North Carolina health insurance exchange
North Carolina enrollment among the highest in the HHS-run exchanges
By Louise Norris
December 1, 2013
By the beginning of November, 1,662 North Carolina residents had finalized their plan selections in the NC exchange, the fourth highest total out of the 34 states where HHS is running the exchange. The NC exchange struggled early on – as did all of the exchanges being run by HHS – due to problems with HealthCare.gov. But as of December 1, the website is dramatically better than it was on October 1, and continuing to improve daily. January 1 effective dates are available for anyone who enrolls by December 23.
North Carolina has accepted President Obama’s proposal that individual policies slated for termination at the end of the year be renewed into 2014, and by the end of November Blue Cross and Blue Shield of North Carolina had opted to do so. Residents with individual BCBS plans that were effective before October 1 may renew those plans for next year, but with rate increases that average at least 16 percent. Policies effective October 1 or later will terminate at the end of the year and must be replaced with ACA-compliant plans.
North Carolina’s path towards ACA implementation was a complicated one that covered all bases. The state took official actions toward each one of the options for a health insurance marketplace: state-run, partnership, and federally operated. In June 2011, North Carolina passed a law stating an “intention” to develop a state-run health insurance exchange. The House at one point authorized a state-run exchange, but the Senate did not. Outgoing Gov. Bev Perdue announced in November 2012 that the state would partner with the federal government to run the marketplace. Finally, new Gov. Pat McCrory announced in February 2013 that North Carolina would default to the federal marketplace.
While the federal government is running the marketplace in North Carolina via Healthcare.gov, the state department of insurance reviewed the rates proposed by insurers who want to sell policies in North Carolina through the federal exchange. Much to the dismay of state Insurance Commissioner Wayne Goodwin, this is the only involvement that the state has with the exchange. North Carolina also rejected federal funds to expand Medicaid.
North Carolina is not doing any marketing or outreach to explain the insurance marketplace to state residents. Instead, the federal government and insurers themselves have taken on that responsibility. Blue Cross and Blue Shield of North Carolina currently dominates the individual insurance market in the state, and the organization is taking a lead role in promoting the marketplace. Its outreach efforts include operating retail stores and taking a trailer to fairs, farmers markets, and other community events across the state.
Historically, competition within the individual insurance market in North Carolina has been limited, and that will still be the case in the exchange in 2014. Just two insurers are offering policies in the exchange in North Carolina: Blue Cross and Blue Shield of North Carolina and Coventry Health Care of the Carolinas (plans from Coventry are available in only 39 of the state’s 100 counties). FirstCarolinaCare Insurance Co. had initially planned to participate and submitted policies to the exchange, but later withdrew. The marketplace for small businesses is even more limited, with only Blue Cross and Blue Shield of North Carolina participating.
In a move that could hinder the success of the official exchange, the North Carolina Chamber of Commerce launched its own private health insurance exchange in mid-October, designed to appeal to workers whose employers stop offering health insurance coverage (the Chamber expects a lot of this, but it remains to be seen whether this will be a significant issue going forward or not). The Chamber exchange will not be affiliated with the state’s official health insurance exchange, and consumers should be aware that no premium or cost-sharing subsidies are available for plans purchased outside of the official exchange.
According to the North Carolina Institute of Medicine, more than 1.5 million of North Carolina residents under age 65 are uninsured.
North Carolina health insurance exchange links
State Exchange Profile: North Carolina
The Henry J. Kaiser Family Foundation overview of North Carolina’s progress toward creating a state health insurance exchange.
Health Insurance Smart NC
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
Toll free: 1-877-885-0231