Availability of short-term health insurance in North Carolina

Yes. As of 2024, there were at least five insurers offering short-term health insurance in North Carolina.

Short-term health insurance in North Carolina follows state statute (§ 58-3-225) which outlines short-term plan duration as described under federal rules (defined in Part 144 of Title 45 of the Code of Federal Regulations).

Under federal rules in effect from October 2018 through August 2024, short-term plans are allowed to have initial terms of up to 364 days, and total duration, including renewals, of up to 36 months. States can set more stringent rules, but North Carolina has opted to default to the federal term limits for short-term health insurance.

However, the Biden administration has finalized new federal rules for short-term health plans. Short-term plans issued or sold on or after September 1, 2024 will be limited to initial terms of no more than three months, and total durations of no more than four months, including renewals.

Short-term health insurance in North Carolina can be purchased by applicants who can meet underwriting guidelines created by participating insurers.

In most cases, this means being younger than 65 and not having any of the medical conditions that will result in a declined application.¹ But the specific requirements vary from one insurance company to another.

Short-term health insurance plans usually include blanket exclusions for pre-existing conditions, and they often use post-claims underwriting. This means they can go back through a person’s medical records after a claim is filed, to make sure it isn’t related to a pre-existing medical condition.²

Short-term health plans also generally exclude coverage for some of the ACA’s essential health benefits (most commonly, maternity care, prescription drugs, and mental health care),¹ and impose dollar limits on the coverage they do provide. It’s important to carefully read the policy details before purchasing short-term health insurance, to make sure that you understand the limitations of the plan.

If you need health insurance in North Carolina, your first step should be to check your eligibility to buy an ACA-compliant (Obamacare) major medical plan through the health insurance exchange/Marketplace in North Carolina (or outside the exchange, although financial assistance is only available if you buy the plan through the exchange). These plans can be purchased during open enrollment (November 1 to January 15) or during a special enrollment period.

Various qualifying life events will trigger a special enrollment period and allow you to buy an ACA-compliant plan. Marketplace plans are purchased on a month-to-month basis, so you can enroll even if you only need the coverage for a few months. And depending on your income, you may be eligible for a premium subsidy to offset some or all of the monthly cost of buying the coverage.

North Carolina expanded Medicaid in late 2023, so low-income adults are eligible for Medicaid with a household income up to 138% of the federal poverty level. Learn more about whether you might be eligible for Medicaid in North Carolina.

There are times when short-term health coverage may be the only realistic option, for example:

• If you missed open enrollment for ACA-compliant coverage and do not have a qualifying event that would trigger a special enrollment period.
• If you’ll soon be eligible for Medicare and just need a few months of coverage for unexpected medical events that might arise before you reach the age of 65. Be aware that although Medicare will cover pre-existing conditions regardless of your insurance history, Medigap plans can impose a waiting period of up to six months for pre-existing conditions for which you didn’t have prior coverage. Since most short-term health plans have blanket exclusions for pre-existing conditions, this is something to keep in mind.
• If you’ve recently become employed and plan to enroll in your employer’s health plan, but have a waiting period of up to three months before you’re eligible. Note that if you also have a qualifying life event that would allow you to sign up for one of the ACA-compliant insurance policies in your area, you could use that instead of a short-term plan for the time before your employer’s coverage starts. But if not, a short-term plan might be your only option.
• If you’re not eligible for Medicaid benefits or a premium subsidy on an ACA-compliant plan from the exchange. In this case, the ACA-compliant plans available to you might not be affordable, and a short-term plan might be the most realistic option, despite the less robust coverage. Although the American Rescue Plan and Inflation Reduction Act have made subsidies larger and more widely available through the end of 2025, there are still some people who don’t qualify for subsidies, even with low or modest incomes. This includes undocumented immigrants (lawfully present immigrants can qualify for subsidies, but undocumented immigrants cannot enroll in a marketplace plan at all, even without subsidies).

North Carolina has various requirements that apply to short-term health insurance plans, as outlined in the state’s rate/form filing guidance for short-term health plans.

North Carolina’s regulations also indicate that an individual would be considered continuously insured (with creditable coverage) if they had short-term coverage prior to enrolling in an employer-sponsored plan, as long as the short-term coverage duration wasn’t more than 12 months.

(Note that federal rules were different pre-ACA, when enrollees could have pre-existing condition waiting periods on employer-sponsored group plans if they hadn’t maintained continuous coverage prior to enrolling in the group plan; that is no longer a factor, as group policies cannot impose pre-existing condition waiting periods even if the person didn’t have prior continuous coverage.)