Need Health Insurance in North Carolina? Read This First

There’s no truer saying than “health is wealth”. But to feel rich in health, you need a great insurance plan. From Wilmington to Winston-Salem, Ashevill to Greenville, and every county along the way, great healthcare is within reach.

So, North Carolinians, read on for the information you need to find a new health insurance plan that protects your health and your wallet.

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Health Insurance Plans in North Carolina

You have options available to you when it comes to your health insurance, but sometimes understanding your options and which one is right for you is the biggest hurdle to getting great healthcare. We’ll explore each of the avenues from which you can seek healthcare coverage, so you can better understand your options.

Medicare

Medicare is a federally funded health insurance program for those over the age of 65 or for those with certain debilitating health conditions like End-Stage Renal Disease, ASL, or a qualifying disability. Medicare is made up of four parts:

Part A: Hospital care, skilled nursing facility, hospice, and home care.
Part B: Outpatient care, including doctor’s visits, tests, preventative care, medical equipment, and more.
Part C: Medicare Advantage, a Medicare-approved plan from a private company that combines Parts A, B, sometimes D, and sometimes vision/dental.
Part D: Prescription drug coverage.

Medicaid

Medicaid is a federal healthcare program for those with low incomes, providing low-cost or even free healthcare. To know if you’re eligible for Medicaid in North Carolina, you must live in North Carolina, meet income restrictions (amount depends on the Medicaid program), and fall into one of these groups:

Pregnant women
Children under age 21
Low-income individuals and families
Adults age 65 or older
Individuals with disabilities

CHIP

The Children’s Health Insurance Program (CHIP) is referred to as NC Health Choice for Children in North Carolina, and provides low-cost or free healthcare for children whose families incomes are too high for Medicaid, but not enough to afford health insurance.

Individual Health Insurance

You can purchase individual health insurance from the federally run exchange in North Carolina. Plans are grouped into four metal tiers to help you compare plans within the same bracket. Tiers include Bronze, Silver, Gold, and Platinum, as well as a Catastrophic plan that requires special eligibility. Here’s a rough guide on the plan tiers:

Bronze: This is a low premium but high out-of-pocket costs plan. The plan typically covers 60% of costs, while the policyholder pays the other 40%.
Silver: This is a step up from bronze with slightly higher premiums and slightly lower out-of-pocket costs, but Silver is important because it’s the only tier that’s eligible for cost-sharing reductions based on income, so Silver can sometimes work out to be the most affordable with the highest benefits for certain individuals. Otherwise, Silver plans cover 70% of costs, and the member is responsible for the other 30%.
Gold: With Gold plans, you’ll pay higher monthly premiums but lower out-of-pocket costs. The plan covers about 80% of costs, with the member paying the other 20%.
Platinum: Platinum plans have the highest premiums out of any plans and the lowest out-of-pocket costs. Deductibles are also lower than other plans, meaning your insurance will pay out sooner. Plans cover 90% of costs and the member will have to pay about 10% of costs.
Catastrophic: This is a plan that’s essentially a safety net, or emergency coverage, for certain individuals. To qualify, you need to be under the age of 30 or you need to have a hardship or affordability exemption. The plans are low cost but with a high deductible and high out-of-pocket costs; once you reach the deductible, the plan pays for your health care for the rest of the year.

There’s no tier that’s better than others; the right tier for you really depends on your health and budget. If you are generally healthy and rarely require medical services, Bronze or Silver plans are a good idea. But if you have recurring healthcare costs and regularly need to see the doctor, you’ll be better off with a Gold or Platinum plan.

Keep in mind that open enrollment happens once a year, which is when you can enroll in a plan or make changes to your current plan. Open enrollment is November 1st to December 15th in North Carolina in order to start coverage beginning January 1st. If you miss the December deadline, you have until January 15th to set up coverage for 2023.

However, you can qualify for a special enrollment period if you’ve had a qualifying life event, like a birth, marriage, job loss, move, and more. This allows you to change your coverage after that event.

If that qualifying life event includes a new birth, congratulations! Health insurance is just one of the items you’ll need to budget for now that junior is here. Grab our free financial guide for new parents for more info.

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Group Health Insurance

Many people qualify for health insurance through their jobs, which is a great option because the employer usually pays for some or all of the premium. This helps reduce your healthcare costs, although you have less or no control over the plan options.

