North Carolina Health Insurance

Health insurance in North Carolina

● North Carolina uses the federally subsidized health insurance exchange.

● The open enrollment for 2021 health plans is from 1 November to 15 December 2020. Residents with eligible events can sign up or make changes to the floor outside of that window.

● Short-term health plans can be sold in North Carolina with initial plan terms of up to 364 days.

● With Bright Health's entry into the state market, four insurers offer 2020 coverage through north Carolina's health insurance exchange. Two other insurers (UnitedHealthcare and Oscar) participate in the exchange for 2021, and Cigna is expanding to 64 other counties.

● North Carolina insurers have implemented all average rate decreases for 2020.

● More than 505,000 North Carolina residents signed up for 2020 coverage through the exchange (up from 501,000 in 2019).

● North Carolina has not accepted the ACA's Medicaid expansion.

This page is dedicated to helping consumers quickly find health insurance resources in the state of Florida. Here you will find information about the many types of health insurance coverage available. You can find the basics of florida's health insurance market and the next open enrollment period; a brief overview of Medicaid expansion in Florida; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of health insurance resources for Florida residents.

North Carolina's health insurance marketplace

North Carolina uses federally managed health insurance exchange, which means enrollment is done through the HealthCare.gov web. The exchange (market) offers individual private health coverage of the market, so it is used by individuals and families who need to buy their own health insurance. This includes early retirees who are not yet entitled to Medicare, the self-employed, and people who are employed by small businesses that do not offer health benefits.

The exchange is also the only place where people who buy individual market health coverage can receive care for costs, including premium subsidies (which help offset the monthly premiums people pay for their coverage) and cost-sharing reductions (which help reduce the out-of-pocket costs people have when they need health care , including copays, franchises and coinsurance).

North Carolina Open Enrollment Period and Dates

Open enrollment for 2021 health plans runs from November 1, 2020 to December 15, 2020. The annual open enrollment period is an opportunity for individuals and families to re-enroll in coverage for the following year or make a change to existing coverage. It is also an opportunity to renew an existing plan and update the exchange on any changes in income or families that may have occurred in the last year and that could affect eligibility for subsidies.

Outside of the open sign-up window, North Carolina residents can sign up for coverage or change their plan only if they experience a qualifying event.

Four insurers - Blue Cross Blue Shield of North Carolina, Cigna, Ambetter and Bright - offer individual market plans for 2020 through north Carolina's health insurance market. (Most of the state has a single aircraft carrier -- Blue Cross Blue Shield of North Carolina -- that offers plans in the exchange.) Bright Health is a newcomer from 2020, offering plans in the Charlotte and Winston-Salem areas.

For 2021, UnitedHealthcare and Oscar both plan to participate in the exchange in North Carolina. Cigna, which offers plans in the Raleigh-Durham area in 2020, is expanding its North Carolina service area to include an additional 64 counties by 2021.

Existing insurers in north Carolina's individual market have proposed average rate changes ranging from a 14% decrease to a 4% increase for 2021.

Average premiums (before any subsidies are applied) for 2020 are slightly lower in North Carolina than in 2019. The average premium of the benchmark plan in North Carolina has fallen by 10% for 2020, although overall average premiums have fallen by just under 6% (for existing plans, not to mention Bright's new plans).

505,275 people enrolled in private plans through north Carolina's health insurance market during the open enrollment period for 2020 coverage, which was an increase over 2019 enrollment.

Medicaid expansion in North Carolina

North Carolina is one of 14 states that have not yet accepted federal funding to expand Medicaid under the ACA (Oklahoma and Missouri will expand Medicaid starting in mid-2021, following voter-approved election initiatives in both states in 2020). An estimated 626,000 in the state would gain coverage if the state accepted federal funding to expand the program.

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

Short-term health insurance in North Carolina

North Carolina is unable to be part of federal short-term coverage regulations. This means that short-term plans can have initial terms of up to 364 days and a total duration – including renewal – of up to 36 months.

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

The Affordable Care Act in the state of the tar heel

In 2010, U.S. senators from North Carolina were divided over health care reform. Kay Hagen, a Democrat, voted yes to 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 repealing the ACA in 2017, though none of them were eventually enacted.

And the U.S. House now includes only three North Carolina Democrats, and ten Republicans.

Governor Roy Cooper, a Democrat, became a democrat in January 2017. He supports the ACA and wants North Carolina to accept federal funding to expand Medicaid, but the state 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 North Carolina's first Republican governor since 1988. McCrory's predecessor, Governor Bev Perdue, had said North Carolina would for a partnership with HHS, but shortly after it became unseen, McCrory announced that the state would default on a federally subsidized market.

In addition, Mr.Crory also decided that the state would not make progress with Medicaid expansion, citing a recent problematic audit of the state's current Medicaid program, and noting that the program's problems needed to be resolved before the state considered expanding it.

McCrory wasn't an ACA fan, but at the start of the 2014 open enrollment period, he softened his position a bit in a public announcement to state residents. While he still noted that he was against the ACA, he provided information and resources to help people direct Healthcare.gov and enrollment assisters.

In general, however, the state government has taken on 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 has led to substantial enrollment in north Carolina's health insurance market.

How Obamacare helped NC residents

North Carolina's refusal to expand Medicaid has led to 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 were legal residents of the United States for at least five years) with a family income of up to 138% of the federal poverty level.

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

According to U.S. Census data, 15.6% of North Carolina residents were un insured in 2013. It had fallen to 10.4% in 2016, although it had risen slightly, to 10.7%, by 2018 (the national average crept in under the Trump administration).

Is there still a high-risk pool in North Carolina?

Before the ACA radically reformed the individual health insurance market, coverage was underwritten in nearly every state, including North Carolina. This meant that pre-existing conditions could prevent an applicant from getting coverage or result in significantly higher premiums or policy exclusions. The North Carolina Health Insurance Risk Pool was created in 2009 to offer people an alternative if they were unable to get individual health insurance because of their medical history.

When the implementation of the ACA led to a guaranteed individual issuance market in January 2014, risk pools were no longer needed. North Carolina's health insurance risk pool ceased operations in late 2013, and members had to switch to new ACA-compliant plan options issued on or off the exchange.

Medicare coverage and enrollment in North Carolina

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