Health Insurance in North Carolina

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Are you having trouble finding affordable health insurance in North Carolina? The odds are good that you’re not alone. North Carolina residents may have a more challenging time finding affordable health coverage due to things like the Medicaid expansion gap, but that doesn’t mean you don’t have options. This article is going to discuss those options below. If you’re not sure whether you can afford to get insurance coverage for you and your family, you will be better equipped to make a decision by the time you finish reading this. 

Major Medical Insurance in North Carolina

As of this writing, it has been a decade since the Patient Protection and Affordable Care Act was passed into law back in 2010. The passing of this law created a whole series of laws, rules, and regulations which made it easier for Americans to find affordable and comprehensive health insurance coverage. It also created the Health Insurance Marketplace back in 2014. The Health Insurance Marketplace is a virtual space where insurance companies who sell insurance products that comply with ACA rules and regulations make that major medical insurance coverage available for sale to Consumers like you.

North Carolina does not have its own state exchange, so you will have to register for insurance on if you want to shop around in the federal Health Insurance Marketplace. And you can only do this during Open Enrollment. Open Enrollment starts every year on November 1st, and usually lasts until around mid-December. Shopping around on the exchange during Open Enrollment is done for health insurance plans that go into effect the following calendar year; So 2019 Open Enrollment was for the sale of policies to give people health insurance coverage in 2020. But if you have an extenuating life circumstance, such as the birth of a child or a significant move, you may be able to qualify for a special enrollment period that will allow you to enroll outside of the Open Enrollment window. 

What makes major medical insurance sold through the federal exchange so much different than other forms of health insurance? The first thing is the fact that these insurance policies are known as guaranteed issue policies. Guaranteed issue insurance cannot reject you for coverage, even if you happen to have a pre-existing condition (or more than one). You also cannot be discriminated against and charged more for your monthly premiums based on your health status. The only things that can cause an insurance provider to charge you more for your premiums and medical costs are the following four factors:

  • Your age 
  • Your location
  • Your use of tobacco products
  • Whether you are applying for an individual policy or a family policy

Another thing that makes major medical insurance special is that it comes with all ten of the guaranteed Essential Health Benefits as regulated by the ACA. These health benefits are important because without things like preventative care, regular check-ups, and mental health counseling (among other basic care needs), you can develop an expensive, chronic medical condition more easily and earlier in life. But having all of the benefits below can help you manage your health care in such a way as to reduce your total costs over time:

  • Ambulatory/outpatient services
  • Emergency services
  • Hospitalization
  • maternity/newborn care
  • Mental health and substance abuse
  • Prescription drugs
  • hab/rehab services and devices
  • Lab tests
  • Preventive and wellness services and chronic disease management
  • Pediatrics (including oral and vision)

As you might imagine, selling guaranteed issue insurance with all of the health benefits described above can get pretty expensive for the average health insurance company. That’s why federal subsidies exist in order to make these insurance policies more affordable for the average working American. These subsidies are more commonly known as the premium tax credit, which is a payment the government makes to your insurance company so that they will charge you a substantially less expensive monthly premium. In North Carolina, all you have to do to qualify for this tax credit is to make at least 138% of the federal poverty limit based on your household size. And according to the chart below, this is what that level of income looks like:

Household Size Annual Income (138% of FPL) Household Income (Medicaid)
1 $17,236 $16,612
2 $23,336 $22,491
3 $29,435 $28,369
4 $35,535 $34,248
5 $41,635 $40,127
6 $47,734 $46,005
7 $53,834 $51,884
8 $59,933 $57,762


The third column in the chart above is important because of the Medicaid expansion gap which still exists in North Carolina. For whatever reason, government officials in the state have not yet accepted free federal money that would expand the Medicaid program in North Carolina to needy, low-income families who fall between the maximum income limit to qualify for Medicaid and the 138% of the federal poverty limit that you need to qualify for a premium tax credit. People who are currently in this income gap are neither eligible for Medicaid nor a premium tax credit and may want to get in touch with their local governing officials about changing the laws which prevent the expansion of the Medicaid system. For people who fall below the Medicaid income threshold, your income level may qualify you for Medicaid in the state of North Carolina – but there may be other qualifications you have to meet first before you have access to this low cost healthcare plan. For more information, be sure to visit the North Carolina Medicaid official website. 

Short Term Health Insurance in North Carolina

In the state of North Carolina, there aren’t any rules or regulations imposed on short-term health insurance providers by the government; therefore, the law naturally defaults to federal regulations. According to federal regulations, short-term health insurance providers in the state of North Carolina are allowed to offer plans that last a full year, and they are allowed to offer their customers the option to extend the plan and renew it for another two years. But short-term health insurance companies are also allowed to practice medical underwriting, to impose caps on annual and lifetime benefits, and to refuse to sell you certain types of coverage that you might otherwise have access to with major medical health insurance.

