Individual Health Insurance

Individual Health Insurance in North Carolina FAQs

10 Things You Should Know About the Affordable Care Act in North Carolina

1. Can I purchase a health insurance plan at any time throughout the year?

For most people, the Open Enrollment period for buying health insurance closed on January 31st, 2017. However, if you have a qualifying event, you are eligible for a “Special Enrollment Period” (SEP). During this 60 day period, you will be able to purchase health insurance coverage, even if it is outside of Open Enrollment.

2. What qualifies as an SEP?

The following are examples of situations which would qualify you for a Special Enrollment Period:

  • Losing job-based or COBRA coverage
  • Losing individual health coverage for a plan you bought yourself
  • Losing coverage through a family member
  • Losing eligibility for Medicaid, CHIP, or Medicare
  • Changes in household size due to marriage, birth, divorce, or death
  • Moving to a new home in NC in a new zip code or county
  • Other circumstances outlined at Healthcare.gov

3. If I do not have an SEP, are there any other health insurance options available? 

Yes, there are certain “short term” plans that you can purchase at any time throughout the year.   These plans are very different from the traditional coverage most people are used to, but they are very affordable and do provide a safety net to protect you in the case of catastrophic illness.

4. What are the limitations of short-term plans?

Short term plans are not traditional Affordable Care Act plans, and are therefore not required to meet the government guidelines for providing “essential health benefits.”  There are significant limitations in terms of what they will cover (for example, pre-existing conditions are excluded from coverage).  But short term plans do provide a viable option for healthy individuals who missed open enrollment or who are simply seeking a lower cost insurance plan.  Contact one of our licensed Agents to advise you about what these plans do and do not cover.

5. I do qualify for an SEP…what is the Marketplace and why should I purchase insurance through there?

The Marketplace is a health insurance exchange- an online collective where individual families and small businesses in North Carolina can purchase health insurance.  Plans on the exchange are offered in three different coverage levels: gold, silver, and bronze.  All of these plans are required to cover 10 “essential health benefits.”  Also, if you purchase your plan from the Marketplace, you may be eligible to receive a government subsidy to assist in paying for your premium.

6. Will I qualify for a subsidy?

Many people qualify for cost saving subsidies in North Carolina but don’t realize it.  Subsidy tax credits are available to people earning up to $97,000 per year for a family of four.  Cost share reduction plans are available to families making 250% of the Federal Poverty Level, or $60,625 for a family of four.

Don’t miss out a subsidy you deserve; consult an Agent to see if you qualify for this financial assistance.

7. If I won’t qualify for a subsidy, do I still need to purchase my plan from the Marketplace?

If you know your income is too high to qualify for a subsidy, you can purchase your plan directly from the insurer.  Bear in mind, you will still need an SEP to be able to do so.

8. What are the “Essential Health Benefits?"

The essential health benefits are specific services that, according to the Affordable Care Act, must be included in any health plan sold to individuals or businesses in North Carolina.  These benefits include coverage for things like maternity, newborn care, hospitalization, ambulatory care, and prescription drugs.

9. What is the Affordable Health Care Act?

The Affordable Health Care Act, or ACA, (also commonly called “Obamacare”) refers to legislative changes to the health care system initiated by the Obama administration.  Now that Trump is in office, it is likely that the system will see many additional changes.  All of these policy transitions can be confusing, but we work hard to stay up to date, and we are always here to help and answer your questions.

10. Do I need to carry health insurance?

Yes, under the ACA, nearly all Americans are required to carry health insurance.  Those who fail to do so will owe a tax penalty.  How much you will owe depends on the size of your household and your income. For many families who qualify for subsidies, purchasing health insurance is less expensive than paying the penalty.

Click here to see of how much you would owe if you had to pay the tax penalty.

*There are some individuals who are exempt from the health care tax, including:

  • People between jobs with no insurance (up to three months)
  • Those with religious objections
  • Illegal immigrants
  • Inmates
  • Members of Indian tribes

Ready to get started? 

We have years of experience meeting the health insurance needs of individuals, families, and small businesses in North Carolina.  When you work with us, you can rest assured that you will have the coverage you need and that we will always be here to answer your questions…all year long.

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