What You Pay

If you get Health Coverage for Workers with Disabilities (HCWD), you may need to pay a small annual fee and a monthly premium, depending on your income. You may also need to pay copayments for certain services.

Annual Enrollment Fee

If your countable income is more than 150% of the Federal Poverty Guidelines (FPG), ($1,956 per month for individuals or $2,644 per month for couples), you have to pay a $50 annual enrollment fee.

Premiums

If your countable income is more than 200% of FPG ($2,608 per month for individuals or $3,525 per month for couples), you also have to pay a monthly premium. The higher your countable income, the higher your premium will be.

Your countable income is not always the same as your real, full income. HCWD counts your money the same way that Supplemental Security Income (SSI) does: almost all of your unearned income is counted, but less than half of your earned income is counted. For example, if you make $4,000 per month at a job and have no other income, that’s only $1,957.50 in countable monthly income.

Use this tool to see your countable income and then check the table below to see how much your premium will be.

Your Countable Income:

Your Monthly Earned Income	$
Your Monthly Unearned Income (not including SSI)	$
Your Monthly Impairment Related Work Expenses (IRWEs)	$
	$1,305
	$20
	$65
	$967
Your Monthly Countable Income
Your Annual Countable Income
	$15,650
Federal Poverty Guideline
Your Countable Income as a Percent of FPG

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Note: American Indians in federally recognized tribes do not have to pay enrollment fees or premiums, regardless of their income.

When Can My Premium Change?

If your income changes, your premium may also change. HCWD will review your eligibility and premium at least every 12 months. Depending on your situation, your premium could go up or down.

If your income, immigration status, residency, disability status, or household size changes, report the change to your local Department of Social Services (DSS) office within 10 days. You can also use North Carolina ePASS to report changes to your situation if you sign up for an Enhanced Account.

Billing

If you have to pay a monthly premium to get HCWD, your Department of Social Services (DSS) office will send you a bill every month, which will tell you how to pay. You have 12 days to pay your bill, or you could lose your HCWD coverage. Information about this is sent with the monthly bill.

If you have to pay a $50 enrollment fee, your Department of Social Services (DSS) office will send you a bill, which will tell you how to pay. The exact process for paying the fee is determined by your Department of Social Services (DSS) office and will depend on where you live.

If you have questions about billing, contact the caseworker listed on your bill or your local Department of Social Services (DSS) office.

Copayments When You Get Services

Generally, if you are 21 years old or older, you may have to pay small copayments ($4 or less) when you use certain medical services that NC Medicaid covers.

You do not need to make copayments if you are:

• Under 21 years old
• Pregnant
• In hospice care
• An American Indian in a federally recognized tribe
• In foster care
• Living in a nursing home or medical facility, or
• Enrolled in Breast and Cervical Cancer Medicaid through the North Carolina Breast and Cervical Cancer Control Program (NC BCCCP).