Best Cheap Health Insurance in North Carolina (NC) for 2022

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 2018 ran about $6,000 per year or $500 per month, 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: $365
• Silver-tier low-cost plan: $511
• Gold-tier low-cost plan: $553

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