North Carolina Health Insurance Exchange Marketplace Guide

Navigating the North Carolina Health Insurance Exchange Marketplace can be a daunting task, but don't worry, we've got you covered.

You can enroll in the North Carolina Health Insurance Exchange Marketplace during the annual Open Enrollment Period, which typically runs from November to December.

The marketplace offers a range of health insurance plans from different insurance companies, including Blue Cross and Blue Shield of North Carolina, Ambetter, and UnitedHealthcare.

These plans come in four levels: Bronze, Silver, Gold, and Platinum, each with varying levels of coverage and costs.

To be eligible for the North Carolina Health Insurance Exchange Marketplace, you must meet certain criteria. You must be a resident of North Carolina and a U.S. citizen, national, or lawfully present immigrant. You also can't be incarcerated and must not have access to affordable employer-sponsored health insurance.

If you meet these criteria, you can enroll in a Marketplace health insurance plan during the open enrollment period, which runs from November 1 to January 15. Alternatively, you can apply during a Special Enrollment Period if you have a qualifying life event, such as getting married, having a child, or losing your job.

To qualify for financial assistance, such as premium tax credits, your income must be low enough. You may also qualify for low-cost or free coverage through North Carolina's Medicaid or Children's Health Insurance Program (CHIP) if your income is low enough.

Here is a summary of the eligibility criteria:

To buy health insurance through the North Carolina Marketplace, you must live in North Carolina. You can enroll during the open enrollment period or if you have a qualifying life event, such as getting married or losing your job.

You must be a U.S. citizen, national, or lawfully present immigrant. Incarceration is not allowed, and you must not have access to affordable employer-sponsored health insurance.

To qualify for financial assistance, your income must be below a certain threshold, which depends on your age and location. You can use the Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace if your employer offers coverage but you feel it's too expensive.

You cannot have access to affordable health coverage through your employer, be eligible for Medicaid or CHIP, or eligible for premium-free Medicare Part A. If married, you must file a joint tax return, and you cannot be claimed by someone else as a tax dependent.

Here's a summary of the eligibility criteria:

You can enroll in an ACA-compliant plan in North Carolina during the open enrollment period, which runs from November 1 to January 15.

If you enroll before December 15, your coverage will start on January 1, but if you apply between December 16 and January 16, your coverage will begin on February 1.

Outside of open enrollment, you'll typically need a qualifying event to enroll or make changes to your coverage, although some people can qualify for a special enrollment period without a specific qualifying life event.

You can apply during the annual open enrollment period from November 1 to January 15 or at any time if you have a qualifying life event, such as getting married, having a child, or losing your job.

Here are the enrollment periods to keep in mind:

You can also apply for help paying for coverage and enroll in a Qualified Health Plan (QHP) through the Marketplace with the help of an insurance agent or broker, who can make specific recommendations about which plan you should enroll in.

In North Carolina, you have several insurance options through the Health Insurance Marketplace. Nine insurance companies offer individual/family health plans through the Marketplace for 2025, covering most counties in the state.

You can choose from four levels of coverage: Bronze, Silver, Gold, and Platinum. Bronze plans cover 60% of healthcare costs, Silver plans cover 70%, Gold plans cover 80%, and Platinum plans cover 90%. Each level offers the same essential health benefits, but with different cost-sharing arrangements.

Here's a quick summary of the levels of coverage:

Short-term health insurance plans are also available in North Carolina, but they typically have cheaper monthly premiums and don't offer comprehensive benefits. However, they can deny you coverage based on your health status.

If you're shopping for health insurance in North Carolina, there are several options to consider. You can enroll in a Marketplace health insurance plan during the open enrollment period, which usually runs from November 1 to December 15 each year.

You can apply for a new plan, renew your current one, or change to a different one. If you miss the open enrollment period, you may still be able to enroll in a Marketplace plan if you have a qualifying life event, such as getting married, having a child, or losing your job.

There are nine insurance companies that offer individual/family health plans through North Carolina's Marketplace for 2025. Coverage areas vary by insurer, but most counties in North Carolina have at least four or five insurers offering coverage through the Marketplace for 2025.

To enroll in a marketplace insurance plan, visit the official Insurance Marketplace website and provide some personal information, such as your name, address, and income, to determine your eligibility for financial assistance and to help you find the right plan.

You'll also need to consider the level of coverage needed, copayment, deductible, network of providers, and options outside the government exchange when buying a policy.

