North Carolina

North Carolina uses the federally run health insurance exchange, which means enrollment is done through the HealthCare.gov website. The exchange (marketplace) offers private individual market health coverage, so it’s used by individuals and families who need to buy their own health insurance. This includes early retirees who aren’t yet eligible for Medicare, self-employed people, and people who are employed by small businesses that don’t offer health benefits.

The exchange is also the only place that people buying individual market health coverage can receive assistance with the costs, including premium subsidies (which help to offset the monthly premiums people pay for their coverage) and cost-sharing reductions (which help to reduce the out-of-pocket costs people have when they need healthcare, including copays, deductibles, and coinsurance).

My Private Health Insurance offers clients who rarely go to the doctor & don’t have multiple prescriptions a chance for an individually tailored insurance plan that is underwritten from providers like Cigna or the United Health Care Choice Plus PPO Network. If you are over the household income limit of $64,000 for an individual or $90,000 for a family of 4 than you won’t qualify for any subsidies on the government marketplace and rates will be closer to a mortgage payment. If there are no major health conditions and some preventative medications than private health coverage is most likely your best chance at affordable insurance from name brand companies.

What private health insurance providers are available in North Carolina?

• Is the Cigna PPO Network health coverage available in North Carolina? Yes at this moment you can only get a Cigna HMO through www.healthcare.gov if you live in the state of North Carolina. The Cigna PPO Network is currently accepted in South & North Carolina.

• Is Blue Cross Blue Shield & the Florida Blue PPO Network available in North Carolina? Blue Cross Blue Shield offers nationwide short term health coverage plans in 12,24 & 36 month increments. The BCBS PPO Network is widely accepted around the country and ran through BCBS in NC.

• Is SideCar Health Insurance available in North Carolina? Sidecar Health Insurance offers fixed indemnity health coverage that gives clients insurance at affordable rates currently in 32 states.

• Is the United Health Care PPO Network available in North Carolina? Yes of course the United Health Care Choice Plus PPO Network is available for private insurance plans in North Carolina and 30 other states. They also sell their golden rule short term plans in time frames of 12, 24 & 36 month options.

Six insurers – Blue Cross Blue Shield of North Carolina, Cigna, Ambetter, Bright, Oscar, and UnitedHealthcare – are offering 2022 individual market plans through the North Carolina health insurance marketplace. Insurer participation is localized in most cases, but nearly all areas of the state have at least two insurers offering plans in 2022.

Aetna CVS Health will join the marketplace for 2022, with plans available starting in November 2021. Two additional insurers have filed plans to participate in North Carolina’s marketplace for 2022, but regulatory approval is not certain.

Bright Health joined the state’s exchange in 2020. For 2021, Oscar joined the exchange and UnitedHealthcare rejoined after exiting at the end of 2016. Cigna, which offered plans in the Raleigh-Durham area in 2020, expanded its North Carolina service area to include an additional 64 counties for 2021.

If you buy your own health insurance in North Carolina, the open enrollment period for 2022 coverage runs from November 1, 2021 through January 15, 2022. Enrollments had to be completed by December 15 in order to have coverage effective January 1, 2022. Enrollment between December 16, 2021 and January 15, 2022 takes effect February 1, 2022.

Outside of the annual open enrollment period, you’ll need a qualifying event to sign up for coverage or make a change to your plan.

Enrollment in 2021 coverage in North Carolina is still possible if you experience a qualifying event or if you’ve received unemployment compensation at any point in 2021.

During the open enrollment period for 2021 coverage, 535,803 people enrolled in private plans through the North Carolina health insurance marketplace – an increase over 2020’s enrollment of 505,275 people.

During the first few months of the COVID-related enrollment period in 2021, more than 91,000 additional people enrolled in plans through the North Carolina exchange. That was roughly triple the normal enrollment volume during that time period (when a qualifying life event would normally be necessary in order to enroll).

Six insurers offer coverage in North Carolina’s individual market as of 2021. Four of them already offered plans in 2020, and their average rate changes for 2021 ranged from a decrease of 14.3% (Cigna) to an increase of 6.2% (Ambetter/Centene).

