Quick Look: The Best Health Insurance in North Carolina
- Best for Nationwide Coverage: BCBS of NC
- Best for Member Support: Aetna
- Best for Same Day Coverage: UnitedHealthcare
- Best for Travelers Needing Flexible Plans: Cigna
- Best for Large Network Access and Flexible Plans: National General
A flu shot here. A wellness check there. A broken leg. Some things you can plan. Other things take you by surprise, and that’s why health insurance is so important. Medical costs can easily race out of control. Health insurance protects you and your bank account from the risk of mounting bills in the event of minor mishaps as well as a serious accident or illness. Use these tips to uncover the best health insurance in North Carolina for you or your family.
Best Health Insurance Providers in North Carolina
When it comes to choosing a health insurance provider and plan you need to balance your needs with your budget. The best health insurance in the U.S. includes Kaiser Permanente, Blue Cross Blue Shield and Cigna. The following are some great options to consider for health insurance in NC.
1. Blue Cross NC
BlueCross BlueShield of North Carolina (Blue Cross NC), the largest health insurance provider in the state, offers its members quality insurance at competitive prices. With 3 plan levels available, Blue Cross NC strives to effectively meet your needs and your budget.
It offers 100% preventive care coverage, access to health and wellness programs, large and local provider networks, online tools to help you find doctors (including telehealth) and 24-hour nurse line services. Since Blue Cross NC offers PPO plans, you don’t need a referral to visit a specialist. Additionally, if you travel for business or pleasure, you’re covered across the country and around the globe.
The National Committee for Quality Assurance (NCQA) rates Blue Cross NC at the top of the list of health insurance providers in North Carolina with a 4 (out of 5). The Better Business Bureau (BBB) gives it an A+ rating.
You can sign up for Aetna health insurance through your employer or eHealth.com. Aetna offers an all-encompassing approach to your care with its health insurance. It provides you with a network of care providers as well as helps you realize your overall health goals.
Aetna members can access health and wellness discounts, Teledoc, and programs that help support better health. It also supplies you with a concierge to help you navigate your benefits. Plus, you can easily track your health progress with its app. NCQA rates Aetna a 3.5 and BBB gives it an A+.
UnitedHealthcare (UHC) is like tailored clothing. You customize its plan to best fit you and your needs. Underwritten by Golden Rule Insurance Company, UHC offers short term and tri-term insurance. It’s important to note that short term insurance doesn’t need to follow the ACA’s minimum standard of coverage.
Offering less than the 10 essential benefits helps keep the monthly premiums low. UnitedHealthcare and Golden Rule both sit under the UnitedHealth Group (UHG) umbrella. UHG is one of the largest health insurance providers in the country. ConsumerAdvocate.org ranks UnitedHealthcare as one of the top health insurance providers in North Carolina. UHC earns a 3.5 rating with NCQA and an A+ rating from the BBB.
In business for more than 200 years, Cigna has a solid track record of offering health insurance that you want and afford. It comes to the table bearing attributes sure to please those who are budget-conscious but still demand quality.
Cigna touts low premiums, affordable copays, and $0 preventive care. Plus, you’ve got access to customer service representatives and your benefits anywhere, anytime. It also offers members telehealth services as well as healthy rewards. Cigna scores an A+ with the BBB and earns a 3 rating through NCQA.
5. National General
- securely through National General Short Term Health Insurance's websiteBest For:Large network access and flexible plansRating:
Previously GMAC Insurance, National General provides convenience with quick quotes and enrollments with year-round availability. It offers short term, 1 month to 12 months PPO health insurance plans to residents of the Tar Heel state. Its offerings come with a great deal of flexibility.
With National General’s options, you can choose a plan that’s worthy of your lifestyle and won’t empty your wallet. As you might expect, plans with higher deductibles have lower monthly premiums. If you’re looking for a lower monthly payment, you can choose a plan with a higher deductible.
Conversely, if you can handle higher monthly premiums but want to safeguard yourself from out-of-pocket expenses you can choose to pay more per month with a lower deductible. Importantly, prescription drug coverage is absent from many of its plans. The BBB gives National General Insurance an A+.
What is Health Insurance?
A flu shot costs about $40. The average wellness visit to your physician costs about $160. Not pocket change, but usually not a financial disaster. But what happens when your need for medical attention becomes more intense? Without insurance, a broken leg can cost more than $7,000 and you’ll pay about $30,000 for a 3-day hospital stay.
Health insurance helps you with the high cost of medical care. It protects you financially in the case of a serious accident or illness. Health insurance also helps cover the cost of preventive or wellness care. Wondering how to get health insurance?
