Useful information for health-care plan decisions

Sep. 10, 2013 @ 11:40 AM

What to know when choosing a plan:

-- Consider all potential costs when making a decision: premiums, co-payments, deductibles, co-insurances and what the annual maximum out-of-pocket costs might be.

-- Make sure that the providers you want to see are “in network” with the plan you choose.

-- Check to ensure your medications are covered by your plan.

-- Make sure that you are getting unbiased facts from the individual who might be helping you make a decision.

Timeline and Contact Information:

One-on-one assistance in Durham for individuals/families less than 65:

-- NC marketplace/exchange – enrollment begins October 1, 2013 and runs through March 31, 2014

-- Use website: or call – 800-318-2596 available 24 hrs/7 days per week; paper applications will also be available

-- Local help: several agencies and institutions will have “navigators” or “certified application counselors” to help people review their coverage options. They include Lincoln Community Health Center, Project Access of Durham County, Legal Aide, El Centro Hispano, the Alcohol and Drug Council of North Carolina, and MDC/The Benefit Bank.

National small business call center or SHOP

-- NC marketplace/exchange – enrollment begins October 1, 2013 and runs through March 31, 2014

-- Use website: or call – 800-706-7893. Hours: Monday through Friday, 9 a.m. to 5 p.m. EST.

Medicare coverage options are not on the marketplaces but continue as usual.

-- Medicare’s annual election period is from October 15 – December 7 every year 

-- Use website: or call 1-800-Medicare; 1-800-633-4223 or call the state Seniors’ Health Insurance Information Program (SHIIP) at 1-800-443-9354

-- Local help: Senior PharmAssist – the SHIIP coordinating site for Durham at 919-688 -4772 or for Lincoln CHC patients, ask the pharmacy staff for assistance

If you have problems with your health coverage (not Medicare) now and in the future:

-- Fortunately in North Carolina, we have Smart NC, which was set up by the NC Department of Insurance to help consumers understand their rights and responsibilities and they can help file complaints and appeals and request external reviews if a health insurance claims are denied. SMART NC - 877-885-0231

Understanding medical coverage options now available in Durham:

-- The Partnership for a Healthy Durham created a brochure that explains free and reduced healthcare services available in Durham for 2013;