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North Carolina Health Insurance Exchange Rates – Compare And Enroll

The North Carolina Health Insurance Marketplace allows consumers to purchase quality individual, family and small business medical coverage at affordable rates. Pre-existing conditions are covered without any waiting periods or surcharges, and applications for policies can not be turned down for past or present medical conditions. There are many NC subsidized plans that allow you to obtain comprehensive or catastrophic benefits.
 

Both "on" and "off" Exchange policies can be reviewed and applied for. You are not obligated to enroll in a federally-subsidized plan. If you have reached age 65, a separate Senior Open Enrollment allows you to compare (and enroll) Many available Medigap plan options. Medicare Supplement and Advantage policies can reduce your out-of-pocket expenses that original Medicare does not pay for. Part D prescription drug coverage is also included in many Advantage plans, and also available separately. Many out-of-pocket costs can be covered, although you must be enrolled in Parts A and B to apply for a supplementary policy.
 

The Obamacare federal subsidy provides savings of thousands of dollars every year to NC residents that qualify. The Affordable Care Act (ACA) has added 10 "essential benefits" that are included on all policies. However, it is possible to qualify for a "catastrophic" policy, that will place a deductible on most non-preventative benefits, and thus, make available very basic cheap North Carolina healthcare. NOTE: Catastrophic plans are offered to applicants under age 30, or any person that can show "financial hardship." However, since these plans are ineligible for instant tax-credit subsidies, often "Bronze-Tier" plans cost less, and provide richer benefits.
 

For example, A 25 year-old single person in Charlotte that makes $23,000 per year, can enroll in the BCBS of NC Blue Value 7150 plan (Bronze tier) at a cost of only $40 per month. Although a "catastrophic" plan is available, the cost is substantially higher. The BCBS of NC Blue Value Catastrophic plan costs $204 per month since it is not eligible for a federal subsidy.
 

Blue Cross and Blue Shield of NC offers a Silver-tier plan (Blue Value 5000) with a limited provider network, for $112 per month. Cost-sharing reduces the deductible to only $1,000 with maximum out-of-pocket expenses of $2,350. The primary-care physician (pcp) office visit copay is $5 while the specialist office visit copay is $20. Generic drugs are also subject to only a $4 copay. An annual eye exam is provided with a $10 copay, and two dental check-ups per year are included at no charge, if a network provider is utilized.  

"Free Coverage"
 

Thousands of thousands of residents will currently qualify for "free" coverage either through meeting Medicaid income guidelines, or qualifying for maximum subsidies that pay all of the premium. State workers and retirees can also expect some help, despite occasional delays in sending their ID cards. Since the financial aid is based on income, retired persons can often qualify for significant amounts of assistance, despite large amounts of assets. However, the determination also must consider the age of the applicant, and how many dependents are in the household.
 

A "gap" still exists for many young low-income residents that make too much money to qualify for Medicaid, but not enough money to qualify for federal subsidies to help pay the premium. More than 200,000 persons between 18-34 fall into this category. It is expected that future legislation will address this issue and provide a low-cost alternative. Federal subsidies are based on projected household income for the upcoming year, which can often help unemployed individuals, or persons that are laid off and actively seeking employment. It is possible that future Trump Administration initiatives may provide several new medical plan options.
 

Compare North Carolina Health Insurance Rates

Easily Compare NC Rates Online And Quickly Enroll

 

How To View Rates
 

We make it easy for you. Of course, the quotes we provide are always free with no obligation. We created a section in the top portion of every page that allows you to enter your current zip code. Instantly, you can view the best options in your area and request to view live prices. There are 16 "rating" areas in the state and you can view prices in all counties. If you move from one county to another, it's important to verify that your doctors, specialists or hospitals remain inside the provider network. If you move to nearby South Carolina, Virginia, or any other state, you will need to re-enroll, since plans, prices, and networks will be different.
 

