Paul Sanchez
North Carolina residents have a variety of health insurance options, including private insurance companies, Medicaid, and Medicare. While the state's Medicare Savings Program (MSP) helps eligible beneficiaries with the cost of coverage, it is unclear if this is the same as a medical savings plan. Additionally, North Carolina transitioned to NC Managed Medicaid Care in 2021, and Medicaid expansion took effect in December 2023, allowing more people to access health care coverage. The state also offers low- and no-cost health care programs, such as North Carolina Health Choice for Children, AIDS Drug Assistance, and the Infant-Toddler Program.
| Characteristics | Values |
|---|---|
| State | North Carolina |
| Health Insurance Options | Private insurance companies, HealthCare.gov, Medicaid, COBRA, Medicare, Medicare Advantage, and Medigap |
| Medicaid Income Eligibility | $1,133/month for singles, $1,526/month for married couples |
| Medicaid Asset Eligibility | $2,000 for singles, $3,000 for married couples |
| Medicare Savings Program (MSP) | Available for beneficiaries who struggle to afford the cost of coverage |
| Medicaid Spend-Down Eligibility | For applicants with incomes higher than the eligibility limit |
| Medicaid Deductible Program | Available in North Carolina |
| Medicaid Long-Term Care Enrollee Allowance | $30/month for personal needs |
| Medicaid Long-Term Care Enrollee Asset Limit | $688,000 in home equity |
| Health Insurance Penalty | No longer applicable as of 2019 |
| Health Insurance Tax Credit | Available for North Carolina residents purchasing coverage from HealthCare.gov |
| Health Insurance Subsidies | Available for Silver plans purchased through HealthCare.gov for those earning up to 250% of the federal poverty level |
| Health Insurance Plan Types | Bronze, Silver, Gold, Platinum |
| Health Insurance Plan Considerations | Plan selection depends on anticipated healthcare needs and cost preferences |
| Health Insurance Application Assistance | Available through Medicaid Ambassadors, NC Navigators, and local Department of Social Services (DSS) |
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What You'll Learn
Medicaid eligibility and enrollment
North Carolina's Medicaid expansion, which took effect on December 1, 2023, has increased the number of people eligible for Medicaid in the state. The expansion, implemented under the Affordable Care Act (ACA), now covers adults under 65 with a household income of up to 138% of the poverty level. This includes parents with dependent children with a household income of up to 45% of the poverty level, and children with incomes up to 211% of the poverty level. Maternity-related coverage is also available for pregnant women with incomes up to 196% of the poverty level.
In North Carolina, Medicaid ABD covers preventive and restorative care, dentures, and oral surgery services for adults. However, it does not cover routine eye visits or eyeglasses for adults. The income limit for Medicaid eligibility is $1,133 per month for single individuals and $1,526 per month for married couples. The asset limit is $2,000 for single individuals and $3,000 for married couples. If only one spouse requires Medicaid, typically only their income is considered for the eligibility limit, and they are allowed to retain a small personal needs allowance of $30 per month, in addition to money for health insurance premiums.
To enrol in Medicaid in North Carolina, individuals can apply online at HealthCare.gov or ePass, by phone at 1-800-318-2596, or in person at their local County Department of Social Services office. They can also complete a paper application. Free advice and assistance with the application process are provided by the NC Navigator Consortium, which can be reached online or by phone at 1-855-733-3711. Additionally, general inquiries can be directed to the local Department of Social Services (DSS) or the NC Medicaid Contact Center at 1-888-245-0179.
It is important to note that Medicaid eligibility is determined on a case-by-case basis, and certain deductions may help individuals qualify. Therefore, even if someone is unsure about their eligibility, they are encouraged to apply.
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Medicare Savings Program (MSP)
The Medicare Savings Program (MSP) is a Medicaid-administered program that helps people with limited income and savings pay for their Medicare premiums. MSPs are also known as Medicare Buy-In programs or Medicare Premium Payment Programs.
There are three main programs, each with different benefits and eligibility requirements:
- Qualified Medicare Beneficiary (QMB): Pays for Medicare Parts A and B premiums. If you have QMB, you should not be billed for Medicare-covered services when seeing Medicare providers or providers in your Medicare Advantage Plan’s network.
- Specified Low-income Medicare Beneficiary (SLMB): Pays for Medicare Part B premium.
- Qualifying Individual (QI) Program: Pays for Medicare Part B premium.
The fourth MSP is the Qualified Disabled Working Individual (QDWI) program, which pays for the Medicare Part A premium.
When you enroll in an MSP, you will also automatically get Extra Help, the federal program that helps pay most of your Medicare prescription drug (Part D) plan costs. There is no resource test for the MSP programs. This means many Medicare beneficiaries who may not qualify for Medicaid because of excess resources can qualify for an MSP.
To qualify for an MSP, you must have Medicare Part A and meet income and asset guidelines (these vary by state, and some states do not count assets when determining MSP eligibility). Income limits are slightly higher in Alaska and Hawaii. You may qualify in other states for these programs even if your income or resources are higher than the federal limits listed.
