North Carolina Health Insurance Rates – Compare Private And Medicare Plans

Last Updated on by Edward Harris

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 2025 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 30 year-old applicant in Charlotte (Mecklenburg County) that makes $37,000 per year, can enroll in the BCBS Blue Home Bronze Basic plan for $10 per month, or the BCBS Blue Home Bronze Standard ($18 per month). Although a "catastrophic" plan is available (under age 30), the price is substantially higher. The Oscar Secure Catastrophic plan costs $280 per month since it is not eligible for a federal subsidy. Previously, the BCBS of NC Blue Local Catastrophic plan (Atrium Health) was priced at $266 per month. There is often a difference in specialist and Urgent Care copays that also must be considered.
 

Aetna CVS offers a Silver-tier plan (Silver 5 Advanced) for $133 per month. The primary-care physician (pcp) office visit copay is $35 while the specialist office visit copay is $65. Preferred generic drugs are also subject to only a $7.50 copay.Preferred brand drugs have a $40 copay. The Urgent Care copay is $60. Lab tests and x-rays are covered with $25 and $50 copays.
 

"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 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), Oscar (Asheville area), UnitedHealthcare (rating areas 2, 7, 9, 13, and parts of rating areas 1, 11, and 15), Cigna (Chatham, Orange, Nash, and Johnston Counties), CareSource, Oscar, AmeriHealth Caritas, and Aetna. Federated Mutual, National Foundation Life, Friday Health Plans, 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.
 

Aetna CVS previously returned and offers plans in 70 counties. CVS Pharmacy, CVS HealthHUB, and MinuteClinics provide quality treatment across many locations. Virtual care is also offered through many MinuteClinic locations.
 

UnitedHealthcare previously 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 four months. ST plans provide an inexpensive option to secure benefits quickly, and cover multiple family members outside of the OE period.
 

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 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 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 2025 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 $94,000. 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 $94,000 Income Living In Raleigh (Wake County)

 

$0 -- BCBS of North Carolina Blue Home Bronze Basic -- Deductible is $7,000, and maximum out-of-pocket expenses are $9,200 with 50% coinsurance. Office visit copays are $100 and $150 (subject to deductible). First three pcp visits have a $0 copay. Tier 1 drug copay is $40 and $150 Urgent Care copay subject to deductible.

$9 -- BCBS of North Carolina Blue Home Bronze Standard -- $50 and $100 office visit copays. Deductible is $7,500, and maximum out-of-pocket expenses are $9,200 with 50% coinsurance. Tier 1 drug copay is $25. Tiers 2, 3, and 4 drug copays (subject to deductible) are $50, $100, and $500. $75 Urgent Care copay. $50 copay for rehabilitation services.

$51 -- BCBS of NC Blue Home Bronze Complete -- $60 and $120 office visit copays. Deductible is $4,000, and maximum out-of-pocket expenses are $9,200 with 50% coinsurance. Tier 1 drug copay is $20. Tiers 2, 3, and 4 drug copays (subject to deductible) are $25, $75, and $150). $120 Urgent Care copay. $120 copay for rehabilitation services.

$187 -- UnitedHealthcare Bronze Standard -- $50 and $100 office visit copays. Deductible is $7,500, and maximum out-of-pocket expenses are $9,200 with 50% coinsurance. Tiers 1, 2, and 3 drug copays are $0, $25, and $50 ($0, $62.50 and $125 mail order). Tier 4 copay is $100 ($250 mail order). $75 Urgent Care copay. $50 copay for rehabilitation services.

$200 -- UnitedHealthcare Bronze Value -- $40 pcp office visit copay. Deductible is $7,000, and maximum out-of-pocket expenses are $9,200 with 40% coinsurance. Tiers 1, 2, and 3 drug copays are $0, $3, and 40% ($0, $7.50 and 40% mail order). $100 Urgent Care copay. Diagnostic testing copays are $20 (free standing facility) and $75 (hospital).

$260 -- Aetna NC Bronze 2 Advanced HSA -- Deductible is $5,695, and maximum out-of-pocket expenses are $7,495 with 50% coinsurance. Tier 1 drug copays are $3 and $25 ($7.50 and $62.50 mail order). HSA-eligible.

