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 2020 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. HSAs, student, small-business, and self-employed coverage is also offered.
 

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 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 additional 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 (Mecklenburg County) that makes $27,000 per year, can enroll in the BCBS of NC Blue Value Bronze 7900 at a cost of $28 per month, or the BCBS of NC Blue Value Bronze 6750 ($36 per month). Although a "catastrophic" plan is available, the price is substantially higher. The BCBS of NC Blue Value Catastrophic plan costs $181 per month since it is not eligible for a federal subsidy. There is often a difference in specialist and Urgent Care copays that also must be considered.
 

Blue Cross and Blue Shield of NC offers a Silver-tier plan (Blue Value Silver Enhanced 4000) with a limited provider network, for $139 per month. The primary-care physician (pcp) office visit copay is $10 while the specialist office visit copay is $40. Generic drugs are also subject to only a $10 copay (after deductible is met). The Urgent Care copay is $40. Tier 1 and Tier 2 drug copays are $10 and $25, although the deductible must be met. Tier 3 and Tier 4 drug copays are $40 and $80, but also subject to the deductible.
 

"Free Coverage"
 

Thousands of thousands of residents 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.
 

If you are age 65 or older, or Medicare-eligible, you might still qualify fr assistance. If you are blind or disabled, or needing long-term care, you may also qualify for Medicaid benefits. However, all applicants must be residents of the state and prove residency. A valid social security number is also required (or in the process of applying) and you must be a US citizen. Any applicant is automatically eligible if they receive work first cash assistance, supplemental security income (SSI), or assistance for the aged or disabled.

 

A "gap" still exists for many young low-income residents that make too much money to qualify for Medicaid (Division Of Medical Assistance) 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, Ambetter (Durham and Wake Counties), Bright Health (Charlotte and Winston-Salem areas), and Cigna (Chatham, Orange, Nash, and Johnston Counties). Federated Mutual, Aetna, National Foundation Life, and First Carolina Health Care no longer participate. Previously, 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. Temporary coverage in NC is available for up to 364 days, and may be renewed for up to three years.
 

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. If future Trump Administration options become available, we will provide rates and reviews.
 

Previously, Carolinas Healthcare System and BCBS jointly offered coverage under the trade name Blue Local. And UnitedHealthcare (UHC), although not currently offering 2019 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. Often, applications are approved within 24 hours, especially for indemnity plans.
 

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. When you retire, typically, you can keep these plans, although the premium may change. Also, some ancillary benefits may not be offered, although they can be purchased privately.
 

Current 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 cost-savings 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 Living In Raleigh (Wake County)

 

$0 -- BCBS of NC Blue Value Bronze 7000 -- The federal subsidy exceeds the cost of the policy, so the premium is reduced to $0. Pcp and specialist office visit copays are $30 and $100. Deductible is $7,000, and maximum out-of-pocket expenses are $7,900 with 40% coinsurance.

$0 -- BCBS Of NC Blue Value Bronze 7900 -- The federal subsidy exceeds the cost of the policy, so the premium is reduced to $0. Deductible is $7,900, and maximum out-of-pocket expenses are $7,900 with 0% coinsurance.

$0 -- BCBS Of NC Blue Value Bronze 6750 -- The federal subsidy exceeds the cost of the policy, so the premium is reduced to $0. Deductible is $6,750, and maximum out-of-pocket expenses are $6,750 with 0% coinsurance. Similar to previous plan, but HSA-eligible.

$168 -- Cigna Connect 7900 -- Deductible is $7,900, and maximum out-of-pocket expenses are $7,900 with 0% coinsurance.

$252 -- Ambetter Essential Care 1 -- Deductible is $7,900, and maximum out-of-pocket expenses are $7,900 with 0% coinsurance.

$257 -- BCBS of NC Blue Value Silver Enhanced 4000 -- Pcp and specialist office visit copays are $10 and $40. Deductible is $4,000, and maximum out-of-pocket expenses are $6,300 with 30% coinsurance. Tiers 1, 2, and 3 drug copays are $10, $25, and $40 (after deductible is met).

 

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

 

$67 -- BCBS of NC Blue Value Bronze 7900 -- Deductible is $7,900, and maximum out-of-pocket expenses are $7,900 with 0% coinsurance.

