Paul Sanchez
If you're wondering about health insurance options in North Carolina, you're not alone. The North Carolina Department of Insurance recognizes that choosing an insurance policy can be confusing, and there are many factors to consider, such as cost, coverage, and provider options. As a North Carolina resident, you have several options for health insurance, including individual and group plans offered by private insurance companies, as well as public programs like Medicaid and COBRA. You can also purchase coverage through HealthCare.gov, the federal exchange, and take advantage of tax credits and subsidies to lower your costs. Understanding the different types of plans, such as PPO, HMO, and HDHP, is essential for making an informed decision about your health coverage.
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What You'll Learn
Types of health insurance plans in North Carolina
North Carolina offers a variety of health insurance plans to cater to the diverse needs of its residents. These plans vary in terms of coverage, provider networks, and price points, ensuring that individuals and families can find suitable options. Here is an overview of the types of health insurance plans available in North Carolina:
Individual and Family Health Insurance Plans
North Carolina residents can choose from a range of individual and family health insurance plans. These plans are designed to meet the needs of individuals and their families, offering coverage for essential health benefits, such as doctor visits, prescriptions, and more. UnitedHealthcare, for instance, provides Individual & Family ACA Marketplace plans, which offer affordable and reliable coverage options. Additionally, short-term health insurance plans are available for those who need temporary coverage, such as during transitions between jobs or for early retirees.
Employer-Sponsored Health Insurance Plans
Employers in North Carolina can offer health insurance plans to their employees. These plans are typically provided through companies like Blue Cross NC, which offers employer-based plans alongside individual and family options. Employer-sponsored plans provide employees with access to a network of healthcare providers and may include additional benefits negotiated by the employer.
Medicare and Medicaid
For North Carolina residents who meet certain eligibility requirements, Medicare and Medicaid are available. Blue Cross NC, for instance, offers plans under these government-sponsored programs. Medicare is designed for individuals aged 65 and older or those with specific disabilities, while Medicaid provides coverage for individuals and families with low incomes.
Dental and Accident Insurance Plans
In addition to medical insurance, North Carolina residents can also opt for dental insurance plans. These plans typically cover basic dental care, such as general dental screenings and preventive care. Accident insurance, also known as supplemental accident insurance or personal accident insurance, is another option. This type of plan provides benefits in the event of an accident, offering financial protection for unexpected medical costs.
Group Health Insurance Plans
Group health insurance plans are available in North Carolina through companies like Cigna Healthcare. These plans are typically offered to members of specific groups, such as employees of a company or members of an organization. Group health insurance plans can include a range of benefits and may provide access to exclusive provider networks.
When choosing a health insurance plan in North Carolina, it is important to consider factors such as the coverage provided, the network of healthcare providers, and the associated costs, including premiums, deductibles, and copayments. Additionally, residents can seek assistance from licensed insurance agents or brokers, as well as Navigators/Assisters, who can help compare and choose the most suitable plan for their needs.
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How to shop for health insurance in North Carolina
Health insurance coverage in North Carolina may be offered either through an individual policy or a group policy with an employer group plan or other group affiliation. The primary insured person is the policyholder of an individual plan and makes all decisions regarding the coverage chosen and changes made. On the other hand, under a group policy, the policyholder may be an employer, association, or trustee, while the insureds are the members of that employer or organization.
Cost
It is important to look at your total out-of-pocket costs, including premiums, deductibles, co-pays, and coinsurance. Generally, the lower your premium, the more you’ll pay in out-of-pocket costs. The cost of health insurance (premium) can change from year to year, as well as the plans that are offered by each company. Even if you intend to continue the same plan from year to year, open enrollment is a good time to review the plan along with any changes to personal circumstances to verify that the chosen plan continues to be the best choice for the upcoming year.
Metal Levels
Metal levels are a way to make "apples-to-apples" plan comparisons on individual insurance coverage. The levels refer to the percentage a health plan will pay, on average, for care across a standard population. For instance, a Bronze plan pays 60% of covered health care costs, on average, and enrollees pay the remaining 40% through cost-sharing (deductibles, copayments, coinsurance, and out-of-pocket limits). Silver 70%/30%, Gold 80%/20%, and Platinum 90%/10%. Plans that pay higher percentages towards claims will generally have higher premiums.
Doctors and Hospitals
It is important to check with your hospital, doctors, and other healthcare providers to see if they participate in the plan. Most plans have a network of hospitals, doctors, and other healthcare providers. Some plans may require a referral before you see a specialist. PPO Benefit Plans allow insureds to select from a network of contracted physicians, hospitals, and other healthcare providers or use an out-of-network provider and be required to pay a higher share of the cost. HMO Benefit Plans require insureds to seek healthcare treatment only at designated hospitals, physicians, HMO facilities, and other in-network providers, except in the case of an emergency.
Insurance Agent or Broker
An insurance agent or broker can help you apply for help paying for coverage and enroll in a Qualified Health Plan (QHP) through the Marketplace. They can make specific recommendations about which plan you should enroll in. Agents are licensed and regulated by states and typically get payments or commissions from health insurers for enrolling a consumer into an issuer's plans. Contact the state Department of Insurance to verify the license status of any agent you choose to work with.
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The cost of health insurance in North Carolina
The cost of health insurance, or premium, can vary from year to year, and it's important to review your plan during open enrollment to ensure it still meets your needs. During open enrollment, you can make changes to your plan or switch to a different one. If you experience certain life changes, such as losing coverage, moving, getting married, or having a baby, you may qualify for a Special Enrollment Period (SEP) and make changes outside of the open enrollment period.