The average benchmark plan premium in North Carolina’s dropped by 8% for 2021, after dropping by 9% the year before.

For 2022 coverage, the six existing insurers have proposed rate changes that vary from a decrease of about 6% (UnitedHealthcare) to an increase of about 9% (Blue Cross Blue Shield of North Carolina).

North Carolina’s refusal to expand Medicaid has resulted in an uninsured rate that is considerably higher than it would be if the state had accepted federal funds to make Medicaid available to all non-elderly adults (assuming they’ve been legal U.S. residents for at least five years) with household income up to 138% of the federal poverty level.

But the ACA has certainly benefitted North Carolina residents who used the exchange to enroll in Medicaid or private plans. The state was one of six states that enrolled more than half of its potential market through its exchange in 2015, and has consistently had third-highest enrollment among HealthCare.gov states, and the fourth-highest among all states.

According to U.S. Census data, 15.6% of North Carolina residents were uninsured in 2013. That had fallen to 10.4 percent by 2016, although it had increased slightly, to 10.7%,, by 2018, and to 11.3% by 2019 (the national average has crept up under the Trump administration).

In 2010, North Carolina’s U.S. Senators were divided on healthcare reform. Kay Hagen, a Democrat, voted yes on the ACA (Obamacare), while Richard Burr, a Republican, voted no. In the U.S. House, five Republican representatives from North Carolina voted no, while eight Democrats voted yes.

Burr remains in the Senate, but Hagen has been replaced by Thom Tillis, a Republican who opposes the ACA. Both Burr and Tillis voted in favor of the three Senate versions of ACA repeal in 2017, although none of them were ultimately enacted.

And the U.S. House now includes five Democrats from North Carolina, and eight Republicans.

Governor Roy Cooper, a Democrat, took office in January 2017. He supports the ACA and wants North Carolina to accept federal funding to expand Medicaid, but the state’s legislature has clashed with him over whether he has the authority to expand coverage.

Cooper replaced former Governor Pat McCrory, who had served for four years as the first Republican governor of North Carolina since 1988. McCrory’s predecessor, Governor Bev Perdue, had stated that North Carolina would enter into a partnership exchange with HHS, but shortly after he took office, McCrory announced that the state would default to a federally-facilitated marketplace.

In addition, MrCrory also decided that the state would not move forward with Medicaid expansion, citing a problematic recent audit of the state’s existing Medicaid program, and noting that the program’s issues needed to be fixed before the state considered expanding it.

McCrory was not a fan of the ACA, but early in the 2014 open enrollment period, he softened his stance a bit in a public announcement to the state’s residents. While he still noted that he was opposed to the ACA, he provided information and resources to help direct people to Healthcare.gov and enrollment assisters.

In general however, the state’s government has taken a largely hands-off role in terms of promoting and implementing the ACA in North Carolina. But a strong network of community-based public health workers, navigators, and volunteers have resulted in substantial enrollment in North Carolina’s health insurance marketplace.

North Carolina is one of a dozen states that still have not accepted federal funding to expand Medicaid under the ACA. An estimated 626,000 in the state would gain coverage if the state were to accept federal funding to expand the program.

Because the state refused to expand Medicaid, North Carolina has an estimated 194,000 residents in the coverage gap, with no access to Medicaid coverage or health insurance marketplace subsidies.

Read more about North Carolina and the ACA’s Medicaid expansion.

North Carolina defaults to federal regulations regarding short-term coverage. That means short-term plans are allowed to have initial terms up to 364 days, and total duration – including renewal – of up to 36 months.

The state does have various laws and regulations that apply to short-term plans.

Read more about short-term health insurance in North Carolina.

As of late 2020, there were more than 2 million North Carolina residents enrolled in Medicare.  About 18% were under age 65 and eligible due to a disability, while the rest are eligible for Medicare based on their age alone (ie, being 65). Of North Carolina Medicare beneficiaries, more than four out of ten are enrolled in Medicare Advantage plans.

You can read more about Medicare in North Carolina, including details about Medicare Advantage and Part D, as well as the state’s rules for Medigap plans.