Individual Health Insurance

Individual Health Insurance in North Carolina FAQs

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 December 15, 2018. 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 a SEP?

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

  • Termination of job-based or COBRA coverage
  • Loss of individual health coverage for a plan you bought yourself
  • Expired coverage through a family member
  • End of 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

3. If I do not have a 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. As of 2019, there is no longer a tax penalty so more and more insurance carriers are offering non-ACA coverage. We keep abreast of the new options on the market and can help you find the right plan for your budget.

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 a 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 for individuals earning between $12,140 and $48,560. The income limits change based on the household size. For instance, a family of four can earn up to $100,400 and still qualify for a subsidy.

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?

As of 2019, there is no longer a tax penalty if you do not have health insurance. Do keep in mind, you run the risk of exorbitant hospital bills should you have a major medical incident. We highly recommend speaking with an Agent at Carolina Insurance Professionals. More options are becoming available and we can help you find the right plan for the right price.

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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