North Carolina Health Insurance: 2021 Coverage Guide

Fran
Fran Majidi
November 3, 2020

North Carolina Affordable Healthcare Insurance

North Carolinians are able to choose from several health insurance options when buying their own coverage or coverage for their families. It’s always a good idea to compare rates and benefits and to understand how different health insurance policies work. Also, remember to shop with SmartFinancial for health insurance during the Open Enrollment period. However, you may qualify for the Special Enrollment Period due to a qualifying event. More on all this below.

When Is Open Enrollment in North Carolina?

November 1, 2020 - December 15, 2020. Coverage begins on January 1, 2021.

How to Get Health Insurance in North Carolina

Some people make the mistake of choosing the least expensive health care option because they are on a limited budget. However, sometimes, a higher premium plan may save you more money in the long-run, depending on how many times a year you get medical attention and care. It’s also important to know which tiers of coverage are available to you and the breakdown of costs. One way to estimate your medical costs for the year is to review your medical history for the prior year. Consider how often you saw your doctors and the number of prescriptions you need. Also consider a health plan based on doctors you’d like to keep, if see if these doctors are in the insurer’s network of providers.

The smartest way to get the most value for the coverage you need is to compare health insurance companies and health insurance quotes. After you submit a form with SmartFinancial we’ll list your options before connecting you with a neighborhood agent so you can buy coverage or ask questions about the plans you’re considering.

What Types of Health Insurance Are Available in North Carolina?

HMOs, EPOs, PPOs and POS plans are most commonly available in North Carolina. However, short-term insurance plans are available too. The plan levels available in this state are bronze, silver and gold. Gold covers 80% of costs and bronze covers 60%. It’s important to consider your out-of-pocket expenses like copays and coinsurance when deciding which plan is most cost effective.

Does Health Insurance Cover Pre-existing Conditions?

The Affordable Care Act made it illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

  • If you lost a job, switched jobs or even started your own business, you can enroll in a new health plan outside the open enrollment period.
  • If you turned 26 and can no longer remain on your parents’ health insurance plan, you can enroll in an individual health plan.
  • If you move to another state or out of an HMO coverage area. If you had a health plan that was only valid in one area but you moved to another after the enrollment period, you are able to enroll in a new health plan.
  • If your Cobra coverage ended. Cobra extends health care coverage from a previous job and has a deadline. When you reach it, you can enroll in a new health plan.
  • If you divorced. If you were married and shared a health plan with your spouse but you divorced, you may enroll in a new individual health plan.
  • If you got married. If you recently married, you may be able to get added onto your spouse’s policy or start an entirely new one together.
  • If you gave birth or adopted a child. If you had a baby outside the open enrollment date, you can buy health insurance for your baby.
  • If a spouse or partner died. If you were covered under your spouse or partner’s health plan but that person passed away, you qualify to buy an individual plan during the special enrollment period.
  • If your spouse or partner lost coverage. If you previously had health insurance through a partner or spouse who lost his/her coverage for any qualifying reason, you are eligible to buy an individual plan or buy coverage with that spouse/partner again.

Is Health Insurance Required in North Carolina?

No, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty. Even though it’s not required in every state, buying health insurance is necessary to avoid medical bankruptcy.

How Much Is Health Insurance in North Carolina?

The average cost of health insurance in North Carolina for a 40 year old is about $490 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.

How to Save on Health Insurance in North Carolina

The best way to save on health insurance in North Carolina is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs.


Medicare in North Carolina

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in North Carolina?

21% of the population of North Carolina is on Medicare.

How Much Is Medicare in North Carolina?

If you do not qualify for Medicare, you can buy it for $458 a month for Part A in 2020 and a standard monthly premium for Medicare Part B was $144.60 for 2020, or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in North Carolina

You may automatically enroll in Medicare if you have received social security payments, but you may have to sign up if you have not. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in North Carolina?

Sign up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.


North Carolina State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2020 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the North Carolina Health System are listed below:

  • North Carolina: Overall Ranking: 36 of 51
  • North Carolina: Overall Performance: Above U.S. Average
  • North Carolina: Access and Affordability: 39
  • North Carolina: Prevention and Treatment: 22
  • North Carolina: Avoidable Hospital Use and Cost: 18
  • North Carolina: Healthy Lives: 36
  • North Carolina: Health Care Disparities: 46
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North Carolina Health Insurance Coverage

The people of North Carolina have different kinds of health insurance while some North Carolina residents are not insured at all. See the breakdown below:

  • Private coverage: 50%
  • Medicaid: 18%
  • Medicare: 19%
  • Uninsured: 13%

Report: America's Health Insurance Plans

North Carolina Health Insurance Companies

The following carriers offer health insurance and/or Medicare in North Carolina.

Get a Free Health Insurance Quote Online Now.

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