NC Companies Offering Marketplace Plans
 

The "Marketplace" is another name for the "Exchange." The participating carriers for on-Exchange coverage are Blue Cross and Blue Shield of NC and Cigna. Federated Mutual, Aetna, National Foundation Life, and First Carolina Health Care no longer participate. First Carolina would have provided plans in Lee, Richmond, Scotland, Montgomery, Hoke and Moore counties. They now offer Small Group benefits. UnitedHealthcare also declined to offer "on-Exchange" plans, although many of their products are available as Group or ancillary plans. Their short-term plans, marketed under the trade name "Golden Rule," remain very popular.
 

BCBS policies are available in all 100 counties in the state. It is hoped that additional companies will also become available in the future, although the Affordable Care Act legislation will have to be tweaked. Currently, there are many NC counties where only one insurer offers plans. The NC Dept. Of Insurance publishes the names of any new carriers that will enter the Marketplace next year. Nationally, UnitedHealthcare, Aetna, and Humana have drastically reduced the number of states they offer "on-Exchange" plans.
 

Previously, Carolinas Healthcare System and BCBS jointly offered coverage under the trade name Blue Local. And UnitedHealthcare (UHC), although not currently offering 2017 Exchange plans, is one of the largest companies in the US, and already has a large market share for plans issued outside of the Marketplace. UHC also underwrites an extremely competitive short-term plan that provides cheap medical coverage for consumers needing temporary benefits that can be quickly implemented. However, temporary contracts do not satisfy the legal mandate of purchasing qualified coverage. Therefore, although these plans are very inexpensive, you may have to pay a tax equal to 2.5% of your household income.
 

NOTE: Several carriers are licensed to offer products in the state but are not authorized to issue Marketplace plans. Some of these plans may include short-term, limited benefit, or critical-illness contracts. Also, carriers often offer small and large group employer coverage, but not private Exchange policies. The companies are: Aetna, Humana, All Savers, National Foundation Life, Federated Mutual, and FirstCarolinaCare. When you secure benefits through an employer, you are not eligible for federal subsidies to help you pay the premium. However, often, Group policy premiums are partially paid by the employer.
 

Sample 2017 Rates
 

For quoting purposes, our first sample household is a husband and wife (both age 50) with two teenage children. They live in the Raleigh area (Wake County) and the household income is $55,000. The federal subsidy tax credit has automatically been applied to all premiums. Deductibles are typically "per person" with a maximum of two per family. Silver-tier plans include adjusted lower deductibles and out-of-pocket expenses. Rates for plans shown below are monthly:
 

Family Of Four -- Ages 50, 50, 18, and 16 With $55,000 Income

 

$0 -- Cigna Connect 4500 -- The federal subsidy exceeds the cost of the policy, so the premium is reduced to $0. $30 pcp office visit copay for the first two visits. Specialist visits are subject to 50% coinsurance. Deductible is $4,500, and maximum out-of-pocket expenses are $7,150 with 50% coinsurance.

$52 -- BCBS of NC Blue Value Bronze 7150 -- $7,150 deductible with $7,150 maximum out-of-pocket expenses and 0% coinsurance. Deductible and coinsurance apply to all non-preventative expenses.

$84 -- BCBS of NC Blue Local 5500 -- $5,500 deductible with $6,550 maximum out-of-pocket expenses and 20% coinsurance. Deductible and coinsurance apply to all non-preventative expenses. Network includes Duke Medicine And WakeMed.

$179 -- Cigna Connect 4000 -- $15 pcp office visit copay and 15% coinsurance for specialist office visits. The deductible is $3,000 with $5,700 maximum out-of-pocket expenses and 15% coinsurance. Preferred generic, non-preferred generic, and non-preferred brand drug copays are $10, $25, and $60 respectively. Specialty drugs have a 30% coinsurance. An annual eye exam and pair of glasses are provided with no charge.