$76 -- BCBS Of NC Blue Value Bronze 6750 -- Deductible is $6,750, and maximum out-of-pocket expenses are $6,750 with 0% coinsurance. Similar to previous plan, but HSA-eligible.

$84 -- BCBS of NC Blue Value Bronze 7000 -- Pcp and specialist office visit copays are $35 and $100. Deductible is $7,000, and maximum out-of-pocket expenses are $7,900 with 40% coinsurance.

$169 -- Cigna Connect 7900 -- Deductible is $7,900, and maximum out-of-pocket expenses are $7,900 with 0% coinsurance.

$188 -- Ambetter Essential Care 1 -- Deductible is $7,900, and maximum out-of-pocket expenses are $7,900 with 0% coinsurance.

$189 -- BCBS of NC Blue Value Silver Enhanced 4000 -- Pcp and specialist office visit copays are $10 and $40. Deductible is $4,000, and maximum out-of-pocket expenses are $6,300 with 30% coinsurance. Tiers 1, 2, and 3 drug copays are $10, $25, and $40 (after deductible is met).
 

Family Of Three -- Ages 45, 45, 18, and 20 With $50,000 Income Living In Charlotte (Mecklenburg County)

 

$0 -- BCBS Of NC Blue Value Bronze 6650 -- The federal subsidy exceeds the cost of the policy, so the premium is reduced to $0. Deductible is $6,650, and maximum out-of-pocket expenses are $6,650 with 0% coinsurance. This plan is HSA-eligible.

$0 -- BCBS Of NC Blue Local Bronze 6650 -- The federal subsidy exceeds the cost of the policy, so the premium is reduced to $0. Deductible is $6,650, and maximum out-of-pocket expenses are $6,650 with 0% coinsurance. Similar to prior plan, but not HSA-eligible.

$307 -- BCBS of NC Blue Value 7000 -- $10 and $40 office visit copays with $40 Urgent Care copay. Deductible is $3,900, and maximum out-of-pocket expenses are $5,850 with 30% coinsurance. The Urgent Care copay is $50 and preferred generic drugs are subject to a $10 copay (retail) or $30 (home delivery). Tier 1, Tier 2, Tier 3, and Tier 4 drug copays (after deductible) are $10, $25, $40, and $80.

$330 -- BCBS of NC Blue Value 7000 -- $10 and $40 office visit copays with $40 Urgent Care copay. Deductible is $3,900, and maximum out-of-pocket expenses are $5,850 with 30% coinsurance. The Urgent Care copay is $50 and preferred generic drugs are subject to a $10 copay (retail) or $30 (home delivery). Tier 1, Tier 2, Tier 3, and Tier 4 drug copays (after deductible) are $10, $25, $40, and $80.

 

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. However, once a plan has officially lapsed, if reinstatement is not offered by the carrier, similar coverage may not be available until the next Open Enrollment period.
 

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. The number of counties in each rating area will also vary. For example, in rating area 7 (Greensboro), the only included counties are Guilford, Randolph, and Rockingham. However, rating area 1 (Asheville) includes 17 counties and rating area 12 includes 11 counties. Rating area 4 (Charlotte) includes the following counties: Anson, Cabarrus, Mecklenburg, Rowan, Stanly, and Union. Durham, (and the county) the fourth largest NC city, is located in Rating area 11, along with the following counties: Alamance, Caswell, Chatham, Lee, Orange, and Person.
 

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. You may also change carriers.
 

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.
 

$51 -- BCBS of NC Blue Value Bronze 7900
$59 -- BCBS of NC Blue Value Bronze 6750
$65 -- BCBS of NC Blue Value Bronze 7000
$135 -- Cigna Connect 7900
$150 -- Ambetter Essential Care 1
$155 -- Ambetter Essential Care 2
$162 -- 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 NC Policies Can Be Purchased On The Exchange?
 

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

Catastrophic Tier
 

BCBS of NC Blue Value Catastrophic

 

Bronze Tier

 

BCBS of NC Blue Value Bronze 7900

BCBS of NC Blue Value Bronze 6750

BCBS of NC Blue Value Bronze 7000

Cigna Connect 7900

 

Silver Tier

BCBS of NC Blue Value Silver Enhanced 4000

Ambetter Balanced Care 11

Ambetter Balanced Care 5

BCBS of NC Blue Value Silver Enhanced 3700

 

Gold Tier

 

BCBS of NC Blue Value Gold 2500

Ambetter Secure Care 1

 

Platinum Tier

 

No plans offered

 

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 four years ago. 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. Once you become eligible for Medicare, although deposits are no longer allowed, accumulated funds can be used to pay for qualified expenses.
 