$267 -- UnitedHealthcare Bronze Value+ -- $40 pcp office visit copay. Deductible is $7,000, and maximum out-of-pocket expenses are $9,200 with 40% coinsurance. Tiers 1, 2, and 3 drug copays are $0, $3, and 40% ($0, $7.50 and 40% mail order). $100 Urgent Care copay. Diagnostic testing copays are $20 (free standing facility) and $75 (hospital). Dental and vision benefits included.

$285 -- Ambetter Standard Expanded Bronze -- $50 and $100 office visit copays. Deductible is $7,500, and maximum out-of-pocket expenses are $9,200 with 50% coinsurance. Tiers 1, 2, and 3 drug copays are $25, $50, and $100 ($62.50, $125, and $250 mail order). Tier 4 copay is $500 ($1,000 mail order). $75 Urgent Care copay. $50 copay for rehabilitation services.

 

Single 35 Year-Old Male Or Female With Income Of $38,000 Living In Raleigh (Wake County)

 

$29 -- Aetna CVS Bronze -- Pcp copays are $40 for first five visits. Specialist copays are $80 for first five visits. Deductible is $8,800, and maximum out-of-pocket expenses are $9,100 with 50% coinsurance. Preferred generic drug copays are $30 and $75 (mail order).

$40 -- Aetna CVS Bronze S -- $50 and $100 office visit copays. Deductible is $7,500, and maximum out-of-pocket expenses are $9,000 with 50% coinsurance. Preferred generic drug copays are $25 and $62.50 (mail order). Preferred brand and non-preferred brand drug copays (subject to deductible) are $50 and $100 ($125 and $250 mail order). $75 Urgent Care copay.

$62 -- Aetna CVS Bronze 2 -- Deductible is $6,000, and maximum out-of-pocket expenses are $7,100 with 50% coinsurance. Preferred generic drug copays are $25 and $62.50 (mail order).

$69 -- Ambetter Clear Bronze -- Deductible is $8,600, and maximum out-of-pocket expenses are $8,600 with 0% coinsurance. Preferred generic and generic drug copays are $5 and $25 ($12.50 and $62.50 mail order).

$76 -- BCBS of NC Blue Home Bronze 7000 -- $100 (first three are $0) and $150 office visit copays. Deductible is $7,000, and maximum out-of-pocket expenses are $9,100 with 50% coinsurance. Tier 1 drug copay is $20. $150 Urgent Care copay.

$77 -- BCBS of NC Blue Home Bronze Standard 7500 -- $50 and $100 office visit copays. Deductible is $7,500, and maximum out-of-pocket expenses are $9,000 with 50% coinsurance. Tier 1 and Tier 2 drug copays are $25. $75 Urgent Care copay.

 

Family Of Three -- Ages 45, 45, and 18 With $82,000 Income Living In Charlotte (Mecklenburg County)

 

$56 -- Aetna CVS Bronze -- Pcp copays are $40 for first five visits. Specialist copays are $80 for first five visits. Deductible is $8,800, and maximum out-of-pocket expenses are $9,100 with 50% coinsurance. Preferred generic drug copays are $30 and $75 (mail order).

$92 -- Aetna CVS Bronze S -- $50 and $100 office visit copays. Deductible is $7,500, and maximum out-of-pocket expenses are $9,000 with 50% coinsurance. Preferred generic drug copays are $25 and $62.50 (mail order). Preferred brand and non-preferred brand drug copays (subject to deductible) are $50 and $100 ($125 and $250 mail order). $75 Urgent Care copay.

$132 -- Ambetter Clear Bronze -- Deductible is $8,600, and maximum out-of-pocket expenses are $8,600 with 0% coinsurance. Preferred generic and generic drug copays are $5 and $25 ($12.50 and $62.50 mail order).

$153 -- BCBS of NC Blue Home Bronze 7000 -- $100 (first three are $0) and $150 office visit copays. Deductible is $7,000, and maximum out-of-pocket expenses are $9,100 with 50% coinsurance. Tier 1 drug copay is $20. $150 Urgent Care copay.