Here's a breakdown of the different levels of coverage available in North Carolina:

You can also consider options outside the government exchange, which have become more accessible due to new regulations. HealthMarkets can help you navigate the health insurance marketplace in North Carolina and find a plan that fits your needs and budget.

Short-term coverage can be a good option for those with temporary gaps in health insurance. In North Carolina, short-term health plans can provide coverage for up to 1 year or 364 days.

If you need a longer period, you can renew coverage for up to 36 months. This can be a lifesaver if you're between jobs or waiting for coverage to start at a new job.

Short-term plans generally have cheaper monthly premiums than ACA plans because they don't offer comprehensive benefits. This can be a cost-effective option for those who are generally healthy and don't need extensive coverage.

However, keep in mind that short-term plans can deny you coverage based on your health status. This is a key difference between short-term plans and ACA plans, which cannot deny coverage based on health status.

Here are some key facts to consider:

It's essential to weigh the pros and cons of short-term coverage before making a decision. If you're unsure about which type of coverage best fits your needs, consider consulting with a licensed insurance professional.

If you're looking for health insurance through North Carolina's Marketplace, you'll be glad to know that nine insurance companies offer individual/family health plans for 2025.

Most counties in North Carolina have at least four or five insurers offering coverage through the Marketplace for 2025, so you've got options.

Coverage areas vary by insurer, but you can rest assured that you'll have multiple choices to find the best plan for your needs.

North Carolinians can expect a 7% overall weighted average proposed rate increase for 2025 Marketplace health insurance premiums, with some plans increasing by as much as 14.77% and others decreasing by as little as 0.4%.

The good news is that most enrollees receive premium subsidies, which can greatly reduce the cost of health insurance. In 2020, 93% of North Carolina Marketplace enrollees received help to lower their monthly costs, with an average subsidy of $607 per month.

Here's a breakdown of the average premium changes in North Carolina's individual/family market over the years:

North Carolina's health insurance premiums have been on a rollercoaster ride in recent years. For 2025, the average rate changes for individual/family plans in the state's health insurance Marketplace show a 7% overall weighted average proposed rate increase, with some insurers increasing their premiums by as much as 14.77%.

The variation in rate increases is significant, with some insurers proposing much larger increases than others. For example, Aetna Health Inc. is increasing its premiums by 14.77%, while Ambetter/Centene is only increasing its premiums by 0.4%.

The average unsubsidized premiums in North Carolina's individual/family market have also fluctuated over the years. Here's a summary of the changes:

In fact, residents in North Carolina paid less for 2021 Marketplace coverage than in 2019, with monthly premiums for bronze, silver, and gold plans declining every year since 2018.

Subsidies can make a huge difference in the cost of health insurance. In North Carolina, 93% of enrollees received subsidies or premium tax credits in 2020.

The average monthly subsidy in North Carolina is $607, which is higher than the national average of $491.

To qualify for subsidy help, your household income must be more than 8.5% of your income on health insurance, as of 2021.

A 40-year-old couple in Raleigh, NC, earning $40,000 a year, could pay $106 for a silver plan with subsidies, a cost savings of $769 from the original price of $875.

A family of four in Charlotte, NC, earning $55,000 a year, could get a silver plan for $105 per month after subsidies, saving $1,294 from the original price of $1,399.

Checking a 2022 subsidy chart and calculator can give you a better idea of which subsidies you might qualify for.

In North Carolina, the open enrollment period for individual/family health coverage runs from November 1 to January 15.

You can enroll in a Marketplace health insurance plan during this time, and your coverage will start on January 1 if you enroll before December 15.

If you apply between December 16 and January 16, your coverage will begin on February 1.

Outside of open enrollment, a qualifying event is generally necessary to enroll or make changes to your coverage.

A qualifying life event can include a change of ZIP code, marriage, or having a baby, which allows you to purchase health insurance from the marketplace under the Special Enrollment Period.

You have 60 days from the qualifying event to enroll in a new plan or change your project.

To enroll in a marketplace insurance plan, visit the official Insurance Marketplace website.

You'll need to provide some personal information, such as your name, address, and income, to determine your eligibility for financial assistance and to find the right plan.

Paying your monthly premiums on time is essential to maintain your coverage.

If you fail to pay your premiums, your insurance company may terminate your coverage, and you may be responsible for any medical expenses incurred during the uninsured period.

It's crucial to understand your plan's benefits and limitations, including any restrictions on specific medical services or medications.

Check with your insurance company before receiving any medical treatment to avoid unexpected costs.