$338 -- BCBS of NC Blue Local Silver 5000 -- $10 and $40 office visit copays. Deductible is $3,000 with maximum out-of-pocket expenses of $5,700 and 30% coinsurance. Tier 1, 2, 3, and 4 drug copays are $10, $25, $45, and $80 respectively. Network includes Duke Medicine And WakeMed.

$359 -- BCBS of NC Blue Value 5000 -- Identical coverage as previous plan but network is "limited" instead of "local."

$365 -- BCBS of NC Blue Local 3500 -- $10 and $40 office visit copays. Deductible is $2,800 with maximum out-of-pocket expenses of $5,700 and 30% coinsurance. Tier 1, 2, 3, and 4 drug copays are $10, $25, $45, and $80 respectively. Network includes Duke Medicine And WakeMed.

$387 -- BCBS of NC Blue Value 3500 -- Identical coverage as previous plan but network is "limited" instead of "local."

$491 -- Cigna Connect 2000 -- $15 and $40 office visit copays. $1,800 deductible with $5,700 maximum out-of-pocket expenses and 30% coinsurance. Preferred generic, non-preferred generic, and non-preferred brand drug copays are $10, $25, and $60 respectively. Specialty drugs have a 30% coinsurance.

$536 -- Cigna US-NC Connect 3500 -- $30 and $65 office visit copays. $3,000 deductible with $5,700 maximum out-of-pocket expenses and 20% coinsurance. Preferred generic, non-preferred generic, preferred brand, and non-preferred brand drug copays are $8, $10, $50, and $100 respectively. Specialty drugs have a 40% coinsurance.

$833 -- BCBS of NC Blue Local 1500 -- $5 and $30 office visit copays. Deductible is $1,500 with maximum out-of-pocket expenses of $7,150 and 40% coinsurance. Tier 1, 2, 3, and 4 drug copays are $4, $10, $35, and $80 respectively. Network includes Duke Medicine And WakeMed.

 

Single 35 Year-Old Male Or Female With Income Of $30,000 Living In Raleigh (Wake County)

 

$106 -- Cigna Connect 6400 -- $45 pcp office visit copay for first two visits. Specialist visits must meet coinsurance. Deductible of $6,400 with $7,150 maximum out-of-pocket expenses and 50% coinsurance. All prescription drugs must also meet coinsurance.

$109 -- Cigna US-NC Connect 6650 -- $45 pcp office visit copay for first three visits. Specialist visits must meet coinsurance. Deductible of $6,650 with $7,150 maximum out-of-pocket expenses and 50% coinsurance. Preferred generic and non-preferred generic drugs receive $30 and $35 copays.

$113 -- Cigna Connect 4500 -- The federal subsidy exceeds the cost of the policy, so the premium is reduced to $0. $30 pcp office visit copay for the first two visits. Specialist visits are subject to 50% coinsurance. Deductible is $4,500, and maximum out-of-pocket expenses are $7,150 with 50% coinsurance.

$121 -- Cigna Connect 60000 -- $40 pcp office visit copay, but specialist visits are subject to 50% coinsurance. Deductible is $6,000, and maximum out-of-pocket expenses are $7,150 with 50% coinsurance. All prescription drugs are subject to 50% coinsurance.

$130 -- BCBS of NC Blue Local Bronze 7150 -- $7,150 deductible with maximum out-of-pocket costs of $7,150 and 0% coinsurance. Network includes Duke Medicine And WakeMed.

$167 -- Cigna Connect 4000 -- $20 pcp office visit copay for first three visits. Specialist visits must meet coinsurance. Deductible of $4,000 with $7,150 maximum out-of-pocket expenses and 15% coinsurance. Preferred generic, non-preferred generic and preferred brand drugs receive $10, $25, and $60 copays.

$207 -- BCBS of NC Blue Local Silver 5000 -- $10 and $40 office visit copays. Deductible is $5,000 with maximum out-of-pocket expenses of $7,150 and 30% coinsurance. Tier 1, 2, 3, and 4 drug copays are $10, $25, $45, and $80 respectively, although separate drug deductible must be met. Network includes Duke Medicine And WakeMed.