$155 -- BCBS of NC Blue Home Bronze Standard 7500 -- $50 and $100 office visit copays. Deductible is $7,500, and maximum out-of-pocket expenses are $9,000 with 50% coinsurance. Tier 1 and Tier 2 drug copays are $25. $75 Urgent Care copay.

$155 -- BCBS of NC Blue Home Bronze 9100 -- Deductible is $9,100, and maximum out-of-pocket expenses are $9,100 with 0% coinsurance.

 

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 2023 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 $34,000 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.
 

$4 -- Aetna CVS Bronze
$12 -- Aetna CVS Bronze S
$30 -- Aetna CVS Bronze 2
$36 -- Ambetter Clear Bronze
$42 -- BCBS of NC Blue Home Bronze 7000
$42 -- BCBS of NC Blue Home Bronze Standard 7500
$43 -- BCBS of NC Blue Home Bronze 9100
$204 -- BCBS of NC Blue Home 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, the cheapest available plans are:
 

Catastrophic Tier
 

BCBS of NC Blue Home Catastrophic

BCBS of NC Blue Local Catastrophic

BCBS of NC Blue Advantage Catastrophic

Oscar Secure

 

Bronze Tier

 

BCBS of NC Blue Advantage Bronze 9100

BCBS of NC Blue Advantage Bronze 7000

BCBS of NC Blue Advantage Bronze Standard

Aetna CVS Bronze

Aetna CVS Bronze S

Ambetter Clear Bronze

Ambetter Virtual Access Bronze

Ambetter CMS Expanded Bronze

Cigna Connect 8700

Cigna Simple Choice 9100

Cigna Simple Choice 7500

UnitedHealthcare Bronze Standard $9,100 Indiv Ded

UnitedHealthcare Bronze Essential $9,100 Indiv Ded

Oscar Simple-Standard

Oscar Bronze Classic

Oscar Bronze Classic -- PCP Saver

AmeriHealth Caritas Next Bronze

CareSource Marketplace Bronze

CareSource Marketplace Bronze First

WellCare Secure Health Bronze

WellCare CMS Standard Expanded Bronze

 

Silver Tier

Aetna CVS Silver S

Aetna CVS Silver 1

Aetna CVS Silver 2

Aetna CVS Silver 3

AmeriHealth Caritas Next Silver

AmeriHealth AHC Silver 30

BCBS of NC Blue Advantage Silver Preferred 3100

BCBS of NC Blue Advantage Silver Standard 5800

BCBS of NC Blue Advantage Silver Secure 1900

BCBS of NC Blue Advantage Silver Choice 4000

Ambetter Virtual Access Silver

Ambetter CMS Standard Silver

Ambetter Clear Silver

Ambetter Focused Silver

Cigna Connect 4500

Cigna Simple Choice 5800

Cigna Connect 5500

UnitedHealthcare Silver Advantage $2,000 Indiv Ded

Oscar Silver Simple PCP Saver

Oscar Silver Simple -- For Diabetes

Oscar Silver Simple Specialist Saver

Oscar Silver Classic -- Standard

Oscar Silver Classic

Oscar Silver Classic -- Deductible Saver

WellCare CMS Standard Silver

WellCare Secure Health Silver

CareSource Marketplace Low Premium Silver

CareSource Marketplace Standard Silver

CareSource Marketplace Low Deductible Silver

CareSource Marketplace Essential Silver

 

Gold Tier

 

BCBS of NC Blue Home Gold 2500

BCBS of NC Blue Local 2500

Aetna CVS Gold

UnitedHealthcare Gold Advantage +

UnitedHealthcare Gold Value +

Bright Gold 1000

Bright Gold $0 Deductible

Ambetter Secure Care 20

Ambetter Secure Care 5

Friday Gold

Friday Gold Copay

Oscar Gold Simple

Oscar Gold Classic

 

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 $3,650 per person, and $7,300 per family. The $1,000 catch-up option remains the same. Minimum deductibles are $1,400 per person, and $2,800 per family. The maximum out-of-pocket expenses are $7,050 per person, and $14,100 per family. We have listed the available NC HSA-eligible plans below:
 

