North Carolina Health Insurance

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Snapshot of North Carolina Health Insurance

  • Total North Carolina Residents – 10,042,802
  • North Carolina uninsured residents – 13.1 percent

*Source: Trust for America’s Health

Do you need to buy North Carolina health insurance?

Yes. Under Obamacare there is an Individual Mandate that requires U.S. citizens under the age of 65 to enroll in a health insurance plan or pay a fine. For 2015, not carrying insurance cost $325 per adult plus $162.50 per child (up to $975 per family) or 2 percent of your family’s income, whichever was more.

In 2016, your penalty for not having health insurance is 2.5 percent of your household income or $695 per person — whichever is higher. That’s a big increase from the 2015 penalty, which was 2 percent of your household income or $325 per person.The fee will increase each year with inflation.

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What are my options for buying affordable North Carolina health insurance through Obamacare?

As a resident of North Carolina, you have multiple options to choose from when it comes to choosing your North Carolina health insurance. You have access to affordable North Carolina health plans from multiple affordable North Carolina health insurance carriers in 5 coverage levels, commonly called metal tiers.

Platinum is the most expensive option, but it offers the best cost-sharing benefits, covering 90 percent of health expenses.

  • If you know your family will use a lot of medical services, and you don’t qualify for Cost Sharing Reduction subsidies, Platinum plans can end up providing the best value.
  • If you are leaning toward a Platinum plan – make sure it’s for the right reasons. This plan should be purchased because it fits your healthcare needs, not because you want the best. Starting in 2018, high-end health insurance plans with be subject to an excise tax.

Gold is the second most expensive option.If you don’t mind paying a higher monthly premium to have a higher percentage of health care costs paid by your plan, a Gold plan may be the right choice for you.

  • Gold plans will typically cover 80 percent of covered health care expenses received in network. You pay the remaining 20 percent in the form of out-of-pocket expenses, such as deductibles, co-payments or co-insurance.

Silver is the most popular option. A Silver plan has lower out-of-pocket costs than the Bronze plan, but higher out-of-pocket costs than the Gold and Platinum plans.

  • Silver plans will typically pay 70 percent of covered health care expenses received in network.You pay the remaining 30 percent in the form of out-of-pocket expenses such as deductibles, co-payments, or co-insurance.

Bronzeis intended to have the lowest premium of the metal tiers of health plans under the Affordable Care Act because it has the highest out-of-pocket cost compared to the other plans.

  • If you choose a Bronze plan your insurance will typically pay 60 percent of covered healthcare expenses with the remaining 40 percent to be paid by you – the consumer.
  • This does not mean that the insurer will pay 60 cents of every dollar of your healthcare expenses. Your expenses are tallied in the form of out-of-pocket fees over and above the cost of the plan’s monthly premium.
  • Out-of-pocket expenses in 2016 are capped at $6,850 for individual plans and $13,700 for family plans, though plans can apply lower limits if they so choose.

Catastrophic plans are offered by some states. Catastrophic plans do not cover any percentage of health expenses, and serve as the most limited form of affordable North Carolina health insurance coverage available in the Obamacare market. Only persons ages 30 and younger or persons of any age with a hardship exemption may opt to purchase these plans.

  • Catastrophic health insurance plans have low monthly premiums and a very high deductible — $6,850. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. You pay most routine medical expenses yourself.

Based on 2014 enrollment figures, Silver plans are the most popular choice amongst Americans who purchased Obamacare plans.

For the 2016 coverage period, four carriers will offer health plans through the North Carolina exchange – there were three in 2015 and two in 2014. They are:

  • Humana
  • Blue Cross Blue Shield of North Carolina
  • Coventry Health Care of the Carolinas
  • United Healthcare

Where do I buy affordable health insurance?

Your search for North Carolina health insurance starts here. We will help to ensure that you’re getting the best possible price for your health insurance coverage. The insurance carriers we partner with offer quality, affordable plans accepted by doctors and hospitals across the state. Simply complete this form or call 855-885-2798 to compare North Carolina health insurance plans now.

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Should I buy aNorth Carolina HMO plan or North Carolina PPO plan?

HMO

If you choose a Health Maintenance Organization (HMO)you will have access to doctors and hospitals within the plan’s approved network. A HMO network is made up of health care providers that have agreed to certain rates for plan members. This typically results in lower premiums and/or copayments.

