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.
For 2023, the following insurers offer plans in the marketplace in North Carolina, with localized coverage areas:
- CareSource (new for 2023)
- Blue Cross Blue Shield of North Carolina
- Bright Health
- Aetna CVS Health
- Friday Health Plans
- AmeriHealth Caritas
In North Carolina, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). More than 90% of consumers who enrolled in 2022 coverage through HealthCare.gov received premium subsidies.
North Carolinians may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in North Carolina.
Short-term health insurance is also a lower-cost coverage option in North Carolina, where eight insurers offer short-term plans.
If you buy your own health insurance in North Carolina, open enrollment for individual and family coverage runs from November 1 through January 15.
Outside of the annual open enrollment window, a special enrollment period is necessary in order to enroll or make a change to your coverage. Most special enrollment periods are tied to qualifying life events, although some special enrollment periods do not require a specific triggering event (such as the enrollment opportunity for Native Americans, or for people earning under 150% of the poverty level).
If you have questions about opportunities to enroll in health coverage, you can read more in our guide to open enrollment and our guide to special enrollment periods.
During the open enrollment period for 2022 coverage (November 1, 2021 through January 15, 2022), a total of 670,223 people enrolled in private individual market plans through North Caroliana’s exchange.
This was a new record high and 25% higher than 2021’s enrollment, when 535,803 people enrolled during the open enrollment period.
Eleven insurers are offering plans in North Carolina’s exchange for 2023. Ten of them already offered plans in 2022, and have proposed the following average rate changes, which amount to an overall proposed average rate increase of just under 7%:
- Aetna CVS Health: 0.08% increase
- Ambetter/Centene: 4.02% increase
- AmeriHealth Caritas: 13.83% decrease
- Blue Cross Blue Shield of North Carolina: 8.68% increase
- Bright Health: 2.46% increase
- Celtic/WellCare: 5.4% increase
- Cigna: 7.39% increase
- Friday Health Plans: 9.09% increase
- Oscar: 3.56% increase
- UnitedHealthcare: 17.44% increase
- CareSource: New for 2023, so no applicable rate change
The North Carolina Department of Insurance notes that revised rates have been approved, although they also clarify that the details won’t be publicized until the Department makes them uniformly available, which is expected in October 2022, just prior to the start of open enrollment for 2023 coverage.
Rate changes are calculated before any subsidies are applied, and most enrollees do receive subsidies. For people who get subsidies, the change in after-subsidy premiums also depends on how the benchmark plan premium changes.
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% 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%,, by 2018, and to 11.3% 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. The GOP-led legislature has long rejected Medicaid expansion, but lawmakers appeared closer than ever before to a Medicaid expansion agreement during the 2022 session, and North Carolina is considered a state to watch in terms of Medicaid expansion in 2023.
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.
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.
Because the state refused to expand Medicaid, North Carolina has an estimated 212,000 residents in the coverage gap, with no access to Medicaid coverage or health insurance marketplace subsidies.
But lawmakers came close to a Medicaid expansion agreement in the 2022 session, and North Carolina is widely expected to enact legislation to expand Medicaid in 2023.
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. Insurers can choose, however, to limit their plans to shorter terms and durations, and are not required to offer renewal.
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 2022, there were more than 2.1 million North Carolina residents enrolled in Medicare. About 14% were 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 North Carolina Medicare beneficiaries, about 49% 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.