BCBS Blue Advantage Bronze 7000

Friday Bronze HSA

UnitedHealthcare Bronze Value + HSA

Oscar Silver Simple -- HSA

Oscar Gold Classic HSA

Bright Bronze 5300HSA

Ambetter Essential Care 2 HSA

 

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)

$83 -- $10,000 deductible and $1 million maximum benefits (Companion Life Economy 10000)
$88 -- $10,000 deductible and $1 million maximum benefits (Everest Flex $10,000)
$98 -- $5,000 deductible and $1 million maximum benefits (Companion Life Economy 5000)
$123 -- $2,500 deductible and $1 million maximum benefits (Everest Flex $,2500)
$194 -- $2,500 deductible and $2 million maximum benefits (UnitedHealthcare Short Term Medical Value)
 

    50-Year-Old Female (Wake County)

$118 -- $10,000 deductible and $1 million maximum benefits (Companion Life Economy 10000)
$143 -- $5,000 deductible and $1 million maximum benefits (Companion Life Economy 5000)
$189 -- $5,000 deductible and $2 million maximum benefits (UnitedHealthcare Short Term Medical Value)
$232 -- $2,500 deductible and $2 million maximum benefits (UnitedHealthcare Short Term Medical Value)
$239 -- $2,000 deductible and $1 million maximum benefits (Companion Life Choice 2000)
 

    50-Year-Old Married Couple (Wake County)

$209 -- $10,000 deductible and $1 million maximum benefits (Companion Life Economy 10000)
$257 -- $5,000 deductible and $1 million maximum benefits (Companion Life Economy 5000)
$316 -- $5,000 deductible and $2 million maximum benefits (UnitedHealthcare Short Term Medical Value)
$394 -- $2,500 deductible and $2 million maximum benefits (UnitedHealthcare Short Term Medical Value)
$442 -- $2,000 deductible and $1 million maximum benefits (Companion Life Choice 2000)
 

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 each county. Advantage plan rates and benefits also can also vary in different counties. Prices below are from Mecklenburg County.
 

NC Medicare Supplement Rates
 

Plan A

 

$90 -- S. USA Life
$91 -- AARP-UnitedHealthcare
$91 -- Cigna
$91 -- Medico
$92 -- Manhattan Life
$93 -- United States Fire
$94 -- Elips Life
$93 -- Lumico Life
$95 -- Great Southern Life
$95 -- Aetna
$96 -- Oxford Life
$97 -- Omaha Insurance
$102 -- Central States
$104 -- Assured Life
$105 -- National Health
$109 -- GPM Health
$119 -- Medico
$119 -- BCBS Of NC
$122 -- Cigna
$131 -- United American

 

Plan B

 

$96 -- Aetna
$109 -- AARP-UnitedHealthcare
$111 -- United States Fire
$167 -- Humana
$175 -- Sentinel Security
$208 -- United American

 

Plan C

 

$108 -- New Era Life
$122 -- Union Security
$171 -- AARP-UnitedHealthcare
$208 -- Humana
$222 -- Sentinel Security
$237 -- United American

 

Plan F

 

$108 -- Cigna
$108 -- Accendo
$109 -- Manhattan Life
$111 -- Omaha Life
$112 -- Humana
$112 -- Central States
$112 -- Capitol Life
$112 -- United States Fire
$113 -- Aetna
$114 -- Great Southern Life
$118 -- New Era Life
$119 -- Lumico Life
$120 -- Cigna
$123 -- Bankers Fidelity
$123 -- Union Security
$131 -- National Health
$132 -- AARP-UnitedHealthcare
$146 -- Assured Life
$168 -- GPM Health
$191 -- Medico
$223 -- United American

 

Plan F (High Deductible)

 

$30 -- New Era Life
$33 -- Medico
$33 -- Great Southern Life
$33 -- United American
$42 -- National Health
$41 -- National Health
$43 -- Humana

 

Plan G

 

