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There are several ways to obtain health insurance coverage in North Carolina. You can enroll in your employer’s health insurance plan, purchase private insurance, or if you’re eligible, you can enroll in Medicare or Medicaid. This guide provides detailed information about your North Carolina health insurance options.
Like many other states, North Carolina does not have a separate website to purchase health insurance. To enroll in North Carolina’s health insurance marketplace, you’ll need to visit Healthcare.gov and create an account to see available plans and compare prices. Creating an account is fairly straightforward. You’ll provide your name and personal contact information, create a password, and set up several security questions.
Once you’re up and running, Healthcare.gov checks to see if you’re eligible for Medicare and whether you qualify for any tax credits, such as the Advance Premium Tax Credit. Whether you’re applying for yourself or your family, you’ll need every person’s name, birth date, and Social Security number included in your application.
The application includes several questions related to your income and family, including the following:
At this point, you’ll be able to see a list of available Healthcare.gov coverage plans for North Carolina. The website also has a tool that allows you to review up to three different plans side-by-side so that you can compare costs for different levels of coverage. You can then pick a plan and complete the application process.
The companies that provide individual health insurance plans in North Carolina are:
There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:
You have several health plan options when you’re only looking for insurance for yourself, including low deductibles with higher premium costs and high deductibles with lower monthly premiums. Some plans can offer coverage at a lower price if you qualify medically. A low deductible means a higher upfront premium cost, but you’ll pay less when you need coverage. A higher deductible results in lower monthly premiums, but you’ll pay more when you’re sick or injured.
There are several different types of health insurance plans.
Your considerations change when you’re thinking about health care for your family. You might be in good health, but perhaps your spouse has diabetes, or you have a child who requires mental health care. You’ll need to balance your family’s needs with your ability to pay out-of-pocket costs.
These concerns will affect the type of plan you select. If your family is healthy overall, an HMO plan might be the best option. However, if you, your spouse, or one of your children requires ongoing health care, you may prefer a PPO plan, which gives you more flexibility to see specialists without referrals. Always check the health care company’s network of providers to ensure it covers a range of specialties that can meet your family’s needs.
Healthcare.gov offers four plan levels or tiers, including bronze, silver, gold, and platinum. Each level offers different premiums, deductibles, and coinsurance payments. Within each level, you’ll find a variety of plans.
|Average premiums in North Carolina||2018||2019||2020||2021|
|Most affordable bronze plan||$464||$417||$365||$350|
|Most affordable silver plan||$609||$570||$518||$503|
|Most affordable gold plan||$656||$605||$553||$518|
Medicaid and the North Carolina Health Choice Health Insurance Program for Children provide health insurance coverage for low-income North Carolina residents. If you’re 65 or older (or younger and disabled) and meet the income and asset requirements, you might qualify for Medicaid.
The North Carolina Health Choice Health Insurance Program for Children is a comprehensive health plan for low-income children. In many other states, the program is called CHIP — Child Health Insurance Program.
Medicaid in North Carolina is available to those who are low income and as qualify as one of the following:
To qualify for Medicaid, you must have a low income. You can’t earn more than the maximum annual income, which is based on your household size. For example, an individual can’t earn more than $17,131 annually, while a family of four can’t have an annual income of more than $35,245 per year.
Asset limits are $2,000 for an individual and $3,000 for a couple. The limit is based on income and property but doesn’t include your primary home, furnishings, appliances, and one vehicle. You can apply for Medicaid at the ePass website.
North Carolina Health Choice is for children in families with low income between 6 and 18. Family income must be between 133% and 211% of the Federal Poverty Guidelines. For example, a single mother in North Carolina with one child cannot earn more than $1,931 per month or $36,768 per year. If your family income is above 159% of Federal Poverty Guidelines, an enrollment fee of $50 per child applies. To find out more about the program, visit the North Carolina Health Choice site.
Medicare is the federal health program open to seniors 65 and older and those who are younger with qualifying disabilities. You can select from several different forms of Medicare.
Medicare Supplement Insurance, also known as Medigap, is designed to plug holes in your Original Medicare coverage by covering deductibles, copays, and coinsurance. These plans can also provide coverage if you travel overseas.
|Eligibility and Enrollment|
The North Carolina State Health Insurance Assistance Program (SHIP) provides free, unbiased, and confidential counseling to all Medicare-eligible residents. The trained volunteer counselors aren’t licensed insurance agents, and they will never endorse any company or try to sell you a plan. Their primary purpose is to advise North Carolina seniors about their health care options.
Short-term health insurance in North Carolina is available through off-exchange health insurance companies. These plans are thin and don’t provide the same essential benefits as Healthcare.gov marketplace plans. The plans are designed to be temporary, primarily to cover gaps in coverage. For example, if you know you’ll be switching jobs, and your new coverage won’t kick in for a few months, a short-term health insurance plan might make sense.
Although North Carolina doesn’t have state rules about short-term policies, it follows federal government guidelines. Plans can provide coverage for up to one year and are renewable for up to 36 months. Short-term policies don’t cover preexisting conditions or mental health care. Conditions that could result in denied or non-renewal of coverage include:
As soon as you know you might have a gap in your health care coverage, consider applying for short-term health insurance. Short-term insurance can also help if you miss the Affordable Care Act (ACA) enrollment period and need health care coverage until you’re able to apply the following year.
Technically, the ACA requires all Americans to have health insurance. While a few states have passed laws requiring citizens to have health care insurance, North Carolina is not one of them. Congress removed the tax penalty for Americans failing to maintain a minimum level of coverage, and North Carolina doesn’t enforce the mandate.
No one will force you to use the Health Insurance Marketplace. However, some incentives make using it attractive (such as the Advance Premium Tax Credit) if you’re trying to reduce your out-of-pocket costs.
Health care sharing and faith-based health plans are usually based on religious beliefs, but you don’t need to be associated with any religious group to purchase a plan. Since they’re not considered insurance, the North Carolina Department of Insurance doesn’t regulate them. You should carefully check the plan before you purchase one. Under the ACA, some benefits are mandated, and faith-based plans may not offer the critical coverage you need.
Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) are good ideas, but they don’t replace health insurance coverage. While these accounts allow you to save money on your health care costs or put money aside to deal with medical expenses, it’s unlikely an FSA or HSA will provide enough money to cover all your out-of-pocket expenses.
Short-term disability coverage is typically used to cover household expenses when you’re injured. You’ll still need regular health insurance to cover your medical expenses. Short-term disability payments won’t help you if you’re hospitalized for an extended period.
Like short-term disability payments, long-term disability payments are used to pay for household expenses. It’s not a substitute for health insurance. Even if you have long-term disability coverage, you should also have health care insurance.
North Carolina Health Choice is a comprehensive health insurance program that provides coverage for low-income children between 6 and 18. It provides support for immunizations, regular checkups, and treatment for injuries or illnesses. Your children may qualify for North Carolina Health Choice if your income is between 133% and 211% of the Federal Poverty Guidelines.