Affordable Healthcare Act Insurance In North Carolina

North Carolina residents can apply for Affordable Care Act (ACA) health insurance plans, also known as Obamacare plans, during the annual Open Enrollment Period, which usually occurs from November 1 to mid-January the following year. ACA plans are required to cover 10 essential benefits, including emergency services, maternity care, and prescription drugs. North Carolina uses the federally facilitated health insurance marketplace, HealthCare.gov, to enroll in health insurance plans, compare plans, and determine subsidy and cost-share reduction eligibility. The state has nine insurers offering ACA-compliant plans in its marketplace for 2024, including Blue Cross and Blue Shield of NC, Ambetter of North Carolina Inc., and Cigna Health and Life Insurance Company.

North Carolina ACA Open Enrollment

The Affordable Care Act (ACA), commonly referred to as Obamacare, is a law enacted in 2010 to make affordable health insurance more accessible to all Americans. Each year, there is a 3-month Open Enrollment Period, usually from November 1 through to January 15, when anyone can sign up for a healthcare policy.

In North Carolina, residents can apply for ACA health insurance plans, or Obamacare plans, during the annual Open Enrollment Period. For 2024 coverage, the deadline was extended to January 16, 2024, due to a federal holiday on January 15.

During the Open Enrollment Period, North Carolina consumers can go online, call, or seek help from a broker or other assister to learn about their coverage options, calculate their potential subsidies, or change plans.

ACA Plans

ACA plans are grouped into coloured tiers: bronze, silver, gold, and platinum. The tier that a plan falls into is based largely on how much cost sharing is required. Bronze plans offer the lowest premiums but usually the highest copayments and deductibles. Platinum plans carry the highest premiums but the lowest out-of-pocket expenses for care.

Subsidies and Tax Credits

ACA plans are often made affordable through consumers receiving a subsidy in the form of a federal tax credit to discount the price of a private insurance plan. The federal government helps pay for insurance through an advance premium tax credit if you buy coverage from the exchange and are eligible for the tax credit based on your income. The Affordable Care Act provides income-based advance premium tax credits (subsidies) that offset your premium payments to help keep expenses down.

Special Enrollment Period

If you miss the ACA's Open Enrollment Period, you may qualify for a Special Enrollment Period. This is a time outside of the Open Enrollment Period when you and your family may sign up for healthcare coverage. To be eligible, you must meet common criteria referred to as a Qualifying Life Event (QLE). Some of the most common QLEs include:

• Involuntary loss of health coverage, usually through your job
• Moving to a new area of residency
• Getting married
• Relocating to a new home
• Having a child
• Losing your health coverage

Where to Enroll

North Carolina uses the federally run health insurance exchange, Healthcare.gov, for residents to purchase ACA Marketplace plans. To enroll in an ACA Marketplace plan, you can:

• Enroll online through Healthcare.gov
• Enroll by phone at (800) 318-2596
• Enroll with local help from an agent/broker, Navigator, or certified application counsellors
• Enroll through an approved enhanced direct enrollment entity

North Carolina's Medicaid expansion

On December 1, 2023, North Carolina expanded its Medicaid program, making hundreds of thousands of North Carolina residents newly eligible for Medicaid. The expansion covers adults aged 19 to 64 earning up to 138% of the federal poverty line. This includes individuals with an income of about $1,730/month and families of three earning about $2,970/month.

The expansion was implemented after North Carolina became the 41st state to adopt the Affordable Care Act (ACA) Medicaid expansion when Governor Roy Cooper signed the legislation earlier in 2023. North Carolina is the first state since Virginia in 2018 to adopt Medicaid expansion through a legislative process.

The expansion was accompanied by an array of communication and outreach strategies to help enroll eligible individuals. The state of North Carolina worked with community partners to aid enrollment and launched a new website with basic information about the expansion, including eligibility, benefits covered, and how to apply. A toolkit of English and Spanish resources was also provided for providers and organizations to conduct outreach.

Medicaid covers most health services, including doctor visits, check-ups, emergency care, hospital services, maternity and postpartum care, vision and hearing services, prescription drugs, behavioral health, preventive and wellness services, dental care, medical devices, and more. There is no monthly fee, and copays are never more than $4.

The expansion of Medicaid in North Carolina is expected to positively impact the state's economy and improve access to mental health services and substance abuse treatment. It will also help prevent rural hospitals from closing and strengthen the state's health systems.

ACA-compliant plans

The Affordable Care Act (ACA) was passed in March 2010 to expand insurance coverage to all Americans. ACA-compliant plans are available in North Carolina, and the state uses the federally run health insurance exchange, Healthcare.gov, for residents to purchase these plans. The federal government provides financial assistance to eligible individuals who buy coverage from the exchange. This is done through an advance premium tax credit, and some enrollees may also be eligible for cost-sharing reductions.

