North Carolina

North Carolina health insurance marketplace: history and
news of the state’s exchange

BCBS of North Carolina and Bright Health offering plans for 2018; cost of CSR added to silver premiums,making other
metal levels particularly affordable

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Louise Norris
Individual health insurance and health reform authority; broker
March 22, 2018

More North Carolina coverage

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    Insurance Guide
    • A guide to health insurance in
      your state.
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    • Your state’s Medicaid expansion,
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    • Insurance for those over 64

Highlights and updates

  • 2018 enrollment down 4.6% from 2017
  • One insurer in 2017, but Bright Health joined in 2018
  • Average rate increase 15.6%, including added premiums to cover CSR cost
  • Cost of CSR added to silver exchange, other metal levels particularly cheap for some
  • 2018 rates and new insurer indicate death spiral no longer a danger

North Carolina exchange overview

North Carolina passed a law in 2013 which prohibits the state from establishing a state-run or partnership exchange. 15.6% of North Carolina residents were uninsured in 2013 and that number dropped to 10.4% by 2016. About 520,000 residents enrolled in a private health care plan for 2018 which was 15% lower than the previous year. North Carolina has two insurers offering coverage: Blue Cross Blue Shield and Cigna. Cigna, however, is localized to the Raleigh-Durham area. For 2018, almost 520,000 people enrolled for health coverage which is the third highest in the country coming in after California, Florida, and Texas. The state was among the handful that chose not to expand their Medicaid under the Affordable Care Act. In 2016, the state announced that benchmark premiums would increase an average of 40% while overall premiums in the exchange rose by just over 24%. For 2018, premiums rose by an average of 14% for Blue Cross Blue Shield and 25% for Cigna.

Health Rankings

North Carolina ranked 35th by the Commonwealth Fund’s Scorecard on State Health System Performance in 2017. They ranked highest in Prevention & Treatment as well as Avoidable Hospital Use & Costs. North Carolina ranked 10th in the nation for the percentage of children ages 19 to 35 who received all recommended doses of seven key vaccines and ranked 8th for number of adults who received recommended screenings. North Carolina ranked 32nd in the 2016 America’s Health Rankings but 37th for lack of health insurance and 43rd for public health funding. The state was in the 90th percentile for the ratio of population to primary care physicians which is 1,410 to 1.

North Carolina and Medicaid

The state opted to not expand Medicaid due to a recent audit that had been dug up that revealed fraud and waste in the state’s Medicaid system. Current Governor Roy Cooper has every intention of revising the current Medicaid plan so that they can expand Medicaid. Due to the lack of Medicaid expansion, North Carolina estimates there are 219,000 to 500,000 residents in the coverage gap with no access to Medicaid or exchange subsidies. For those who don’t qualify for Medicaid and have incomes below poverty level have almost no health coverage options.


Risks in North Carolina

The North Carolina Health Insurance Risk Pool was enacted in 2009 to give residents an alternative if they had a pre-existing medical condition and were unable to get health coverage. The North Carolina Health Insurance Risk Pool operations ended in 2013 due to the Affordable Care Act.  

Medicare and North Carolina

Residents from North Carolina can enroll in a Medicare Advantage Plan if they want additional benefits. 30% of Medicare enrollees in North Carolina opted for this. They can also select a Medicare Part D plan for stand-alone prescription drugs in which 45% of enrollees opted for.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.