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. The maximum allowed contribution is $3,500 per person, and $7,000 per family. The $1,000 catch-up option remains the same. Minimum deductibles are $1,350 per person, and $2,700 per family. The maximum out-of-pocket expenses are $6,750 per person, and $13,500 per family. We have listed the available NC HSA-eligible plans below:
 

BCBS Blue Value Bronze 6750

BCBS Blue Local Bronze 6750

BCBS Blue Advantage Bronze 6750

 

NC Short-Term Health Insurance
 

Temporary coverage is very inexpensive, and offered by many carriers, including UnitedHealthcare, National General, Companion Life, Everest, and Independence American. Plans do not meet all ACA guidelines and are not eligible for federal subsidies. However, these types of temporary policies are popular for applicants that missed Open enrollment or want a more affordable healthcare option. Several examples are listed below. Rates shown are monthly.
 

    40-Year-Old Male (Mecklenburg County)

$87 -- $10,000 deductible and $1 million maximum benefits (Everest)
$89 -- $10,000 deductible and $2 million maximum benefits (UnitedHealthcare)
$105 -- $5,000 deductible and $1 million maximum benefits (Companion Life)
$123 -- $2,500 deductible and $1 million maximum benefits (Everest)
$137 -- $2,500 deductible and $2 million maximum benefits (UnitedHealthcare)
 

    50-Year-Old Female (Wake County)

$132 -- $10,000 deductible and $2 million maximum benefits (UnitedHealthcare)
$162 -- $5,000 deductible and $2 million maximum benefits (UnitedHealthcare)
$164 -- $5,000 deductible and $1 million maximum benefits (Companion Life)
$203 -- $2,500 deductible and $2 million maximum benefits (UnitedHealthcare)
$250 -- $2,500 deductible and $1 million maximum benefits (Everest)
 

    50-Year-Old Married Couple (Wake County)

$224 -- $10,000 deductible and $2 million maximum benefits (UnitedHealthcare)
$276 -- $5,000 deductible and $2 million maximum benefits (UnitedHealthcare)
$297 -- $5,000 deductible and $1 million maximum benefits (Companion Life)
$344 -- $2,500 deductible and $2 million maximum benefits (UnitedHealthcare)
$501 -- $2,500 deductible and $1 million maximum benefits (Everest)
 

Senior Medigap 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. Supplement plans are standardized, while Advantage contracts often differ in out-of-pocket maximums, deductibles, office visit copays, and level of prescription, dental, and vision coverage.

 

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. Prices can vary, depending on your zip code. Also, additional discounts may reduce the illustrated premium. Prices shown are estimated, and subject to the most recent updates. Note: Not all Advantage and Part D prescription drug plans (below) are offered in all counties. Advantage plan rates and benefits also can also vary in different counties.
 

Plan A

 

$85 -- Aetna
$85 -- CSI Life
$88 -- Continental Life
$89 -- New Era Life
$89 -- Assured Life
$90 -- Heartland National Life
$91 -- Globe Life
$93 -- Lumico Life
$97 -- Western United Life
$99 -- Guarantee Trust Life
$99 -- Companion Life
$101 -- Union Security
$102 -- Shenandoah Life
$104 -- Everest
$104 -- Thrivent
$105 -- State Farm
$107 -- Cigna
$108 -- Great Southern Life
$111 -- Aetna
$112 -- BCBS Of NC
$116 -- United American
$119 -- Medico
$119 -- Greek Catholic Union
$124 -- United World Life
$130 -- Coventry
$135 -- Americo
$136 -- Humana
$150 -- Oxford Life
$221 -- Colonial Penn

 

Plan B

 

$99 -- Continental Life
$103 -- Aetna
$131 -- First Health Life
$135 -- Globe
$148 -- Humana
$151 -- Coventry
$178 -- United American
$183 -- Colonial Penn

 

Plan C

 

$124 -- Union Security
$125 -- Western United Life
$133 -- Atlantic Coast Life
$136 -- Everest
$137 -- Liberty Bankers Life
$156 -- Manhattan Life
$158 -- State Farm
$160 -- BCBS of NC
$161 -- Globe
$181 -- Sentinel Security
$182 -- Humana
$199 -- United American
$215 -- Constitution Life
$244 -- Reserve National

