Health insurance is an essential part of our lives, providing us with peace of mind that we will be covered in the event of illness or injury. If you’re living in North Carolina, you’ll be happy to know that there are a variety of health insurance options available to you. In this article, we’ll cover everything you need to know about health insurance in North Carolina, including the types of plans available, how to enroll, and frequently asked questions.
Types of Health Insurance Plans in North Carolina
There are several types of health insurance plans available in North Carolina, including:
Type of Plan |
Description |
|---|---|
Individual and Family Plans |
Plans purchased by individuals or families on the Health Insurance Marketplace or directly from insurance companies. |
Employer-Sponsored Plans |
Plans provided by employers to their employees as part of their benefits package. |
Medicare |
A federal health insurance program for people over the age of 65, people with certain disabilities, and people with end-stage renal disease. |
Medicaid |
A joint federal-state program that provides health insurance to low-income individuals and families. |
Individual and Family Plans
If you’re not eligible for employer-sponsored health insurance or government programs like Medicare or Medicaid, you can purchase an individual or family plan on the Health Insurance Marketplace or directly from an insurance company.
Individual and family plans are categorized into four “metal” levels: Bronze, Silver, Gold, and Platinum. The metal level reflects how much you’ll pay in monthly premiums and how much you’ll pay out of pocket for health care services. Bronze plans have the lowest monthly premiums but the highest deductibles, while Platinum plans have the highest monthly premiums but the lowest deductibles.
In addition to the monthly premium and deductible, you’ll also be responsible for copays and coinsurance. Copays are a fixed amount you pay for a specific health care service, while coinsurance is a percentage of the cost of the service that you’re responsible for paying.
One important thing to keep in mind when choosing an individual or family plan is that you can only enroll during the annual open enrollment period, which typically runs from November 1st to December 15th.
Employer-Sponsored Plans
If your employer offers health insurance as part of your benefits package, you’ll have the option to enroll in their plan. Employer-sponsored plans are typically categorized into three types: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans.
HMOs typically have lower monthly premiums and require you to choose a primary care physician who will refer you to specialists as needed. PPOs and POS plans offer more flexibility in choosing health care providers, but may come with higher monthly premiums and out-of-pocket expenses.
One advantage of employer-sponsored plans is that your employer may contribute to the cost of your monthly premiums, making it more affordable for you.
Medicare
Medicare is a federal health insurance program for people over the age of 65, people with certain disabilities, and people with end-stage renal disease. There are four parts to Medicare:
- Part A: Hospital Insurance
- Part B: Medical Insurance
- Part C: Medicare Advantage
- Part D: Prescription Drug Coverage
Parts A and B are often referred to as “Original Medicare,” while Parts C and D are offered by private insurance companies.
Medicaid
Medicaid is a joint federal-state program that provides health insurance to low-income individuals and families. Eligibility for Medicaid varies by state, but generally includes pregnant women, children, people with disabilities, and low-income adults.
If you think you may be eligible for Medicaid, you can apply through the North Carolina Department of Health and Human Services.
How to Enroll in Health Insurance in North Carolina
Enrolling in health insurance in North Carolina depends on the type of plan you’re interested in. Here’s how to enroll in each type of plan:
Individual and Family Plans
To enroll in an individual or family plan, you’ll need to visit the Health Insurance Marketplace or contact an insurance company directly. During the annual open enrollment period, you can enroll, renew, or make changes to your plan. If you experience a qualifying life event, like getting married or having a baby, you may also be able to enroll outside of the annual open enrollment period.
Employer-Sponsored Plans
If your employer offers health insurance, they will provide you with information on how to enroll in their plan during your new hire orientation or open enrollment period. You’ll typically have a few weeks to enroll or make changes to your coverage.
Medicare
If you’re turning 65 or have certain disabilities, you’ll be automatically enrolled in Parts A and B of Medicare. If you’re not automatically enrolled, you can enroll during the initial enrollment period, which runs from three months before your 65th birthday to three months after your 65th birthday.
If you’re interested in Part C or Part D of Medicare, you can enroll during the annual open enrollment period, which runs from October 15th to December 7th.
Medicaid
You can apply for Medicaid through the North Carolina Department of Health and Human Services online, by phone, or by mail. You’ll need to provide information about your income, household size, and other factors to determine your eligibility for the program.
Frequently Asked Questions
1. How much does health insurance cost in North Carolina?
The cost of health insurance in North Carolina depends on the type of plan you’re interested in, your age, your location, and other factors. On the Health Insurance Marketplace, the average monthly premium for a benchmark plan in North Carolina is $411 for a 40-year-old non-smoker.
2. What is a deductible?
A deductible is the amount you’re responsible for paying for health care services before your insurance kicks in. For example, if you have a $1,000 deductible and receive a $2,000 medical bill, you’ll be responsible for paying the first $1,000 and your insurance will cover the remaining $1,000.
3. What is a copay?
A copay is a fixed amount you pay for a specific health care service, like a doctor’s visit or prescription medication. For example, you may have a $20 copay for a primary care visit or a $10 copay for a generic prescription.
4. Can I get financial assistance to help pay for health insurance?
Yes, if you’re eligible, you may be able to get financial assistance to help pay for health insurance premiums and out-of-pocket costs. On the Health Insurance Marketplace, financial assistance is available to individuals and families with incomes between 100% and 400% of the federal poverty level.
5. What is a network?
A network is a group of health care providers, hospitals, and other medical facilities that have contracted with an insurance company to provide services to their members. In-network providers typically cost less than out-of-network providers, and some plans may only cover services provided by in-network providers.
With this guide, you’re now equipped with the information you need to choose the right health insurance plan for you and your family in North Carolina. Remember to consider your health care needs, monthly premium, deductible, copays, and coinsurance when selecting a plan. And if you ever have any questions, don’t hesitate to reach out to an insurance company or the North Carolina Department of Insurance for assistance.