Frequently asked questions about health insurance
coverage options in North Carolina
North Carolina uses the federally run health insurance exchange, which means enrollment is done through the HealthCare.gov website. The exchange (marketplace) offers private individual market health coverage, so it’s used by individuals and families who need to buy their own health insurance. This includes early retirees who aren’t yet eligible for Medicare, self-employed people, and people who are employed by small businesses that don’t offer health benefits.
The exchange is also the only place that people buying individual market health coverage can receive assistance with the costs, including premium subsidies (which help to offset the monthly premiums people pay for their coverage) and cost-sharing reductions (which help to reduce the out-of-pocket costs people have when they need healthcare, including copays, deductibles, and coinsurance).
Read our overview of the North Carolina health insurance marketplace – including news updates and exchange history.
Six insurers – Blue Cross Blue Shield of North Carolina, Cigna, Ambetter, Bright, Oscar, and UnitedHealthcare – are offering 2021 individual market plans through the North Carolina health insurance marketplace. Insurer participation is localized in most cases, but nearly all areas of the state have at least two insurers offering plans in 2021.
Bright Health joined the state’s exchange in 2020. For 2021, Oscar joined the exchange and UnitedHealthcare rejoined after exiting at the end of 2016. Cigna, which offered plans in the Raleigh-Durham area in 2020, expanded its North Carolina service area to include an additional 64 counties for 2021.
Open enrollment for 2021 health plans ended on December 15, 2020, but the federal government is currently offering a one-time COVID-related enrollment window. The COVID-related enrollment window continues until August 15, 2021.
During this special enrollment window, North Carolina residents who are uninsured can enroll in coverage, and those who already have a plan can switch to a different plan if it better fits their needs. This is an important provision that allows people to take full advantage of the enhanced premium subsidies created by the American Rescue Plan.
No qualifying event is necessary during the COVID-related enrollment window. But after August 15, a qualifying event will be necessary in order to enroll or make a plan change for 2021 coverage. Open enrollment will begin again on November 1, for coverage effective in January 2022.
Six insurers offer coverage in North Carolina’s individual market as of 2021. Four of them already offered plans in 2020, and their average rate changes for 2021 ranged from a decrease of 14.3% (Cigna) to an increase of 6.2% (Ambetter/Centene).
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 non-elderly adults (assuming they’ve been legal U.S. residents for at least five years) with household income up to 138% 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, and to 11.3 percent by 2019 (the national average has crept up under the Trump administration).
In 2010, North Carolina’s U.S. Senators were divided on healthcare reform. Kay Hagen, a Democrat, voted yes on the ACA (Obamacare), 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 five Democrats from North Carolina, and eight 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 health insurance marketplace.
North Carolina is one of a dozen 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.
North Carolina defaults to 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.
As of late 2020, there were more than 2 million North Carolina residents enrolled in Medicare. About 18 percent are under age 65 and eligible due to a disability, while the rest are eligible for Medicare based on their age alone (ie, being 65). Of MissouriNorth Carolina Medicare beneficiaries, more than four out of ten are enrolled in Medicare Advantage plans.
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.
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 needed to transition to new, ACA-compliant plan options issued on or off-exchange.