North Carolina Health Insurance: Find Affordable Plans

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.

• Marketplace plans: In North Carolina, if you choose not to enroll in your employer’s health care insurance ― or you’re not happy with the coverage offered by your employer ― you can purchase a health insurance plan from the Health Insurance Marketplace or from a private insurer.
• Open enrollment: The Open Enrollment period for North Carolina’s Health Insurance Marketplace runs from November 1 to January 15. In most cases, you’ll need a qualifying event to enroll outside of these dates. Otherwise, you’ll need to wait until the following year.
• Special enrollment: Qualifying events enable you to use a Special Enrollment Period. These occur when you lose qualifying coverage or need to change your current plan due to getting married, losing your job, having a baby, or getting divorced.
• Premium tax credit: If you’re interested in applying for health care tax credits, North Carolina uses the Federal Health Insurance Exchange. You can purchase health coverage directly from one of North Carolina’s health insurance companies. Many of the plans on the exchange offer a tax credit to help with costs.
• Coverage types: Slightly more than 46% of North Carolina residents get health coverage through another 17.9% are enrolled in Medicaid, 15.3% are enrolled in Medicare, 6.7% are enrolled in non-group private individual or family coverage, and 2.4% are enrolled in military coverage. Currently, 11.4% of North Carolina residents are uninsured.

Like many other states, North Carolina doesn’t 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:

• Are you single or married?
• How many tax dependents will you claim on your current return?
• How much income will your household make this year?
• Do you want to see if you can get help paying for coverage?

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:

• Aetna CVS Health
• Ambetter of North Carolina
• AmeriHealth Caritas
• Blue Cross and Blue Shield of NC
• Bright HealthCare
• Cigna Healthcare
• Friday Health Plans
• Oscar Health Plan of North Carolina, Inc
• UnitedHealthcare
• WellCare of North Carolina

There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:

• Medical needs
• Preferred plan type
• Premium affordability
• Individual vs. family deductibles

Insurance for individuals in North Carolina

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 three types of insurance plans that you can select.

• Health Maintenance Organization (HMO) plans offer a network of doctors that you can visit. You’ll need to get a referral whenever you need to see a specialist.
• Preferred Provider Organization (PPO) plans provide much more freedom to see any doctor or specialist you want, but you’re required to pay higher premiums for this freedom.
• Point of Service (POS) plans rest in the middle because they offer a network of doctors you can receive care from at a discount, but you’re able to see doctors outside of the network as long as you pay a higher copayment.

Insurance for families in North Carolina

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. 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:

• Bronze plans have a low monthly premium and a high deductible. You’ll also have to pay a 40% coinsurance payment when you receive medical services. These plans are best if you’re healthy but want to have some coverage. The most affordable bronze plan in North Carolina has an average monthly premium of $350.
• Silver plans have higher premiums than bronze plans but also have lower deductibles and a 30% coinsurance requirement. Silver plans can be less expensive than bronze plans if you have a lower income and qualify for extra savings and cost-sharing programs. Silver plans are ideal for younger people with chronic conditions who are starting their first jobs. The lowest-priced silver plan in North Carolina costs $503 per month.
• Gold and Platinum plans have lower deductibles and coinsurance payments (only 20% for gold and 10% for platinum), but you’ll pay a much higher monthly premium. A gold or platinum plan would be ideal if you require regular medical care for a chronic condition, such as a heart problem or arthritis. The most current affordable gold plan in North Carolina costs $518 per month.

Medicaid and the North Carolina Health Choice Health Insurance Program for Children provide affordable 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 Child Health Insurance Program (CHIP).

Medicaid in North Carolina

Medicaid in North Carolina is available to those who are low income and as qualify as one of the following:

• At least 65 years old
• Blind
• Pregnant
• Responsible for a child age 18 or younger
• Disabled
• Care for a disabled family member

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.

NC Health Choice Health Insurance Program for Children in North Carolina

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 aged 65 and older and those who are younger with qualifying disabilities. You can select from several different forms of Medicare:

• The most basic form is Original Medicare. It includes Part A, which covers hospitalizations, hospice, skilled nursing facilities, and home care, and Part B, which covers doctor’s visits, mental health care, ambulance services, and durable medical equipment (DME). Medicare Part D provides prescription drug coverage. Original Medicare doesn’t cover prescription drugs, so you’ll need to purchase a Part D plan if you want coverage.
• Another option is a Medicare Advantage Plan. There are four different types of Medicare Advantage plans, including HMOs, PPOs, Private Fee-For-Service (PFFS) plans, and Special Needs Plans (SNPs). Medicare Advantage plans offer vision, dental and hearing coverage, and they sometimes cover fitness programs. Many Medicare Advantage Plans also offer prescription drug coverage.

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

To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

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’ll 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.

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