis <br /> o Individuals not eligible for subsidies if they have employer-based coverage, <br /> TRICARE, VA, Medicaid, or Medicare <br /> o North Carolina's median household income in 2008 <br /> Sliding Scale Subsidies (table) <br /> Employer Responsibilities <br /> ■Employers with 50 or more full-time employees required to offer insurance or pay penalty <br /> (Sec. 1201, 1513, amended Sec. 1003 Reconciliation) <br /> ■Employers with less than 50 full-time employees exempt from penalties. (Sec. 1513(d)(2)) <br /> •Employers with 25 or fewer employees and average annual wages of less than $50,000 can <br /> receive a tax credit. (Sec. 1421, Sec. 10105) <br /> ■ Orange County has approximately 2,991 employers with less than 50 employees. <br /> Health Benefits Exchange <br /> - States will create a Health Benefits Exchange for individuals and small businesses. <br /> o Limited to citizens and lawful residents who do not have access to employer- <br /> sponsored or governmental-supported health insurance and to small businesses <br /> - Exchanges will: <br /> o Provide standardized information (including quality and costs) to help <br /> consumers choose between plans <br /> o Determine eligibility for the subsidy <br /> Health Benefits Exchange (HBE) <br /> ■"No wrong door approach" between Medicaid and HBE (Sec. 1311, 1411, 1413) <br /> •Individuals who apply for health insurance through the HBE will have their eligibility <br /> determined for Medicaid; those who apply for Medicaid will have their eligibility determined for <br /> HBE subsidies <br /> ■Patient navigators to help link individuals to Medicaid or private insurance through HBEs <br /> Income Eligibility for Subsidized Insurance (2010, 2014) (table) <br /> Safety Net Overview <br />