In North Carolina, Medicaid ABD covers preventive and restorative care, as well as dentures and oral surgery services for adults. The income limit is $1,133 a month if single and $1,526 a month if married. The asset limit is $2,000 if single and $3,000 if married. Applicants with incomes higher than the eligibility limit for Medicaid for the aged, blind, and disabled can enroll in the Medicaid spend-down, which allows medical bills to be subtracted from income that is counted toward the Medicaid eligibility limit. This is called the Medicaid Deductible program in North Carolina.
Free volunteer Medicare counseling is available by contacting the Seniors’ Health Insurance Information Program (SHIIP) at 1-855-408-1212. The SHIIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections.
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Private insurance companies
As a North Carolina resident, you have the option to choose from health insurance plans offered by private insurance companies. These companies include Cigna Health and Life Insurance Company, which offers plans in several states, including North Carolina. Cigna provides individual and family medical and dental insurance plans, as well as group health insurance and health benefit plans. They also have a rewards program where customers over 18 can earn up to $325 in points redeemable for various benefits.
Another private insurance company operating in North Carolina is Ambetter, which offers affordable health insurance plans. They provide services such as video and phone consultations with doctors, maternity health programs, and a mobile app to manage your healthcare.
Additionally, North Carolina residents can purchase individual and family coverage from private insurers through HealthCare.gov, the federal exchange. This platform allows self-employed individuals without employees to acquire coverage. Tax credits are available for North Carolina residents who purchase coverage from HealthCare.gov, and subsidies are offered to those earning up to 250% of the federal poverty level to assist with out-of-pocket expenses.
It is important to note that eligibility for different plans may depend on factors such as income, family size, and residency status. North Carolina has expanded its Medicaid program to cover more individuals, and there are also state and federal programs like COBRA and the Medicare Savings Program that may be worth exploring.
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Low- and no-cost healthcare
There are various state and federal programs that offer low- and no-cost healthcare, such as Medicaid and COBRA. Medicaid is administered by the State Department of Health and Human Services (NCDHHS) in North Carolina. You can apply for Medicaid or an MSP (Medicare Savings Program) using the NCDHHS website or by visiting your county Division of Social Services. If you are a beneficiary, you can also contact the Seniors' Health Insurance Information Program (SHIIP) for free volunteer Medicare counselling.
Additionally, North Carolina offers the following low- and no-cost healthcare programs:
- North Carolina Health Choice for Children: health insurance for eligible children.
- AIDS Drug Assistance Program.
- Children with Special Health Care Needs: for eligible children from birth to 21.
- Infant-Toddler Program: assistance for children through age two with developmental delays.
- Medical Eye Care Program: preventive and corrective services for eligible residents.
- Medication Access and Review Program: prescription assistance for eligible residents.
Furthermore, thousands of free clinics and healthcare centers offer services on a sliding scale for people who are uninsured. These include federally qualified health centers, community health centers, rural health clinics, and safety-net hospitals and clinics.
It is also worth noting that tax credits are available to North Carolina residents who purchase coverage from HealthCare.gov. These credits are based on your estimated income for the calendar year, and if your actual income exceeds the eligibility limit, you will have to reimburse the government for the difference.
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Health Savings Account (HSA)
North Carolina residents have access to a range of health insurance options, including major medical health insurance coverage, Medicaid, and COBRA. They can also take advantage of low- and no-cost healthcare programs such as North Carolina Health Choice for Children, the AIDS Drug Assistance Program, and the Infant-Toddler Program.
One option for managing healthcare costs in North Carolina is through a Health Savings Account (HSA). An HSA is a tax-advantaged personal savings account that helps those with a High Deductible Health Plan (HDHP) save money on out-of-pocket medical expenses like doctor visits, prescriptions, vision, and dental care. HSAs offer the potential for tax advantages, such as pre-tax contributions, tax-free interest, and earnings. The funds in an HSA can be used to pay for qualified health care expenses throughout one's life, including retirement, and there is no time limit on when to spend the funds.
To be eligible for an HSA, an individual must have a qualifying health plan, such as a High-Deductible Health Plan, and must not be enrolled in Medicare or receiving Veterans Affairs benefits within the past three months. Additionally, they cannot be claimed as a dependent on someone else's tax returns. HSAs are owned by the individual, which means that the balance rolls over every year, even if the person changes health plans, retires, or leaves their employer.
The funds in an HSA can be used to pay for a variety of qualified medical expenses, including prescriptions, hearing aids, contact lenses, doctor visits, and pharmacy purchases. The HealthEquity debit card, for example, can be used to make purchases directly from the HSA and can be run as a credit card without a PIN. HSAs may also offer investment options, allowing individuals to invest in mutual funds and potentially grow their savings over time.
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Frequently asked questions
A Medicare Savings Program (MSP) helps beneficiaries with the cost of Medicare coverage.
You can apply for an MSP using the website for the State Department of Health and Human Services (NCDHHS) in North Carolina or by visiting your county Division of Social Services.
Medicaid is a form of health insurance provided by the state. In North Carolina, Medicaid ABD covers preventive and restorative care, as well as dentures and oral surgery services for adults.
You can apply for Medicaid online through the ePASS website or by visiting your county Division of Social Services.
As a North Carolina resident, you can choose from health insurance plans offered to individuals and groups by private insurance companies. You may also purchase individual and family coverage from participating private insurers through HealthCare.gov, the federal exchange.