 

Can I Pay Monthly And Send Premiums In Mail?
 

Yes, you can. Although many policies had to be paid via electronic withdraw in previous years, direct monthly billing is available. Checks, debit cards and EFT are also accepted for the first payment and subsequent ongoing payments. You may change your billing mode with a simple request, although it's best to allow your broker or carrier to handle the paperwork. A grace period is also provided with all plans.
 

Which Parts Of  The State Have The Least Expensive Prices?
 

NC BCBS Exchange Rates

BCBS Of North Carolina Offers Healthcare In All Counties

 

As earlier mentioned, there are 16 "rating areas" that include all 39 counties. Two territories with some of the cheapest prices are rating areas 11 and 13. They consist of the following counties: Alamance, Person, Orange, Lee Durham, Chatham, Caswell, Franklin, Johnston and Wake.
 

Rating areas 3 and 16 feature some of the highest  premiums. They consist of the following counties:Allegheny, Ashe, Watauga, Wilkes, Beaufort, Carteret, Craven, Dare, Hyde, Jones, Lenoir, Pamlico, Tyrell and Washington.
 

Perhaps the principal reason for higher prices in those areas is actual cost of medical care, including office visits, cost of hospital room and board, procedures, treatment and overall facility charges. The lack of competition may also be contributing to the rate disparity. Also, in areas where free preventive benefits are not highly utilized, often prices are higher. Whether it is being uninsured, or lack of knowledge that compliant plans cover routine physicals, mammograms and OBGYN visits, many rural parts of the state don't take advantage of many free services.

 

What Are The Four Categories Of Plans That Are Available?
 

Exchange policies are divided into four groups that are based on their "cost-sharing." This is the anticipated out-of-pocket expenses consumers will pay for their healthcare. The four categories are Platinum, Gold, Silver and Bronze. The expenses include deductibles, copays and coinsurance. Regardless of your income, you can freely change from one tier to another each year.
 

Platinum plans are the most expensive, since their cost-sharing ratio is only 10%. However, the Bronze plans have a cost-sharing ratio of 40%, and thus, their premiums are typically the lowest of all available policies. There is also an additional "catastrophic" option for persons under age 30 and other applicants that meet specific low-income financial guidelines.
 

However, since catastrophic options are not eligible for federal subsidies, often, Bronze-tier plans are much more cost-effective. For example, consider a 25 year-old with $27,000 of income, that resides in the Raleigh area (Zip code 27601 in Wake County). Shown below are monthly rates, with the federal subsidy reduction already included. It's quite evident that in this scenario, a catastrophic contract is not cost-effective.
 

$83 -- Cigna Connect 6400
$86 -- Cigna US-NC Connect 6650
$89 -- Cigna Connect 4500
$96 -- Cigna Connect 6000
$104 -- BCBS of NC Blue Local 7150
$118 -- BCBS of NC Blue Value 5500
$134 -- Cigna Connect 4000
$178 -- BCBS of NC Blue Value Catastrophic

 

Silver-tier plans are often the most cost-effective options of all Metal policies. Unique "cost-sharing" specifically helps lower and moderate income households (less than 250% of the Federal Poverty Level guidelines) by reducing deductibles, copays, and coinsurance. Thus, instead of these plans paying an expected 70% of all medical expenses, often it is as much as 94%, if the FPL ratio is between 150% and 200%.
 

What Are The Least Expensive NC Policies That Can Be Purchased On The Exchange?
 

