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 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 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

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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