$90 -- Manhattan Life
$90 -- Elips Life
$90 -- Aetna
$91 -- United States Fire
$91 -- Medico
$91 -- Oxford Life
$92 -- Accendo
$93 -- Union Security
$94 -- Omaha Insurance
$94 -- AARP-UnitedHealthcare
$94 -- Capitol Life
$95 -- Heartland National
$95 -- Humana
$96 -- New Era Life
$97 -- Cigna
$98 -- Bankers Fidelity
$101 -- Great Southern Life
$105 -- Assured Life
$107 -- National Health
$110 -- GPM Health
$123 -- Guarantee Trust Life
$207 -- 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)
 

MA plans are an alternative option to secure Medicare healthcare benefits for Seniors. Approved carriers offer Parts A and B though their Advantage plan, along with many other benefits. Typically, prescription drug coverage is included along with excess benefits such as vision, hearing, dental, and podiatry. Premiums are generally lower than Supplement plans.
 

AARP Medicare Advantage Patriot No Rx NC-MA02 (HMO-POS) -- $0 monthly premium and no Rx coverage. Plan H5253-040-0. $7,900 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $0-$0-$50 (Specialist). Diagnostic test copay is $45, and outpatient x-ray copay is $25.

AARP Medicare Advantage from UHC NC-0021 (HMO-POS) -- $37 monthly premium and $255 Rx deductible. Plan 5253-037-0. $3,900 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $0-$20. Diagnostic test copay is $40, and outpatient x-ray copay is $25. Preferred generic, generic, and preferred brand prescription drug copays are $0, $5, and $47.

AARP Medicare Advantage from UHC NC-0022 (HMO-POS) -- $0 monthly premium and $340 Rx deductible. Plan 5253-038-0. $4,900 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $0-$30. Diagnostic test copay is $50, and outpatient x-ray copay is $25. Preferred generic, generic, and preferred brand prescription drug copays are $0, $10, and $47.

AARP Medicare Advantage from UHC NC-0015 (HMO-POS) -- $0 monthly premium and $255 Rx deductible. Plan H5253-117-0. $3,900 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $0-$20. Diagnostic test copay is $40, and outpatient x-ray copay is $25. Preferred generic, generic, and preferred brand prescription drug copays are $0, $5, and $47.

AARP Medicare Advantage from UHC NC-0016 (PPO) -- $46 monthly premium and $420 Rx deductible. Plan H2406-034-0. $3,800 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $0-$30. Diagnostic test copay is $40, and outpatient x-ray copay is $25. Preferred generic, generic, and preferred brand prescription drug copays are $0, $8, and $47.

AARP Medicare Advantage from UHC NC-0017 (PPO) -- $0 monthly premium and $420 Rx deductible. Plan H2406-098-0. $5,500 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $0-$35. Diagnostic test copay is $50, and outpatient x-ray copay is $15. Preferred generic, generic, and preferred brand prescription drug copays are $0, $10, and $47.

AARP Medicare Advantage from UHC NC-0021 (HMO-POS) -- $37 monthly premium and $255 Rx deductible. Plan H5253-037-0. $3,900 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $0-$20. Diagnostic test copay is $40, and outpatient x-ray copay is $25. Preferred generic, generic, and preferred brand prescription drug copays are $0, $5, and $47.

Aetna Medicare Eagle Plan (PPO) -- $0 monthly premium and no Rx coverage. Plan H5521-241-0. $6,500 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $35 (Specialist), and the Urgent Care and ER copays are $0-$35 and $90.

Aetna Medicare Value Plan (HMO) -- $0 monthly premium and $0 Rx deductible. Plan H3146-001-0. $5,500 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $25 (Specialist), and the Urgent Care and ER copays are $0-$25 and $90.

Aetna Medicare Premier Plan (PPO) -- $0 monthly premium and $150 Rx deductible. Plan H5521-081-0. $5,900 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $35 (Specialist), and the Urgent Care and ER copays are $0-$35 and $90.

Aetna Medicare Essential Plan (PPO) -- $0 monthly premium and $200 Rx deductible. Plan H5521-170-0. $7,500 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $50 (Specialist), and the Urgent Care and ER copays are $0-$50 and $90.