Many people get health insurance through their employers. Most employers help pay for the insurance offered through the company. And that’s quite a relief on your pocketbook.
You can still get affordable health insurance if you’re waiting for benefits from your employer to begin. You can also get health insurance if you’re in-between jobs, self-employed or amid a life transition like a divorce, relocation or graduating from school.
Average Cost of Health Insurance in North Carolina
The average annual premium for an employee enrolled in their company’s health insurance plan in 2022 runs around $500 per month, depending on your age, medical status and how much an employer may have contributed to your policy, according to the Kaiser Family Foundation (KFF). If you don’t have access to an employer-sponsored plan, you can shop for health insurance on the government’s healthcare marketplace. The marketplace categorizes plans by tier: bronze, silver and gold. Bronze is the lowest cost and lowest coverage option. Silver is mid-level based on cost and coverage. And, gold costs the most but also offers the most coverage.
If you’re shopping for a health insurance plan using the government’s health marketplace expect to pay the following per month:
- Bronze-tier low-cost plan: ~$360
- Silver-tier low-cost plan: ~$500
- Gold-tier low-cost plan: ~$550
The above rates are based on a 40-year-old living in North Carolina. Though the premiums seem high, they’ve actually decreased. Even with that good news, the cost of health insurance may still strain your budget. Depending on your income and the size of your household, you may qualify for subsidies.
Types of Health Insurance
Health insurance is either funded publicly or privately. Public health insurance is funded by the government. Private health insurance is purchased by individuals either directly or through their employer. Health insurance plans are then split into categories based on how they’re organized. Let’s take a look.
Health maintenance organization (HMO): A network of healthcare providers and facilities delivers all health services. With an HMO you choose a primary care physician (PCP) who manages your care through a network of healthcare providers and facilities. You also need to stay in-network to receive coverage. If you see a doctor who is out of network, you’ll likely need to pay the entire bill yourself. Additionally, you need a referral to see a specialist.
Preferred provider organization (PPO): A PPO works similar to an HMO but with fewer restrictions. While this type of plan works from a network of care providers, you can choose to see a doctor who is outside-of-network, but you’ll pay more. You do not need a referral from a PCP to see a specialist.
Exclusive provider organization (EPO): With this plan you must choose an in-network provider but you don’t need a referral to see a specialist.
Point of service plan (POS): This plan combines pieces of an HMO and PPO. You can choose your PCP from a pool of in-network providers. You’ll need a referral from your PCP to see a specialist.
High-deductible plans: This option lets you pay less for your insurance by paying a higher deductible. Once you reach your maximum out-of-pocket amount, you’re 100% covered.
Catastrophic plan: You must be under 30 to enroll in this type of plan. A catastrophic plan covers you if you become seriously injured or ill. You’re responsible for wellness care or less serious injuries and illnesses.
What Does Health Insurance Cover?
Per the Affordable Care Act, health insurance plans in the U.S. must cover a minimum level of services. According to HealthCare.gov, all health insurance plans must include:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
What Does Health Insurance Not Cover?
While there’s a lot included in the health insurance minimum standard, many things aren’t included. And, many plans don’t cover them. You can get insurance to cover some of things like dental and vision services. Services that most health insurance plans don’t cover include:
- Adult dental services
- Vision services
- Hearing aids: For assistance getting a hearing aid contact the Hearing Loss Association of America. AARP also offers hearing care for members.
- Uncovered prescription drugs: You can ask your doctor for a substitute covered drug, or to request your insurer to make an exception.
- Acupuncture and other alternative therapies
- Weight loss programs and weight loss surgery
- Cosmetic surgery: Most insurers will cover plastic surgery only if it’s medically necessary.
- Infertility treatment: However, diagnosing infertility is covered.
- Sterilization reversal
- Private nursing
- Travel vaccines: Most providers believe travel vaccines as elective rather than essential.
- LASIK: As this is viewed as not medically necessary, most plans don’t cover it.
Discover Quality Health Insurance in North Carolina
Surprises can be good. A winning play at the end of a sporting event is exciting. A particularly beautiful sunset over the ocean is breathtaking. But a mountain of unforeseen medical bills isn’t at all welcome. That’s why it’s wise to enroll in a health insurance plan.
Health insurance helps protect you from life’s surprises. Consider what you need out of health insurance and what you can afford. Look into plans and options and find the one that fits you best to stay protected no matter what comes your way.
Frequently Asked Questions
Is health insurance unlimited?
No. Health insurance coverage is not unlimited because you have a yearly and lifetime and maximum. Also, your coverage is limited in that health insurance doesn’t cover every possible disorder, service or procedure.
Does health insurance renew annually?
Yes, you renew health insurance annually during the open enrollment period.