Unlike PPO insurance plan types, care is covered only if you see a provider within your HMO’s network. In addition, your HMO plan will only cover your visit to a health care specialist (obstetrician, cardiologist, rheumatologist) if you get a referral from your primary care physician.An HMO plan usuallyinvolves more restrictions, such as allowing only a certain number of visits, tests or treatments per year.

In general, HMO plans will have the following characteristics:

  • Lower monthly premiums
  • Must see primary care physician for a referral before seeing a specialist
  • If you seek care outside of your network (emergencies excluded), your insurance won’t cover the cost

PPO

A Preferred Provider Organization (PPO) is a managed care health plan that gives you access to multiple choices in health care and health care providers. The network of physicians in a PPO is often much larger than an HMO and you will be able to refer yourself to physicians outside of the network, but you may pay a higher copayment for this service.  Unlike HMO plans, the PPO plan does not require the use of a primary care physician (PCP) referral to see a specialist.

In general, PPO plans will have the following characteristics:

  • Higher monthly premiums
  • Higher co payments
  • Referrals aren’t needed to see a specialist
  • You can see any health care professional you want – inside or outside of your PPO network. However, going outside of your PPO network may cost you more

Who is exempt from insurance?

The individual mandate requires most everyone to purchase health insurance or pay a penalty. You may qualify for an exemption from the Obamacare penalty if you are:

  • Uninsured for less than 3 months
  • Unable to find a plan that would cost less than 8 percent of your household income
  • A member of a recognized health care sharing ministry, a recognized religious sect with religious objections to insurance or a federally recognized tribe
  • Incarcerated
  • Qualify for a hardship exemption

What if I don’t buy North Carolina Health Insurance?

Before you decide to go without health insurance, consider the risks. There’s a 1 in 5 chance you will land in the ER at some point between the ages of 25 and 44, a trip that could cost you as much as $1,450 a pop, according to WebMD. Say you need surgery on a broken arm. That could leave you with more than $16,000 in medical bills if you’re without insurance. In fact, 1 in 4 uninsured people will lose all their savings to medical bills, which remain the leading cause of bankruptcy in the U.S.

If you’re still not convinced that purchasing affordable health insurance in North Carolina is a good idea, remember that under the Affordable Care Act (ACA), you now must pay a penalty tax for going without health coverage unless you meet certain exemption criteria.

In 2016, your penalty for not having health insurance is 2.5 percent of your household income or $695 per person — whichever is higher. That’s a big increase from the 2015 penalty, which was 2 percent of your household income or $325 per person. The flat fee will continue to be adjusted for inflation every year.

I am in between jobs – can I buy short-term insurance?

North Carolina short-term health insurance plans offer health care coverage for a limited period of time (around 1 to 12 months) and are a great solution when you’re between jobs, waiting for group coverage to start, or if you’re a recent college graduate.Simply complete this form or call 855-885-2798 to compare coverage plans and prices today.

Short-term health insurance plans rarely cover pre-existing medical conditions. A pre-existing medical condition is usually defined as conditions that have been diagnosed or treated within the previous 3 to 5 years. If you have an existing medical condition, it’s a good idea to research whether you can extend your current insurance. Employer-sponsored insurance can be extended under a government-regulated option commonly referred to as COBRA.

Can I purchase an affordable family health insurance plan?

Family health insurance is probably one of the most important purchases you’ll ever make.If you don’t have insurance, aren’t happy with your current coverage, or are looking for a more affordable plan, we can help provide you with new options to find North Carolina health coverage that fits your budget. Simply complete this form or call 855-885-2798 to find affordable family health insurance coverage today.

Can I purchase Obamacare coverage for my children and not for myself?

Yes – you can purchase insurance for your children and not include yourself in the coverage. Simply complete this form or call 855-885-2798 to compare coverage plans and prices today. Note that if you and your spouse are uncovered, you will be subject to the tax penalty.

Can I buy an affordable dental insurance plan?

We can help you compare affordable dental plans designed to meet different needs. Take care of your oral health with a range of dental discount plans and dental insurance options. You’ll also be able to compare rates and benefits for individual dental coverage or family dental coverage. Simply complete this form or call 855-885-2798 to gain access to a large network of dental providers.