Best Health Insurance Plans in North Carolina

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Compare Health Insurance Plans in North Carolina

Curious about health care in the Tar Heel State? North Carolina holds the 37th best health care ranking in the nation. The US News study looked at health care access, quality, and good public health for the rankings.

Health Care Choices in North Carolina

According to the North Carolina Department of Insurance, there are a number of ways residents can get health insurance:

  1. Employer-provided
    1. From your employer
    2. Through your spouse's employer
    3. Through COBRA
  2. Individual or family plans
    1. Through HealthCare.gov
    2. Directly from a health insurance company
  3. Government-assisted
    1. Medicare (SHIIP)
    2. Medicaid

Where do most North Carolina residents get their health insurance coverage?

North Carolina Health Insurance Sources
Sources Percent
Employer-Provided 45%
Individual or family 9%
Medicaid 18%
Medicare 15%
Other Public Care 3%
Uninsured 11%
Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population

Eleven percent of NC residents are uninsured, a few percent above the national average. This is bad news for policyholders, as the higher the rate of uninsured people, the more prices rise for insured people.

North Carolina Health Insurance Costs and Rate Factors

North Carolina residents spend an average of $7,264 on health care expenditures per year, less than the national average. Health care costs are largely determined by the risk level of each person. Here are the factors insurance companies will look at to price your policy:

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Body Mass Index

According to the CDC, a high BMI can lead to several health conditions. Because of this, insurance companies look at your BMI to determine your risk level. A high BMI means high insurance costs.

In 2016, North Carolina had a 31.8 percent obesity rate, the 16th highest in the country. An average of 34 percent of North Carolina residents who use QuoteWizard to compare health insurance plans have a BMI in the obese range.

Tobacco Use

Due to the harmful effects of smoking, insurance companies will charge you more if you're a tobacco user. About 17.9 percent of North Carolina residents are smokers, ranking 28th in the nation.

Age

You'll also be paying more as you age. According to HealthCare.gov, older people pay three times more in premiums than younger people. On average, North Carolina residents who shop for health insurance on QuoteWizard are 41 years old.

Plan Type

Your costs also depend on the level of coverage you want. You'll pay more for a higher level of coverage. Marketplace plans come in metal tiers: bronze, silver, gold, and platinum.

How do these metal categories affect your costs? These are the average costs for a 40-year-old North Carolina resident in 2018:

North Carolina Martketplace Plan Rates
Bronze Silver Gold
$464 $609 $656
Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier

A gold plan costs about 41 percent more than a bronze plan. This steep price jump is because gold plans cover 80 percent of health care costs, and bronze plans cover 60 percent of costs.

You may qualify for a catastrophic health plan, which is the lowest level of coverage. Monthly premiums for this type of plan are low, but it also comes with a $7,150 yearly deductible. A bronze or silver plan may save you money when you need to use your insurance.

Location

Where you live plays a major role in how much you'll be paying for health care. Every state has different rules, regulations, and providers surrounding the health insurance marketplace.

According to the North Carolina Department of Insurance, health insurance costs are also community rated. Rates are based on the combined claims people around you are filing. So, if a neighbor files an abnormally high number of claims, your premium prices could soar.

Living in a more health-conscious state could keep your costs low. According to America's Health Rankings, North Carolina is the 33rd healthiest state in the country.

North Carolina Health Insurance Companies

There are only two insurers that offer coverage for 2018 in the North Carolina insurance marketplace exchange:

BlueCross BlueShield of North Carolina

BlueCross BlueShield of North Carolina offers individual and family plans for NC residents. Plans include benefits like health and wellness programs, fully covered preventive care, fitness discounts, a 24/7 nurse line, and more. Plans levels are organized into metal tiers. The metal tiers include bronze, silver, and gold. Bronze covers 60 percent of medical costs, silver covers 70 percent of costs, and gold covers 80 percent. You may also qualify for a catastrophic health plan If you are under 30 or qualify for a hardship.

Blue Cross NC was founded in 1933. The company has more than 4,700 employees and serves more than 3.89 million members.

Cigna

Cigna has several individual and family plan options. Plan options vary based on the NC county you live in, the size of your household, income, and more. Plan levels include bronze, silver, and gold. The company also offers several health and wellness resources for members. These include tips on nutrition, healthy aging, exercise, family care, and more.

Cigna has over 40,000 employees and 95 million customers around the world.  Founded in 1982, their mission is “to improve our customers’ health, well-being, and sense of security with the power of preventive care.”

These providers offer both family and individual health care plans. Your policy could depend on which county you live in, so check insurer websites to see what policies your zip code qualifies for.

North Carolina Health Insurance Laws

The Affordable Care Act made it so that insurance companies can't use certain factors when pricing your policy. Here's what they can't use:

There's a limit to how much you'll be paying out-of-pocket for a marketplace plan. The out-of-pocket maximum limit for 2018 is $7,350 for an individual plan and $14,700 for a family plan.

NC law requires insurance providers to offer at least some coverage for the following services:

  • Emergency care
  • Certain clinical trials
  • Anesthesia for dental procedures
  • Treatment of diabetes
  • Newborn hearing screening
  • Cancer screening
  • Hearing aids

There are more requirements for providers in North Carolina. Check the full list of required benefits here.

Medicare and Medicaid in North Carolina

Medicare and Medicaid are both government-funded health care programs. Medicare helps people over 65 pay for health care. Similarly, Medicaid offers financial assistance to low income families and children.

Medicare

In North Carolina, Medicare is called SHIIP and is available for people over 65. There are several options within the program, including parts A, B, C, D, and supplemental coverage plans. There are three levels of Medicare-Aid that you may qualify for as a resident of North Carolina. These are the requirements for the state's Medicare Savings Program:

Comprehensive Medicare-Aid (MQB-Q)

  • Single person with a monthly income lower than $1,012.
  • Couple with a monthly income lower than $1,372.

Limited Medicare-Aid (MQB-B)

  • Single person with a monthly income lower than $1,214.
  • Couple with a monthly income lower than $1,646.

Limited Medicare-Aid Capped Enrollment (MQB-E)

  • Single person with a monthly income lower than $1,366.
  • Couple with a monthly income lower than $1,852.

Medicaid

North Carolina offers Medicaid to low income families. These are the state's Medicaid financial requirements:

North Carolina Medicaid Financial Requirements
Household Size Maximum Yearly Income
1 $16,040
2 $21,599
3 $27,159
4 $32,718
5 $38,277
6 $43,837
7 $49,396
8 $54,956

North Carolina Office of the Insurance Commissioner

Website:
Homepage
Insurance Commissioner:
Mike Causey
Insurance Hotline:
(855) 408 – 1212
Office Hours:
Monday - Friday
8:00 am to 5:00 pm
File a Consumer Insurance Complaint
Complaint Page

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