 

Plan F

 

$116 -- Southern Guaranty
$118 -- New Era Life
$122 -- SBLI USA Life
$123 -- National Health
$124 -- Continental Life
$125 -- Lumico Life
$125 -- Union Security
$128 -- CSI Life
$129 -- Great Southern Life
$130 -- Thrivent
$133 -- Cigna
$134 -- Assured Life
$137 -- Everest
$139 -- Shenandoah Life
$140 -- Companion Life
$145 -- Aetna
$147 -- Greek Catholic Union
$154 -- USAA
$155 -- Americo
$156 -- Manhattan Life
$158 -- Medico
$186 -- Humana
$194 -- United American
$223 -- Colonial Penn
$231 -- Gerber

 

Plan F (High Deductible)

 

$30 -- United American
$32 -- New Era Life
$35 -- United World Life
$35 -- Globe
$38 -- Colonial Penn
$39 -- Continental Life
$39 -- Cigna
$39 -- Mutual Of Omaha
$43 -- Medico
$51 -- Great Southern Life
$50 -- Aetna
$56 -- Humana
$58 -- Aetna

 

Plan G

 

$76 -- CSI Life
$77 -- Western United Life
$93 -- CSI Life
$94 -- Lumico Life
$94 -- New Era Life
$95 -- Loyal Christian
$96 -- Everest
$87 -- Unified Life
$98 -- Massachusetts Mutual
$99 -- Cigna
$100 -- Central States
$103 -- Mutual Of Omaha
$106 -- Medico
$112 -- Equitable
$114 -- CSI Life
$122 -- BCBS Of NC
$152 -- Colonial Penn
$164 -- Gerber
$186 -- United American

 

Plan N

 

$73 -- Individual Assurance
$79 -- Western United life
$78 -- Assured Life
$78 -- Union Security
$79 -- Continental Life
$80 -- Greek Catholic Union
$82 -- Lumico Life
$82 -- Everest
$83 -- Thrivent
$84 -- Shenandoah Life
$84 -- Aetna
$87 -- United World Life
$88 -- Sentinel Security
$88 -- Mutual Of Omaha
$89 -- Manhattan Life
$89 -- Great Southern Life
$92 -- Cigna
$94 -- Colonial Penn
$94 -- Americo
$95 -- USAA
$98 -- State Farm
$121 -- BCBS Of NC
$139 -- Oxford Life

 

NC Medicare Advantage Plans (Mecklenburg County)
 

AARP Medicare Advantage Essential (HMO-POS) -- $0 monthly premium and no Rx coverage. Plan H5253-040-0.

AARP Medicare Advantage Plan 1 (HMO-POS) -- $27 monthly premium and $50 Rx deductible. Plan 5253-037-0.

AARP Medicare Advantage Plan 2 (HMO-POS) -- $0 monthly premium and $95 Rx deductible. Plan 5253-038-0.

AARP Medicare Advantage Choice (PPO) -- $38 monthly premium and $50 Rx deductible. Plan H2228-018-0.

AARP Medicare Advantage Walgreens (HMO) -- $0 monthly premium and $435 Rx deductible. Plan H5253-110-0.

Aetna Medicare Core Plan (PPO) -- $0 monthly premium and no Rx coverage. Plan H5521-241-0.

Aetna Medicare Value Plan (HMO) -- $0 monthly premium and $0 Rx deductible. Plan H3146-001-0.

Aetna Medicare Premier Plan (PPO) -- $195 monthly premium and $0 Rx deductible. Plan H5521-081-0.

Blue Medicare Medical Only (HMO) -- $0 monthly premium and no Rx coverage. Plan H3449-012-0.

Blue Medicare Enhanced (PPO) -- $59 monthly premium and $0 Rx deductible. Plan H3404-003-1.

Blue Medicare Choice (HMO) -- $0 monthly premium and $0 Rx deductible. Plan H3449-026-601.

Blue Medicare Essential Plus (HMO) -- $0 monthly premium and $195 Rx deductible. Plan H3449-023-1.

Blue Medicare Medical Only (HMO) -- $0 monthly premium and no Rx coverage. Plan H3449-012-0.