North Carolina residents can apply for ACA health insurance plans during the annual Open Enrollment Period, which usually occurs from November 1 to December 15 each year. If you miss the Open Enrollment Period, you will have to wait until the next period or qualify for a Special Enrollment Period, which can be triggered by certain life events such as getting married, relocating, having a child, or losing your health coverage.

The ACA also provides income-based advance premium tax credits (subsidies) that offset premium payments to keep expenses down for individuals. People with household incomes up to 250% of the federal poverty level may also qualify for cost-sharing reductions that reduce out-of-pocket expenses when purchasing a Silver plan.

North Carolina's Marketplace insurer participation

North Carolina uses the federally facilitated health insurance marketplace, HealthCare.gov, for its residents to purchase ACA Marketplace plans. The state does not have a state-specific law requiring residents to have health insurance, and there is no longer a federal insurance mandate. However, health insurance is essential to avoid excessive medical costs.

North Carolina residents can apply for Affordable Care Act (ACA) health insurance plans, also known as Obamacare plans, during the annual Open Enrollment Period, which usually occurs from November 1 to January 15 each year. If you miss the Open Enrollment Period, you will have to wait for a Special Enrollment Period, which involves experiencing certain life events, such as getting married, relocating, having a child, or losing your health coverage. The federal government may also open a Special Enrollment Period.

There are several health care providers in North Carolina that individuals can use to access health coverage. The best health insurance company depends on various factors, such as the type of health insurance plan, health care needs, and budget.

North Carolina uses the federally run exchange for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov. The Affordable Care Act provides income-based advance premium tax credits (subsidies) that offset premium payments to help keep expenses down. People with household incomes up to 250% of the federal poverty level also qualify for cost-sharing reductions (CSR) that may reduce deductibles and out-of-pocket expenses when purchasing a Silver plan.

There are nine insurers offering plans in North Carolina's marketplace for 2024. The approved average rate changes for 2024 are as follows:

Blue Cross and Blue Shield of NC

The overall average approved rate change represents a 1.3% reduction in individual market premiums for 2024.

North Carolina's ACA Marketplace provides access to health insurance products from private insurers. The federal government helps pay for insurance through an advance premium tax credit if you buy coverage from the exchange and are eligible based on your income. Some enrollees are also eligible for cost-sharing reductions, which lower out-of-pocket costs on Silver-level plans.

The state of North Carolina offers several health insurance coverage options to all permanent, full-time employees. Temporary employees are offered separate coverage through the State Health Plan (known as the High Deductible Health Plan) in compliance with the Affordable Care Act.

North Carolina's ACA premium tax credits

The Affordable Care Act (ACA) was passed in 2010 to expand insurance coverage to all Americans. The ACA provides income-based advance premium tax credits (subsidies) that offset premium payments to help keep expenses down.

North Carolina uses the federally run health insurance exchange, Healthcare.gov, for residents to purchase ACA Marketplace plans. The federal government helps pay for insurance through an advance premium tax credit if you buy coverage from the exchange and are eligible for the tax credit based on your income.

To be eligible for a premium tax credit, you must meet the following requirements:

• Have a household income of one to four times the Federal Poverty Level (FPL).
• Not have access to employer-based affordable coverage.
• Not be eligible for coverage through Medicare, Medicaid, the Children's Health Insurance Program, or other forms of public assistance.
• Be a U.S. citizen or have proof of legal residency.
• File joint taxes if married.

The premium tax credit is a tax credit you can use to lower your monthly insurance payment when you enroll in a plan through the Health Insurance Marketplace. Your tax credit is based on the income estimate and household information you put on your Marketplace application.

If your income is between 100% and 400% FPL, you qualify for premium tax credits that lower your monthly premium for a Marketplace health insurance plan. If your income is above 400% FPL, you may still qualify for premium tax credits.

You can use all, some, or none of your premium tax credit in advance to lower your monthly premium. If you use more of the advance payments of the tax credit than you qualify for, you must repay the difference when you file your federal income tax return. If you use less premium tax credit than you qualify for, you'll get the difference as a refundable credit when you file your taxes.

The other form of ACA subsidies is cost-sharing reductions, which reduce an individual or family's out-of-pocket costs for using healthcare services. These costs include deductibles, copayments, and coinsurance. Cost-share reductions may only be applied toward a silver-level plan.

To be eligible for a cost-sharing subsidy, you must be eligible to receive a premium tax credit and have a household income from 100% to 250% of the FPL.

Frequently asked questions