Health insurance in North Carolina
- North Carolina utilizes the federally facilitated health insurance exchange.
- Open enrollment for 2020 health plans has ended, although residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
- Short-term health plans can be sold in North Carolina with initial plan terms up to 364 days.
- With Bright Health’s entry into the state’s market, four insurers are offering 2020 coverage through the North Carolina exchange.
- Insurers in North Carolina all implemented average rate decreases for 2020.
- More than 505,000 North Carolina residents enrolled in 2020 coverage through the exchange (up from 501,000 in 2019).
- North Carolina has not accepted the ACA’s Medicaid expansion.
North Carolina’s health insurance marketplace
North Carolina uses the federally run health insurance exchange, which means enrollment is through HealthCare.gov.
Open enrollment for 2020 health plans has ended, although North Carolina residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
Four insurers – Blue Cross Blue Shield of North Carolina, Cigna, Ambetter, and Bright – are offering 2020 individual market plans through the North Carolina exchange. (Most of the state has a single carrier – Blue Cross Blue Shield of North Carolina – offering plans in the exchange.) Bright Health is a newcomer as of 2020, offering plans in the Charlotte and Winston-Salem areas.
Average premiums (before any subsidies are applied) for 2020 are a little lower in North Carolina than they were in 2019. The average benchmark plan premium in North Carolina’s dropped by 10 percent for 2020, although overall average premiums dropped by a little less than 6 percent (for existing plans, not counting Bright’s new plans).
505,275 people enrolled in private plans through the North Carolina exchange during the open enrollment period for 2020 coverage, which was an increase over 2019’s enrollment.
Read more about North Carolina’s health insurance marketplace.
Medicaid coverage in North Carolina
North Carolina is one of 14 states that still have not accepted federal funding to expand Medicaid under the ACA. An estimated 626,000 in the state would gain coverage if the state were to accept federal funding to expand the program.
Read more about North Carolina and the ACA’s Medicaid expansion.
Short-term health insurance in North Carolina
North Carolina defaults to new federal regulations regarding short-term coverage. That means short-term plans are allowed to have initial terms up to 364 days, and total duration – including renewal – of up to 36 months.
The state does have various laws and regulations that apply to short-term plans.
Read more about short-term health insurance in North Carolina.
The Affordable Care Act in the Tar Heel State
In 2010, North Carolina’s U.S. Senators were divided on healthcare reform. Kay Hagen, a Democrat, voted yes on the ACA, while Richard Burr, a Republican, voted no. In the U.S. House, five Republican representatives from North Carolina voted no, while eight Democrats voted yes.
Burr remains in the Senate, but Hagen has been replaced by Thom Tillis, a Republican who opposes the ACA. Both Burr and Tillis voted in favor of the three Senate versions of ACA repeal in 2017, although none of them were ultimately enacted.
And the U.S. House now includes just three Democrats from North Carolina, and ten Republicans.
Governor Roy Cooper, a Democrat, took office in January 2017. He supports the ACA and wants North Carolina to accept federal funding to expand Medicaid, but the state’s legislature has clashed with him over whether he has the authority to expand coverage.
Cooper replaced former Governor Pat McCrory, who had served for four years as the first Republican governor of North Carolina since 1988. McCrory’s predecessor, Governor Bev Perdue, had stated that North Carolina would enter into a partnership exchange with HHS, but shortly after he took office, McCrory announced that the state would default to a federally-facilitated marketplace.
In addition, MrCrory also decided that the state would not move forward with Medicaid expansion, citing a problematic recent audit of the state’s existing Medicaid program, and noting that the program’s issues needed to be fixed before the state considered expanding it.
McCrory was not a fan of the ACA, but early in the 2014 open enrollment period, he softened his stance a bit in a public announcement to the state’s residents. While he still noted that he was opposed to the ACA, he provided information and resources to help direct people to Healthcare.gov and enrollment assisters.
In general however, the state’s government has taken a largely hands-off role in terms of promoting and implementing the ACA in North Carolina. But a strong network of community-based public health workers, navigators, and volunteers have resulted in substantial enrollment in North Carolina’s exchange.
How Obamacare has helped NC residents
North Carolina’s refusal to expand Medicaid has resulted in an uninsured rate that is considerably higher than it would be if the state had accepted federal funds to make Medicaid available to all adults (assuming they’ve been legal U.S. residents for at least five years) with incomes up to 138 percent of the federal poverty level. But the ACA has certainly benefitted North Carolina residents who used the exchange to enroll in Medicaid or private plans. The state was one of six states that enrolled more than half of its potential market through its exchange in 2015, and has consistently had third-highest enrollment among HealthCare.gov states, and the fourth-highest among all states.
According to U.S. Census data, 15.6 percent of North Carolina residents were uninsured in 2013. That had fallen to 10.4 percent by 2016, although it had increased slightly, to 10.7 percent, by 2018 (the national average has crept up under the Trump administration).
Is there still a high-risk pool in North Carolina?
Before the ACA dramatically reformed the individual health insurance market, coverage was underwritten in nearly every state, including North Carolina. This meant that pre-existing conditions could prevent an applicant from getting coverage, or could result in significantly higher premiums or policy exclusions. The North Carolina Health Insurance Risk Pool was created in 2009 to give people an alternative if they were unable to obtain individual health insurance because of their medical history.
When ACA implementation resulted in a guaranteed issue individual market in January 2014, risk pools were no longer necessary. The North Carolina Health Insurance Risk Pool ceased operations at the end of 2013, and members were able to transition to new, ACA-compliant plans issued on or off-exchange.
Medicare enrollment in the state of North Carolina
As of late 2019, there were nearly 2 million North Carolina residents enrolled in Medicare. You can read more about Medicare in North Carolina, including details about Medicare Advantage and Part D, as well as the state’s rules for Medigap plans.
State-based health reform legislation
You can scroll to the bottom of this page for a summary of recent health care reform legislation in North Carolina.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.