Aetna Medicare Value Plus Plan (HMO) -- $24 monthly premium and $95 Rx deductible. Plan H3146-006-0. $4,950 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $30 (Specialist), and the Urgent Care and ER copays are $0-$30 and $90.

Blue Medicare Medical Only (HMO) -- $0 monthly premium and no Rx coverage. Plan H3449-012-0. $4,400 maximum out-of-pocket limit.

Blue Medicare PPO Enhanced (PPO) -- $59 monthly premium and $0 Rx deductible. Plan H3404-003-1. $5,900 maximum out-of-pocket limit.

Blue Medicare Choice (HMO) -- $0 monthly premium and $0 Rx deductible. Plan H3449-026-601. $3,900 maximum out-of-pocket limit.

Blue Medicare Essential Plus (HMO) -- $0 monthly premium and $195 Rx deductible. Plan H3449-023-1. $4,200 maximum out-of-pocket limit.

Cigna HealthSpring Advantage (HMO) -- $0 monthly premium and no Rx coverage. Plan H9725-005-0. $4,900 maximum out-of-pocket limit.

Cigna HealthSpring Preferred (HMO) -- $0 monthly premium and $0 Rx deductible. Plan H9725-001-0. $4,900 maximum out-of-pocket limit.

Cigna HealthSpring PreferredPlus (HMO) -- $29 monthly premium and $0 Rx deductible. Plan H9725-006-0. $3,900 maximum out-of-pocket limit.

Cigna HealthSpring TotalCare (HMO D-SNP) -- $0 monthly premium and $0 Rx deductible. Plan H9725-003-0.

Erickson Advantage Freedom (HMO-POS) -- $60 monthly premium and $200 Rx deductible. Plan H5652-006-0. $4,200 maximum out-of-pocket limit.

Erickson Advantage Liberty With Drugs (HMO) -- $25 monthly premium and $250 Rx deductible. Plan H5652-008-0. $6,700 maximum out-of-pocket limit.

Erickson Advantage Liberty Without Drugs (HMO) -- $0 monthly premium. Plan H5652-002-0. $6,700 maximum out-of-pocket limit.

Erickson Advantage Signature With Drugs (HMO-POS) -- $195 monthly premium and $0 Rx deductible. Plan H5652-001-0. $2,900 maximum out-of-pocket limit.

Humana Gold Plus -- $265 monthly premium and $0 Rx deductible. Plan H1036-263-0. $6,700 maximum out-of-pocket limit.

Humana Gold Plus SNP-DE -- $0 monthly premium and $0 Rx deductible. Plan H1036-167-0.

Humana Gold Plus -- $21 monthly premium and $160 Rx deductible. Plan H1036-137-0. $3,400 maximum out-of-pocket limit.

Humana Gold Choice -- $86 monthly premium and $215 Rx deductible. Plan H8145-063-0.

HumanaChoice -- $82 monthly premium and $360 Rx deductible. Plan H1390-002-0. $6,700 maximum out-of-pocket limit.

HumanaChoice -- $0 monthly premium. Plan H1390-001-0. $5,400 maximum out-of-pocket limit.

HumanaChoice -- $50 monthly premium and $160 Rx deductible. Plan H5216-211-0. $6,700 maximum out-of-pocket limit.

Lasso Healthcare -- $0 monthly premium and no Rx coverage. Plan H1924-001-0. MSA Plan.

Liberty Advantage -- $26.40 monthly premium and $435 Rx deductible. Plan H6351-001-0.

Liberty At Home -- $56 monthly premium and $0 Rx deductible. Plan H6351-003-0.

Liberty Advantage Gold -- $175 monthly premium and $0 Rx deductible. Plan H6351-002-0.

UnitedHealthcare Dual Complete -- $0 monthly premium and 15% Rx coinsurance. Plan H5253-041-0.

UnitedHealthcare Dual Complete RP -- $0 monthly premium and $0 Rx deductible. Plan R1548-001-0.

UnitedHealthcare Assisted Living Plan -- $20.40 monthly premium and $200 Rx deductible. Plan H5253-043-0.