When considering the cost of health insurance in North Carolina, it's essential to look at your total out-of-pocket expenses, including premiums, deductibles, co-pays, and coinsurance. Generally, a lower premium will result in higher out-of-pocket costs. Metal levels are a way to compare plans and understand their costs. For example, a Bronze plan has lower premiums but higher out-of-pocket costs, while a Platinum plan has higher premiums but covers a more significant portion of healthcare expenses.
Several insurance companies in North Carolina offer affordable health plans with exclusive benefits and extensive provider networks. Blue Cross Blue Shield of North Carolina offers plans with premiums as low as $0, including federal government subsidies. Their Blue Advantage plan provides a broad choice of providers across the state and nationwide, while the Blue Value plan offers lower monthly premiums with a smaller selection of in-network providers. UnitedHealthcare is another option with cheaper-than-average premiums and the lowest-cost silver and gold plan deductibles in the state.
To navigate the various health insurance options in North Carolina, you can seek assistance from insurance agents or brokers licensed by the state. They can help you apply for coverage and enroll in a Qualified Health Plan (QHP) through the Marketplace. Additionally, Navigators/Assisters are unbiased individuals or organizations that can provide free guidance in finding health coverage options through the Federal Marketplace.
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The North Carolina Department of Insurance
North Carolina residents can choose from a range of health insurance plans offered to individuals and groups by private insurance companies. These include major medical health insurance coverage such as Personal Health Quotes, Family Health, and Group Health. Residents can also purchase individual and family coverage from participating private insurers through HealthCare.gov, the federal exchange. If you are self-employed with no employees, you can also use the federal exchange to purchase coverage.
The cost of health insurance (premium) can vary from year to year, and it's important to consider your total out-of-pocket expenses, including premiums, deductibles, co-pays, and coinsurance. Generally, a lower premium will result in higher out-of-pocket costs. The North Carolina Department of Insurance recommends checking with your preferred hospitals and doctors to ensure they participate in the plan you're considering. Most plans have a network of hospitals and healthcare providers, and some may require a referral before you can see a specialist.
When shopping for health insurance in North Carolina, you may work with an insurance agent or broker who can help you apply for financial assistance and enroll in a Qualified Health Plan (QHP) through the Marketplace. These agents are typically licensed and regulated by the state and receive payments from health insurers for enrolling consumers. It is important to verify the license status of any agent you choose to work with through the state Department of Insurance.
Additionally, North Carolina residents can explore state and federal programs such as Medicaid and COBRA, as well as tax credits and subsidies to help with out-of-pocket expenses.
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North Carolina health insurance law, plans, and regulations
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. If you are self-employed with no employees, you can also use the federal exchange to purchase coverage. You may also be entitled to certain state and federal programs such as Medicaid and COBRA.
The Patient Protection and Affordable Care Act (also known as ObamaCare and the Affordable Care Act, or ACA) became law in 2010. As of January 1, 2014, most U.S. citizens and legal residents are required by law to have qualifying health care coverage or pay an annual tax penalty for every month they go without insurance.
North Carolina mandates that the following benefits, which exceed ACA requirements, must be provided or offered by private providers authorized to sell health insurance within the state:
- Access to non-formulary drugs
- Hearing aids coverage
- Reconstructive breast surgery following mastectomy
- Congenital anomaly including cleft lip/palate coverage
- Diabetes care management
- Off-label prescription drugs coverage for certain drug use in cancer treatment
- TMJ disorder treatment
Additionally, under North Carolina law, health insurers are required to provide coverage for colorectal cancer screening for individuals over 50 and those under 50 who are at high risk. Other mandated coverages include emergency care, ovarian cancer screenings, HIV/AIDS treatment, and coverage for adopted children.
If you own a small business in North Carolina (with 50 or fewer full-time employees), you can purchase qualifying coverage for your employees through the Small Business Health Option Program (SHOP) or through a private broker or insurance agent. You may qualify for tax credits worth up to 50% of your premium costs if you use SHOP. Beginning in 2016, SHOP will be open to employers with up to 100 full-time employees. Under the ACA, employers with 50 or more full-time employees must offer at least one ACA-compliant plan or face fines.
When shopping for health insurance in North Carolina, it is important to consider the cost, including premiums, deductibles, co-pays, and coinsurance. You should also check if your preferred doctors and hospitals participate in the plan and understand how the plan works, including any requirements for referrals or prior authorizations. You can seek help from an insurance agent or broker, or a Navigator/Assister, to find the right plan and enroll.
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Frequently asked questions
As of 2014, most U.S. citizens and legal residents are required by law to have qualifying health care coverage or pay an annual tax penalty for every month they go without insurance. The penalty for not having qualifying coverage is $95 per adult and $47.50 per child, or 1% of your taxable income, whichever is higher.
Types of plans offered in North Carolina include major medical health insurance coverage such as Personal Health Quotes, Family Health, and Group Health. 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.
There are a few key things to consider when choosing a health insurance plan in North Carolina. Firstly, consider the cost, including premiums, deductibles, co-pays, and coinsurance. Secondly, check if your preferred doctors and healthcare providers participate in the plan. Finally, understand how the plan works, including any requirements for referrals before seeing a specialist.
If you've recently experienced a major life event, such as losing coverage from an employer, moving, getting married, or having a baby, you may be eligible for a special enrollment period to help you get the coverage you need.
There are several resources available for finding affordable health insurance in North Carolina. You can visit websites like eInsurance, Ambetter of North Carolina, and HealthCare.gov to explore different plans and options. Additionally, you can consider using an insurance agent or broker who can help you apply for coverage and enroll in a Qualified Health Plan (QHP) through the Marketplace. Legal Aid of North Carolina also leads the NC Navigators Consortium, which provides unbiased and free assistance to consumers looking for health coverage options.
