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North Carolina Health Insurance Marketplace


The North Carolina Health Insurance Exchange

North Carolina’s uninsured population can finally receive financial assistance for health insurance costs through the marketplace. Ideal for residents who earn between 100 and 400 percent of federal poverty and don’t have access to coverage elsewhere, marketplace plans can be paired with subsidies to lower your costs. As health insurance is a requirement, even for many low-income individuals, the exchange is a great resource that connects people to ample benefits and sufficient coverage. These plans adhere to Affordable Care Act provisions guaranteeing issue of coverage and not discriminating against health problems, gender, or occupation when determining premiums, which is a huge plus for Carolinians previously subject to strict underwriting.

Every health plan on the Obamacare exchange is sold by a private North Carolina insurance company, which has met certain criteria defined by the ACA. This means each policy covers at least 60 percent of your overall medical costs, and exchange plans also must cover myriad services such as maternity care, prescriptions and office visits — the necessities known as essential health benefits. Especially because Medicaid isn’t available to as many residents in North Carolina as it is in other states, it’s essential to find out what discounts you may qualify for on the marketplace.Individual Marketplace Health Insurance

Maintaining your health with adequate coverage is important not only to your longevity, but to your finances, as well. Medical care adds up, and once you allow one condition to fall by the wayside, comorbidities enter the picture. Minimizing the nation’s health problems and medical costs is one key goal of the ACA, and getting covered is a great first step in taking initiative for your personal health and finances. Exchange plans help make that a reality for many individuals. For further details on plans in your county, rates, and getting enrolled, call a licensed agent at 888.803.5917.



Individuals and Families

While the exchange won’t turn anyone away, there are some individuals who will not qualify for subsidies or coverage. In order to apply for a health plan, you must be a U.S. citizen or legal resident. To qualify for subsidies, you must not have access to any other form of minimum essential coverage (pays for at least 60 percent of total costs) such as employer-sponsored coverage, Medicaid, NC Health Choice for Children, Medicare, or military health benefits. You can still apply for the exchange, but it will cost much more if you are eligible for other coverage.

Subsidies are awarded to individuals who have family income between 100 and 400 percent of FPL, which unfortunately leaves out residents whose income is less than poverty level, but exceeds the threshold for Medicaid. Federal poverty guidelines change slightly each year, which changes subsidy eligibility by a small but significant amount every year, as well.


Small Business Owners

Plans are also available to small business owners who want to insure their workers. If you own a North Carolina small business with fewer than 50 full-time equivalent employees, you may be interested in applying for the Small Business Health Options Program (SHOP). If your business has less than 25 workers who each earn up to $50,000 per year or less, you may qualify for the Small Business Health Care Tax Credit, which can cover up to 50 percent of your premium contribution.



Bronze, Silver, Gold, Platinum

Shopping on the health insurance marketplace is made simpler by grouping plans into one of four coverage tiers representing the plan’s actuarial value. This number indicates how much covered care your plan will pay for. Bronze plans offer the lowest actuarial value at 60 percent, while platinum plans cover 90 percent. The graphic below helps explain the different levels of coverage and why you may prefer one over another. For many seeking coverage, the lowest premium is the most enticing, but it will also result in the highest cost sharing.

Catastrophic Plans

In addition to the four main tiers, the marketplace offers catastrophic policies for healthy residents under age 30. These plans are less costly than the comprehensive plans on the exchange as they only cover a few services and leave policyholders financially exposed for most forms of care. Catastrophic plans do include preventive care and four office visits covered in full, which is a great option for those who rarely see a doctor anyway. Emergency care is covered at deductible.

Premium Tax Credit

You may be eligible for a subsidy if your income is between 100 and 400 percent of poverty. If your income is between 100 and 250 percent of FPL, you may receive tax credits to help pay for your premiums and cost sharing, including copays, deductibles, and coinsurance. Those who earn just over 250 to 400 percent of the poverty line qualify for premium assistance only. The amount of assistance you receive depends on your income compared to your household size. The cost of a mid-level plan on the exchange in your area is also a factor in determining your subsidy. The simplified version of calculating subsidies is shown in the chart below, with six income groups and the portion of premiums you’re expected to afford based on your earnings.





For such a large state, not many companies serve individuals on the exchange. Essentially, you can be sure that BlueCross BlueShield of North Carolina and Coventry Health Care offer plans in your county.


How to Apply

You’re in the right place if you want to find coverage on the North Carolina marketplace. Call a licensed agent at 888 803 5917 to discuss your eligibility for tax credits or get an application started. We’re certified to sell exchange plans and ready to help you get the guaranteed issue coverage you need for an affordable cost. This is likely the most efficient way to apply, as we can connect directly to insurers, rather than sending you on a potentially long journey through HealthCare.gov. You can also call 800-318-2596 to request a paper application to be faxed or mailed. You can also apply in person where navigators and application assistants are staffed, including health care facilities statewide.


Compare North Carolina Marketplace Plans

Below is a cost comparison tool designed to provide an idea of plan costs and availability on the marketplace in your zip code. The tool is for research purposes only. For a more accurate idea of coverage costs and subsidy eligibility, or to sign up for a plan, call a licensed agent at 888 803 5917.

*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.