Medical underwriting means that your short-term health insurance provider can and will reject you for coverage if you are not in good enough health or if you have a pre-existing medical condition. If they don’t reject you for coverage outright, then they can and likely will charge you more for your monthly premiums. There won’t be any caps on your total out-of-pocket costs. As a matter of fact, many short-term health insurance plans come with deductibles as high as $5,000 or more. This means that you have to pay $5,000 worth of your own medical costs completely out-of-pocket before your short-term health insurance provider will start paying for your medical care. However, for some people, it’s better than nothing and it can cost up to 1/3 less than an unsubsidized major medical policy through the Health Insurance Marketplace. If the monthly premiums are low enough and if you are in good enough health, then a short-term health insurance policy can definitely save you a lot of money in the event that you face an unexpected medical emergency.

Christian Health Plans/Health-Sharing Plans in North Carolina

Were you thinking about a Christian health plan instead of short-term health insurance in North Carolina? A few years ago, this would make a lot of sense. Back then, the individual mandate was still the law of the land, and the religious status of Christian health plan or health share plan organizations meant that you could get an exemption to the federal mandate with a health share plan even though they don’t qualify as legally equivalent alternative coverage under the ACA. Now that the individual mandate is no more, there’s less of an incentive for people to take a look at Christian health plans. But that doesn’t mean it isn’t a good idea to at least consider them as an option.

This is especially true given the fact that, like short-term health insurance, the monthly cost of a health share plan can be up to 1/3 less than an unsubsidized Marketplace policy. Here are a few other things the Christian health plans have in common with short-term health insurance:

  • These plans are NOT guaranteed issue
  • They have unlimited out-of-pocket costs
  • They have lifetime and annual benefit caps
  • They likely won’t have all of the guaranteed essential health benefits

But you should know that Christian health plans are very different from short-term health insurance in several ways. For one, you won’t be paying a monthly premium, you’ll be paying a monthly share amount. You’ll also be paying a “personal responsibility amount” or an “unshared amount” instead of a deductible, a copay, or a coinsurance fee. There are fewer protections with a Christian health plan because their religious status protects them from state and federal regulation; so you’d better hope that they honor their commitment to you and pay out their claims as they describe in their plan, because if they don’t, you won’t have any legal recourse. Lastly, you will be expected to follow participation guidelines if you want to maintain good status with your plan provider. This can be a simple is declaring allegiance to their preferred faith and/or picking up healthy habits like the cessation of tobacco use so that you require less expensive medical care. But some Christian health plans may require you to adhere to more extensive and stringent participation guidelines, so make sure you discuss what those are with your plan provider to make sure that your plan is right for you.

Fixed Indemnity Plans in North Carolina

Do you need supplemental coverage for one of the plans we’ve discussed so far? Then you might want to add a fixed indemnity plan to the coverage you already have. Some people also looked at fixed indemnity plans in order to replace major medical coverage, although that would not be advisable. This is because fixed indemnity plans don’t pay out a percentage of your total medical costs the way major medical insurance does – they pay out a fixed amount, and then you have to cover the rest of your costs. Your benefits are paid out either on a daily, weekly, monthly, per visit, or per event basis depending on the plan you have and the care you need. Fixed indemnity plans can come with doctor benefits, hospital benefits, dental benefits, or some combination therein. And you can basically see any medical provider you wish – they don’t come with restricted medical networks like HMOs or PPOs the way most major medical insurance does.

Much like short-term health insurance or a Christian health plan, you will have to endure medical underwriting with a fixed indemnity plan. This means you might get rejected for coverage if you have pre-existing conditions, or you may simply get charged a substantially higher monthly premium. But these plans still work as a good supplement to major medical coverage or something similar if, for example, you have a high deductible or a lower-tier plan that pays out a lower percentage of your total medical costs. And they can still provide you a financial cushion if they are the only thing standing between you and paying for 100% of your medical costs out-of-pocket – although it won’t be as large of a cushion as it would be with major medical, short-term health insurance, or the like.

Discount Cards in North Carolina

Medical discount cards are another good way to supplement your medical care and reduce your out-of-pocket costs – but despite the deceptive business practices of some providers, these cards are absolutely not an adequate replacement for major medical health insurance. You have to be careful of scammers because it’s not uncommon for companies to exaggerate the discounts you are eligible to receive or claim that they work with providers they don’t exactly work with. But you can double-check and make a few phone calls to verify their advertisement claims before you purchase a membership in order to protect yourself from an unscrupulous company.

If you’re familiar with membership organizations like the AARP or the AAA Club, then you already know how medical discount cards work. You pay a membership fee (either once a month or once a year) and they will send you a medical discount card in the mail. Once you get that card, you have to remember to present it when you purchase prescription drugs, visit certain medical providers, or pay for qualifying medical expenses. For many people, the savings they enjoy from the discounts they receive is as much or more than their membership fee, making the medical discount card a good deal. But if not, then it doesn’t make a whole lot of sense to buy a membership. Sitting down and doing the math to figure out whether or not a medical discount card is a good deal might seem like a hassle, but if you end up saving money at the end of the day, then the effort is worth it.  

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