Although options vary, depending on your county of residence and other factors, some of the cheapest available plans are:
 

Catastrophic Tier
 

Aetna Leap

BCBS Blue Value (Limited Network)

UnitedHealthcare Compass 6850

BCBS Blue Local 6850

 

Bronze Tier

 

Aetna Leap Basic HSA

Aetna Leap Basic Plus

UnitedHealthcare Bronze 4200

UnitedHealthcare Compass HSA 5200

BCBS Blue Value 6850 (Limited Network)

 

Silver Tier

 

Aetna Leap Everyday

UnitedHealthcare Compass 5000

UnitedHealthcare Compass HSA 3600

UnitedHealthcare Compass 2000

Aetna Leap Everyday Plus

BCBS Blue Value 5000 (Limited Network)

BCBS Blue Local 5000

BCBS Blue Value 3500 (Limited Network)

 

Gold Tier

 

UnitedHealthcare Gold Compass HSA 1600

Aetna Leap Specialty

UnitedHealthcare Gold Compass 1000

 

Platinum Tier

 

BCBS Blue Value 500 (Limited Network)

HSA Rates NC

Save Money With An HSA

 

HSA Options
 

If you currently have an existing non-Marketplace HSA (Health Savings Account), unless you have been notified otherwise, it is probably a "grandfathered" plan or a policy purchased in 2015. Therefore, you can keep the policy along with the separate side account that you make qualified deposits into. Although specific benefits such as maternity may not be covered (grandfathered plans only), these plans are allowed to be kept in force. Group HSA contracts are also quite popular, although they are required to meet all ACA Legislation mandates.
 

None of the provisions of the contract will be changed, although each year, new maximum deposit limits may be established. How to get the best HSA plans and other related topics are covered by us through a separate article. This type of plan helps you organize and take charge of your personal medical treatment. We have listed (with short plan description) several of the most popular and affordable NC HSA-eligible plans below:
 

Aetna Leap Basic (Carolinas HealthCare) -- $5,825 deductible with 100% coverage after deductible is met. 0% coinsurance.

Bronze Compass HSA 5200 (UnitedHealthcare) -- HMO with a $5,200 deductible, 10% coinsurance, and maximum out-of-pocket expenses of $6,500.

Blue Value 5000 (BCBS of NC) -- POS (Point-Of-Service) option with limited network. $5,000 deductible with 20% coinsurance and $6,550 maximum out-of-pocket expenses.

 

Senior Health Insurance Coverage In North Carolina
 

For residents that have reached age 65 and are Medicare-eligible, many Medigap plans are offered by highly-rated companies. Medicare Supplement options along with Advantage plans (that replace original Medicare benefits) help pay many of the out-of-pocket expenses that otherwise may not be covered. Part D prescription drug plans can also be purchased, although many Advantage contracts include these benefits.

 

NOTE: The Open Enrollment period for existing customers (October 15th to December 7th) is different than the OE period for applicants under age 65. A separate seven-month Open Enrollment is available for persons that become Medicare-eligible. Also, additional information regarding all topics, including durable medical equipment, disability guidelines, and assistance in paying premiums, can be found at the NC Seniors Health Insurance Information Program.(SHIIP)

 

Two of the most popular Supplement options are Plans F and N, which are comprehensive policies that cover the Part A deductible, hospice care, and coinsurance, skilled nursing facility coinsurance, and blood. Shown below are sample monthly rates (Attained Age) for a 65-year old non-smoking female.
 

Plan F

 

$115 -- SBLI USA Life
$116 -- Combined Insurance Company Of America
$117 -- Thrivent
$111 -- Individual Assurance Company
$119 -- Cigna
$121 -- Manhattan Life
$122 -- Everest
$122 -- Massachusetts Mutual
$126 -- Aetna
$132 -- Medico
$141 -- Central States
$146 -- Equitable
$134 -- State Farm
$128 -- USAA
$146 -- Mutual Of Omaha
$153 -- BCBS of NC
$154 -- Globe
$172 -- Humana
$198 -- Gerber
$254 -- Physicians Mutual

 

Plan N

 

$73 -- Individual Assurance
$79 -- Western United
$79 -- Greek Catholic Union
$82 -- Everest
$82 -- Manhattan Life
$84 -- Aetna
$84 -- Cigna
$85 -- Mutual Of Omaha
$93 -- Medico
$93 -- Colonial Penn
$97 -- Oxford Life
$106 -- First Health
$107 -- Humana
$114 -- Medico
$120 -- Coventry
$144 -- United American

