Individual Health Insurance
Individual Health Insurance in North Carolina FAQs
1. Can I purchase an individual health insurance plan at any time throughout the year?
For most individuals, the Open Enrollment period for buying health insurance closes on December 15 each year, depending on the state. However, if you have a qualifying life event, you are eligible for a “Special Enrollment Period” (SEP). During this 60-day period, you may purchase individual 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:
- Termination of job-based, employer-sponsored, or COBRA coverage
- Loss of individual health insurance coverage for a plan you bought yourself
- Expired insurance coverage through a family member
- End of eligibility for Medicaid, Children’s Health Insurance Program (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 individual health insurance options available?
Yes, there are short-term insurance plans you can purchase at any time throughout the year. These plans are very different from traditional coverage most individuals are used to. However, they are very affordable and do provide a safety net to protect you in the case of catastrophic illness that you’d otherwise have to pay out of pocket. As of 2019, there is no longer a tax penalty for not having health insurance, so more and more insurance carriers are offering non-ACA (American Care Act) coverage. We are always up-to-date with new individual health insurance options on the market and can help you find the right plan for your health care cost budget.
4. What are the limitations of short-term insurance plans?
Short-term policies 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 cover (for example, pre-existing conditions are excluded from coverage). However, short-term medical 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 health insurance agents for information 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 health insurance through there?
The health insurance 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. Each of these insurance plans are required to cover 10 essential health benefits. If you purchase your plan through the Marketplace, you may be eligible to receive a government subsidy to assist in paying for your health insurance premiums.
6. Will I qualify for a subsidy to help with my individual health insurance premiums?
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 on a subsidy you deserve. Consult with one of our licensed health insurance agents to see if you qualify for financial assistance to lower your monthly premiums.
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 medical plan directly from the insurer and take advantage of working with a no-cost health insurance agent. Keep in mind you will still need an SEP to be able to do so.
8. What are the “Essential Health Benefits?”
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 to be considered compliant. These benefits include coverage for events like maternity, newborn care, hospitalization, ambulatory care, and prescription drugs.
9. Do I need to carry health insurance?
As of 2019, there is no longer a federal tax penalty if you do not have individual health insurance. However, some tax penalties may be enforced on the state level beginning in 2020, which individuals will see on their 2021 taxes. Do keep in mind thateven if your state does not enforce tax penalties, you still run the risk of exorbitant hospital bills should you have a major medical incident. We highly recommend speaking with a licensed health insurance agent at Carolina Insurance Professionals. More options are becoming available and we can help you find the right plan for the right price.
10. How can a health insurance broker help me?
Although the Marketplace has navigators to help customers apply for government subsidies, a health insurance broker can do this as well and make the health insurance enrollment process even easier at no additional cost to you. Health insurance brokers can recommend a health insurance plan based on your budget, help you understand your benefits, and support you even after enrollment. Health insurance agents with Carolina Insurance Professionals hold a state license, undergo criminal background checks, and use their insurance expertise to find you the best coverage.
Ready to get started?
We have years of experience meeting the health insurance needs of individuals, families, and small businesses in North Carolina. It can be scary being uninsured. Our health insurance agents can guide you through the SEP and Open Enrollment processes to get you covered. When you work with us, rest assured that you will have the health care coverage you need and that we will always be here to answer your questions all year long. Contact us today to learn more about your health insurance options.
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