Is It Illegal to Not Have Health Insurance in NC? Separate the Fact from Fiction

One of the questions we hear a lot is if it’s illegal to not have health insurance in NC. No, it’s not illegal at all. Former President Obama signed the Affordable Care Act (ACA) into law in 2010 in hopes of ensuring every U.S. resident had access to affordable health care coverage, even if they had preexisting conditions. Subsidies and the cost-sharing group enrollment pools helped lower costs. Those who didn’t enroll in a health insurance program faced a tax penalty for not meeting the mandate. 

ACA is still a law, but tax penalties do not exist as of 2019. It’s not illegal if you don’t have health insurance, but it’s insurance coverage you should carefully consider if you don’t have it through your employer or a Medicaid or Medicare plan. Our health insurance brokers at Carolina Insurance Professionals are also here to answer any other questions you may have with their expertise, such as:

Do You Have to Have Health Insurance in North Carolina?

While the ACA was a federal law, what happens on a state level? Does North Carolina require all residents to sign up for health insurance plans through the health insurance marketplace or one of the health insurance companies?

North Carolina follows federal law and doesn’t require state residents to purchase health insurance policies at all. It doesn’t matter if you are unemployed, your employer doesn’t offer group health insurance, or you simply cannot afford the cost of health care insurance. Medical insurance costs may seem out of reach, but low-income people and tax-credit options help lower the cost.

You are welcome to purchase health insurance through a marketplace if you want, but it’s not mandatory. The levels of health insurance use the names of metals to make them easy to navigate. 

• Bronze – Insurance pays 60% while you pay 40%.
• Silver – Insurance pays 70% while you pay 30%.
• Gold – Insurance pays 80% while you pay 20%.
• Platinum – Insurance pays 90% while you pay 10%.

These are estimates, as some essential health care procedures and tests are not covered using the average rate. To keep things simple,  work with an expert in health insurance coverage in North Carolina.

What Happens if NC Residents Don’t Have Health Insurance?

If you do not have health insurance in North Carolina, you do not get charged a fine or penalty. Before you skip enrolling to get health insurance, consider the cost of care without insurance. At the Select Family Practice urgent care center, a single office visit starts at $75 for uninsured patients, and physicals cost $221 for men and $287 for women. Labs increase the amount you pay. If a health issue is discovered, the necessary care increases the amount you pay for health care.

Why Get Health Insurance if It’s Not Required in North Carolina?

Sure, health insurance isn’t required in North Carolina. However, that doesn’t mean you should skip signing up for health insurance through your employer or the insurance marketplace. You could qualify for Medicare and Medicaid if you’re over a certain age or meet the income requirements.

Consider how much you’ll spend if something goes wrong with your health or you have an accident. The NC Department of Health and Human Services maintains the Transparency in Health Care Costs. If you look at prices for common tests and treatments at Duke Raleigh in Raleigh, NC, hospitals, the prices (as of September 30, 2024) are astounding.

• Colonoscopy: $6,178 to $9,284, depending on whether a biopsy becomes necessary
• Diabetes care (without complications): $14,677
• High blood pressure care (without major complications): $22,881
• Hip, leg, knee, or ankle MRI: $1,830
• Joint replacement surgery: $52,646

Don’t risk your financial health just to save money on health insurance premiums. Carolina Insurance Professionals are experts in finding the best health insurance coverage in NC for your budget. Affordable health care plans exist, and we help you find them.

How to Get Health Insurance in North Carolina

If you do not receive health insurance through a parent, job, or government program, you still have several ways to get coverage in North Carolina. The process can seem confusing, but understanding your options makes it much easier to find a plan that fits your needs and budget.

Option 1: Get Coverage on Your Own
You can apply for coverage through the Health Insurance Marketplace at HealthCare.gov. This is where individuals and families can compare plans and sign up during the open enrollment period, which typically runs from November through mid-January. If you have a qualifying life event, such as losing coverage or getting married, you may be eligible to apply at other times of the year.

Marketplace plans are divided into Bronze, Silver, Gold, and Platinum levels, each offering a different balance of premiums and out-of-pocket costs. Depending on your income, you may also qualify for premium tax credits that lower your monthly payments.

You can also look into Medicaid or Medicare if you qualify based on age or income. North Carolina’s expanded Medicaid program helps more residents gain access to affordable care.

Option 2: Work With a Health Insurance Broker
If you prefer guidance, you can work with a licensed health insurance broker at no cost to you. A broker’s job is to help you compare multiple health insurance plans, explain subsidy eligibility, and find the coverage that best fits your needs.

The brokers at Carolina Insurance Professionals are based in Raleigh and specialize in helping North Carolina residents choose affordable plans from trusted providers. We can walk you through the entire process, help you avoid common mistakes, and make sure you understand what your plan covers before you enroll.

Working with a broker does not increase your costs. In fact, it often saves you time and money by ensuring you select the most affordable coverage available for your situation.

Our professional insurance agents help you navigate the different options and find health insurance policies that protect you from financial hardship without leaving you struggling to afford other necessary expenses. Reach Carolina Insurance Professionals by phone at (919) 285-4732 or use the online “Get a Quote” form to compare plans and buy insurance today.