 

Plan C

 

$119 -- Western United Life
$121 -- Everest
$122 -- Manhattan Life
$133 -- New Era Life
$139 -- Loyal Christian Benefit
$145 -- State Farm
$150 -- Government Personnel
$153 -- Globe
$154 -- BCBS of NC
$156 -- Central States
$160 -- Sentinel Security Life
$166 -- Standard Life And Casualty
$169 -- Humana
$174 -- State Mutual
$199 -- United American
$203 -- Constitution Life
$206 -- Order Of United Commercial Travelers Of America
$223 -- Reserve National
$308 -- Standard Life And Accident

Updates From The Past:
 

June 2014: UnitedHealthcare is coming in 2015! UHC will offer subsidized plans on the NC Exchange. They will join Blue Cross Blue Shield and Coventry, who both were available to consumers in 2014. Although BCBS participated in every county, UHC has not indicated which counties it will offer individual and family plans.
 

We believe that UnitedHealthcare will capture a fairly significant market share. Typically, their prices are very attractive in most states, and they were able to effectively "sit out" and watch other companies before entering the Marketplace.
 

October 2014: North Carolina Blue Cross and Blue Shield 2015 health insurance rates will increase by about 13% for Marketplace plans for individuals and families. Naturally, not all plans will see double-digit increases. However, grandfathered plans that don't conform to Affordable Care Act mandates (generally issued in 2010 and earlier) will see prices go up as much as 15%-19%, depending on the issue date and type of policy.
 

January 2015 -- As of mid-January (the second Open Enrollment deadline), almost 500,000 persons have applied for coverage. More than 100,000 persons signed up for new policies and Bronze-tier and Silver-tier contracts continue to be the most popular option. After February 15th, a special approved exemption will be needed to purchase coverage that complies with ACA guidelines.
 

More than four out of every five person applying for coverage is paying less than $100 per month (subsidies included). Also, this year, an average of about 25 policy options are available in each county, which is a 40% increase from last year. Of course, with more available carriers, the number of choices has increased.
 

May 2015 -- Humana will be offering both on and off Marketplace coverage in 2016. Carriers must file their intent with the DOI and specific plan and price information will be provided later in the summer. Other companies will state their 2016 intentions, and also provide detailed policy information within the next few months.
 

June 2015 -- 2016 NC Marketplace rates are increasing for most carriers. Although not yet approved by the Department of Insurance, we have listed below several of the requested premium increases for popular plans that would become effective January 1, 2016.

50.7% -- Time Individual Medical
26.7% -- Blue Cross And Blue Shield Blue Value
26.4% -- Blue Cross and Blue Shield Blue Local
25.8$ -- Aetna POS-PD
17.7% -- Blue Cross and Blue Shield Blue Select
13.2% -- Coventry NC Group PPO
12.5% -- UnitedHealthcare Compass
11.3% -- HumanaOne PPO

 

August 2015 -- Blue Cross and Blue Shield of North Carolina has revised their initial rate increase estimates. Instead of a 26% increase, the average rate hike will be approximately 35%. Higher medical costs and more expensive claims than anticipated were cited as reasons. However, customers with grandfathered plans and group policies through employers are not impacted by the latest increase. Also, NC regulators may not approve the proposed changes. A decision is expected within the next 60 days.

 

August 2016 -- Open Enrollment begins on November 1, and fewer carriers are offering plans in North Carolina, along with the most other states. The issue is the large underwriting losses that companies are experiencing. Once the Presidential election is over, Congress will have to work together and tweak the ACA Legislation. Offering plans without maternity and other mandated benefits will be discussed. Aetna and UnitedHealthcare also will not be offering on-Exchange plans in 2017. September 23rd is the last day carriers can decide which areas they will be offering plans.

1 comment

  1. jordan

    Hello there! This post couldn’t be written any better! Thank you for sharing!

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