There’s a reason so many young professionals are flocking to North Carolina, and there’s more to it than good weather and friendly residents. North Carolina has a growing job market, miles of beautiful coastline and equally gorgeous interior settings thanks to features like the Blue Ridge Mountains, and no shortage of dining and entertainment options for young and old alike.
The Tar Heel State has endless opportunities for outdoor recreation, so whether you like rafting or rock climbing, hiking or biking, or simply lounging on beautiful beaches, North Carolina can accommodate. They’ve also got great schools, a burgeoning music scene that rivals neighboring Tennessee, notable businesses like banking, and nationally ranked, award-winning hospitals. Plus, North Carolina boasts delicious BBQ and craft brews.
In other words, there’s a lot to love when you’re a resident of North Carolina or you’re thinking of moving to the Tar Heel State. Of course, no matter where you decided to hang your hat, so to speak, you need to be aware of health insurance options available to you.
Following the passage of the Affordable Care Act (ACA), or Obamacare, all U.S. citizens, nationals, and lawfully present aliens must meet individual responsibility mandates for maintaining minimum health coverage. Failure to comply with this mandate could result in penalties and fines, so you want to make sure that you have access to suitable options when you live in North Carolina.
Luckily, the state provides many opportunities for residents to meet minimum coverage standards. Here are a few things you need to know when you start seeking health insurance coverage in North Carolina.
Health Insurance Options
There are three main options to explore when you’re comparing health insurance coverage. You may gain insurance benefits through an employer-sponsored plan, you can enroll in Obamacare through the health insurance marketplace, or you may seek private insurance coverage outside the exchange. The important thing to remember is that under the ACA, every American (and lawful resident) must meet the individual mandate for minimum coverage or risk penalties.
If you’re lucky, your employer is one of many that offers health insurance plans as part of the benefits package for employees. Under the ACA employer mandate, all companies with 50 or more full-time employees or full-time equivalents (FTEs), must provide affordable healthcare options that meet mandatory minimum essential coverage.
Businesses with fewer than 50 FTEs are not subject to the employer mandate and therefore need not offer health insurance to employees. However, companies with fewer than 25 FTEs (earning less than $50,000 annually on average) may enjoy tax incentives by signing up for employer-sponsored plans through the Small Business Health Options Program (SHOP).
Many people will not have access to health insurance through an employer, in which case another affordable option is to enroll in Obamacare through the health insurance marketplace. North Carolina residents can enroll via HealthCare.gov during open enrollment unless they qualify for a special enrollment period. These periods generally coincide with major life changes such as job loss or switching jobs, marriage or divorce, or the birth of children, just for example.
Once you have enrolled in Obamacare you’ll find out if you’re eligible for any cost assistance. In North Carolina, some form of cost assistance may be available to a variety of enrollees, including those with low income, the elderly, pregnant women, children, disabled persons, and other groups.
Enrollment in plans like Medicare, Medicaid, and CHIP will depend on eligibility. Although North Carolina was one of many states that elected to forego participation in the Medicaid Expansion program (adding additional state funds to match federal funding for Medicaid), many residents are able to qualify for Medicaid and receive benefits.
If you’re not eligible for cost assistance, you can still take advantage of a variety of health insurance options offered through the healthcare marketplace. These plans include four coverage tiers: bronze, silver, gold, and platinum. Bronze level plans offer less coverage and lower rates while moving all the way up to platinum will offer the best coverage, but at the highest rates.
Private Health Insurance
This is the last option for insurance coverage, but it is also the least appealing for many consumers. Not only is this likely to be the most expensive option, but the onus is on consumers to ensure that the private health insurance policy purchased meets mandatory minimums for individual coverage.
On the upside, consumers seeking private insurance outside the healthcare marketplace may have even more options for providers and policies that best suits their needs. However, they will pay for the privilege.
Healthcare in North Carolina
Despite a rocky start, Obamacare has helped millions of previously uninsured Americans to overcome hurdles like low income and preexisting conditions that stopped them from obtaining health insurance coverage prior to the passage of the ACA. In North Carolina, conditions have improved dramatically.
In 2009, before the passage of Obamacare, North Carolina ranked 44th (out of 50 states and the District of Columbia) on the Scorecard on State Health System Performance released by The Commonwealth Fund. By 2014, the state had advanced to 36th place and they continue to make improvements that benefit North Carolina residents.
North Carolina faces several challenges when it comes to improving health rankings within their state, including income disparity, a high population of children in poverty, the prevalence of diabetes, and a shortage of dentists in the state. On the other hand, the instances of childhood immunization within the state are relatively high, reducing the occurrence of common ailments such as pertussis.
Despite the fact that North Carolina’s state government has done little to support and promote the ACA, this state ranked fifth highest in enrollment during the first open enrollment period, and residents continue to enroll in Obamacare and take advantage of cost assistance when applicable.
The rate of uninsured residents in 2013 was 20.4%, a number that dropped to 16.7% in 2014 and then to 14.7% in 2015. It would likely be even lower if the state participated in Medicaid Expansion.
Most recently, the North Carolina legislature approved House Bill 372, voting for legislation that will privatize Medicaid within the state, allowing for stricter controls and, hopefully, reduced costs for both the state and Medicaid recipients.