If you lose your job, you can continue coverage for a certain number of months through COBRA, but keep in mind that your employer will no longer pay for part of your premiums, so your costs can shoot up.

If you’re self-employed, you have options too. Read this for more details.

Short-Term Health Insurance

Short-term health insurance is available to help bridge the gap between plans. You might also need it if you’re trying to search for a new long-term plan, if you’ve lost your health insurance through work, or while waiting to become eligible for Medicare.

In North Carolina, you’re allowed to have short-term health insurance for an initial period of up to 364 days and then an option to renew for a total duration of 36 months. There are eight or more insurers offering short-term health insurance in North Carolina currently.

Short-term health insurance can be a great option for a quick fix, but sometimes it can end up being more expensive than traditional plans. Plus, it often doesn’t cover pre-existing conditions, so it’s not always an option for everyone.

How Much Is Health Insurance in North Carolina?

What you pay for healthcare is going to depend on a number of factors, but it helps to know a rough range for planning purposes. So here’s the facts:

A Bronze plan will cost a 21-year-old $397 per month, but a 40-year-old $508 per month.
A Silver plan will cost a 21-year-old $521 per month, but a 40-year-old $666 per month.
A Gold plan will cost a 21-year-old $582 per month, but a 40-year-old $744 per month.

Plans also change yearly; on average, plans went up $50 per month in North Carolina, although Bronze and Catastrophic plans increased between 11-15% each.

Your rates will depend on your age, health, any pre-existing conditions, your location, your income, and more. You may also be able to save on health insurance thanks to cost-sharing reductions and premium subsidies, depending on your income.

But don’t worry: we’ve got even more cost-saving tips coming up next.

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How to Find Affordable Health Insurance Plans in North Carolina

It’s no secret that health insurance can be a major expense in any household budget. But that doesn’t mean you have no say in what you spend. We’ve gathered up the best ways to save on health insurance plans in North Carolina, so that you can keep your costs down without sacrificing your health and wellness. These tips include:

Review Coverage Annually: Open enrollment is exactly when you need to be reviewing your plan and all of your options. If your plan is still the best fit, then great! But if it’s not serving you well or you can find better coverage/rates in another plan, even better. Reviewing your coverage and needs annually will not only help you save money, but get the coverage you need before you need it.
Use Preventative Benefits: Preventative care is included in most health insurance plans, but it’s overlooked by too many people. Preventative care is key for preventing issues down the line that cost you in more ways than one. We’re talking screenings, tests, vaccines, and more.
Educate Yourself: No one likes thinking about health insurance, but avoiding it can cost you big time. A 2017 study showed that many people pick the wrong health insurance for their needs and end up spending more than they need to. One of the reasons could be that people simply get overwhelmed by their options, confused by insurance lingo, or don’t actively think about their own healthcare needs. By educating yourself on the terminology, your options, and what you need to be your healthiest self, you can save money and improve your overall wellness.
Stay In Network & Choose Generic: Your insurer has negotiated preferred pricing with a network of doctors, pharmacists, and hospitals. By staying in that network, you get to take advantage of that preferred pricing. By going out of network, you’re going to pay more—if your insurer even covers it. While you’re at it, ask for the generic version of any prescription drug to avoid paying the brand-name “tax”.
Choose a Higher Deductible: A higher deductible means lower monthly premiums. If you’re in relatively good health, a higher deductible will save you on your premiums, although you will have to pay more should anything happen.
Check for Tax Subsidies: Depending on your income and plan, you could be eligible for tax credit subsidies to lower your premiums. When reviewing a plan, you’ll be able to see if you qualify.
Note: You might also be able to save come tax time. Read this for the details.

This doesn’t mean you’re going to find dirt cheap health insurance in North Carolina, but each of these tips can put a few welcome bucks back into your pocket to do more of what you love.

Find the Best Health Insurance in North Carolina

You may not have a choice when it comes to having health insurance, but you do have options. In North Carolina, your options range from private to short term, government programs to employer-sponsored insurance, and more. Finding the best plan for you will depend on your income, health, age and more, but the right plan is out there.

Your journey to great healthcare starts by getting access to free quotes here. A little research and due diligence goes a long way when it comes to your health, so don’t be afraid to dig in and find the best plan for you.

To your health!