Cigna HealthSpring Advantage (HMO) -- $0 monthly premium and no Rx coverage. Plan H9725-005-0.

Erickson Advantage Freedom -- $48.00 monthly premium and $0 Rx deductible

Humana Gold Plus -- $0 monthly premium and $265 Rx deductible

Humana Gold Plus SNP-DE -- $0 monthly premium and $265 Rx deductible

HumanaChoice -- $0 monthly premium and no Rx coverage

Lasso Healthcare -- $0 monthly premium and no Rx coverage

UnitedHealthcare Dual Complete $0 monthly premium and 15% Rx coinsurance

UnitedHealthcare Dual Complete RP $0 monthly premium and $0 Rx deductible

UnitedHealthcare Assisted Living Plan $28.90 monthly premium and $200 Rx deductible

UnitedHealthcare Nursing Home Plan $28.90 monthly premium and $415 Rx deductible

 

NC Part D Prescription Drug Plans
 

Plans should be carefully reviewed since copays and out-of-pocket expenses can greatly vary for generic, non-generic, preferred, non-preferred, and specialty drugs. The current medications you take can greatly influence which plan is the most cost-effective, despite a higher premium. Illustrated below are available plans, deductible, and estimated monthly premium.
 

EnvisionRxPlus -- $365 deductible and $14.50 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $6, and $34.

Aetna Medicare Rx Select -- $365 deductible and $17.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $2, and $47.

Aetna Medicare Rx Saver -- $275 deductible and $27.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $2, and $30.

WellCare Value Script -- $415 deductible and $15 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $6, and $44.

Cigna-HealthSpring Rx Secure-Essential -- $415 deductible and $21.90 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $3, and 20%.

Humana Walmart Rx Plan -- $415 deductible and $30.30 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $4, and 20%.

Humana Preferred Rx Plan -- $415 deductible and $28.80 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $1, and 25%.

Humana Enhanced -- $415 deductible and $74.60 per month. Preferred generic, generic, and preferred brand prescription drug copays are $5, $10, and $47.

Express Scripts Medicare Choice -- $350 deductible and $95.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $2, $7, and $42.

Express Scripts Medicare Value -- $415 deductible and $31.10 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $3, and $25.

Express Scripts Medicare Saver -- $415 deductible and $23.90 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $4, and 18%.

SilverScript Choice -- $0 deductible and $29.70 per month. Preferred generic, generic, and preferred brand prescription drug copays are $3, $18, and $45.

SilverScript Plus -- $0 deductible and $61.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $5, and $35.

AARP MedicareRx Preferred -- $0 deductible and $73.30 per month. Preferred generic, generic, and preferred brand prescription drug copays are $5, $10, and $40.

AARP MedicareRx Saver Plus -- $415 deductible and $29.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $6, and $25.

AARP MedicareRx Walgreens -- $415 deductible and $28.00 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $5, and $30.

Blue Medicare Rx Enhanced -- $415 deductible and $28.00 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $5, and $30.

Blue Medicare Rx Standard -- $305 deductible and $69.30 per month. Preferred generic, generic, and preferred brand prescription drug copays are $4, $8, and $37.

Basic Blue Rx Value -- $415 deductible and $24.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $1, and 15%.

Basic Blue Rx Standard -- $415 deductible and $29.00 per month. Preferred generic, generic, and preferred brand prescription drug copays are $2, $6, and 15%.

Cigna-HealthSpring Rx Secure-Extra -- $100 deductible and $55.70 per month. Preferred generic, generic, and preferred brand prescription drug copays are $4, $10, and $42.

Cigna-HealthSpring Rx Secure -- $415 deductible and $55.70 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $3, and $30.

WellCare Extra -- $0 deductible and $74.50 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $5, and $40.

WellCare Classic- $415 deductible and $30.30 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $1, and $37.

 

Updates From The Past:
 

UnitedHealthcare is coming! 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.
 

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.
 

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.
 

Humana will be offering both on and off Marketplace coverage. 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.
 

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.

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

 

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.

 

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.

 

Blue Cross Blue Shield of NC has requested a 22.90% rate increase (average) for 2018 policies. More than 500,000 persons are currently enrolled in BCBS plans, which represents more than 95% of the available private market share. Cigna has requested a 32% rate increase (average). Cigna's market share is approximately 21,000 persons.

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