UnitedHealthcare Nursing Home Plan (HMO) $26.40 monthly premium and $435 Rx deductible. Plan H5253-042-0.

UnitedHealthcare Nursing Home Plan (PPO) $23.80 monthly premium and $435 Rx deductible. Plan H0710-042-0.

 

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.
 

WellCare Value Script -- $505 deductible and $11.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $5, and $44. 50,533 members in the state. 3.0 Summary Star Rating.

WellCare Classic -- $505 deductible and $32.00 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $5, and $33. 24,525 members in the state. 3.0 Summary Star Rating.

WellCare Medicare Rx Value Plus -- $0 deductible and $71.30 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $4, and $47. 12,731 members in the state. 3.0 Summary Star Rating.

Cigna Saver Rx -- $505 deductible and $12.70 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $10, and $40. 13,286 members in the state. 3.0 Summary Star Rating.

Cigna Secure Rx -- $505 deductible and $34.80 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $7, and $38. 16,796 members in the state. 3.0 Summary Star Rating.

Cigna-Extra Rx -- $100 deductible and $67.60 per month. Preferred generic, generic, and preferred brand prescription drug copays are $4, $10, and $45. 11,949 members in the state. 3.0 Summary Star Rating.

Humana Walmart Value Rx Plan -- $445 deductible and $17.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $4, and 17%. 34,557 members in the state.

Humana Premier Rx Plan -- $455 deductible and $65.30 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $4, and $45. 36,329 members in the state.

Humana Basic Rx Plan -- $445 deductible and $27.70 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $1, and 20%. 52,035 members in the state.

Express Scripts Medicare Choice -- $100 deductible and $70.70 per month. Preferred generic, generic, and preferred brand prescription drug copays are $2, $7, and $42. 1,662 members in the state.

Express Scripts Medicare Value -- $445 deductible and $45.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $3, and $30. 5,463 members in the state.

Express Scripts Medicare Saver -- $285 deductible and $26.50 per month. Preferred generic, generic, and preferred brand prescription drug copays are $2, $7, and $35. 7,808 members in the state.

SilverScript Choice -- $330 deductible and $25.10 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $5, and $35. 118,517 members in the state.

SilverScript Plus -- $0 deductible and $61.60 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $2, and $47. 6,306 members in the state.

SilverScript SmartRx -- $445 deductible and $7.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $19, and $46. 24,315 members in the state.

AARP MedicareRx Preferred -- $0 deductible and $86.00 per month. Preferred generic, generic, and preferred brand prescription drug copays are $5, $10, and $45. 57,984 members in the state.

AARP MedicareRx Saver Plus -- $445 deductible and $26.50 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $6, and $34. 35,554 members in the state.

AARP MedicareRx Walgreens -- $445 deductible and $38.60 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $6, and $40. 17,990 members in the state.

Blue Medicare Rx Enhanced -- $0 deductible and $121.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $3, $6, and $30.

Blue Medicare Rx Standard -- $305 deductible and $89.60 per month. Preferred generic, generic, and preferred brand prescription drug copays are $4, $8, and $37.

Basic Blue Rx Standard -- $435 deductible and $26.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $3, $7, and $25.

Cigna-HealthSpring Rx Secure-Extra -- $100 deductible and $57.90 per month. Preferred generic, generic, and preferred brand prescription drug copays are $4, $10, and $42.

Cigna-HealthSpring Rx Secure -- $435 deductible and $27.00 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $2, and $30.

Cigna-HealthSpring Rx Secure-Essential -- $435 deductible and $22.10 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $2, and 18%.

WellCare Wellness Rx -- $435 deductible and $13.70 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $6, and $43.

WellCare Classic- $435 deductible and $25.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $3, and $31.

WellCare Value Script- $435 deductible and $16.70 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $7, and $43.

WellCare Medicare Rx Select- $365 deductible and $21.90 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $3, and $47.

WellCare Medicare Rx Saver- $435 deductible and $27.80 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $2, and $28.

WellCare Medicare Rx Value Plus- $0 deductible and $71.80 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $4, and $47.

 

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 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.