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Finding Affordable Health Insurance In North Carolina

Alvin Nelson
March 26, 2021
Alvin Nelson

affordable health insurance north carolina

When you're looking for the best deals on affordable health insurance in North Carolina, it pays to know what to expect well ahead of time. Otherwise, you could get lost in a maze of jargon that may cost you a chance to save money over the long run.

Overall, North Carolina residents enjoy some of the lowest prices on health insurance nationwide. The catch is that it's not so easy to compare premiums and deductibles from a wide variety of health plans at one time.

Which insurance companies give the best rates on family coverage? Which ones work best for single individuals in outstanding health? And what's an exclusion?

If you're a price-conscious shopper, you might have even more questions that need reliable answers, so the goal of this guide to affordable health insurance in North Carolina is to answer those questions and much more.

At the end of the day, finding the best prices on health insurance in North Carolina takes time, but it's well worth the effort once you know the basics.

What to look for in affordable health insurance in North Carolina

Essentially, you have a choice between a private insurance plan or one of four "metal-tier" plans available through the Affordable Care Act's health insurance marketplace. The most significant benefit of a plan through is the subsidies to offset the cost of coverage.

But there are other aspects to keep in mind as you search online and compare policies closely. One insurer may offer every type of plan available, but another may only offer a limited selection.

Either way, the general rule of thumb is that finding affordable health insurance in North Carolina boils down to premiums, deductibles, co-payments, and out-of-pocket costs.

Let's go over each expense category to clarify why they matter so much when choosing health insurance.


A premium is the monthly cost of the health insurance plan. Usually, consumers pay them monthly, but they can also opt for a single annual payment.

At the time of this writing, North Carolina residents pay an average of $516 per month for a private, unsubsidized health plan. Although, choosing a plan through the ACA's marketplace cuts that price in half for most people.

The only downside is that most people can't afford to pay several thousand dollars upfront, so they like to spread out the cost of coverage to suit their budgets.


A deductible is a price you must pay before the insurance company covers any medical services. It doesn't matter if you just broke your leg or if you're only going to the doctor for a physical. Like auto insurance, some insurance plans come with very high deductible amounts in exchange for the lowest rates on premiums.


A co-payment is a cost-sharing mechanism between you and the insurer each time you see the doctor. You could choose an insurance policy covering all co-payments, but it's common to have modest co-payments even with the most affordable health plans.

Out-of-pocket costs

Out-of-pocket costs include everything you have to pay that your health insurance carrier doesn't cover automatically. Before the passing of the ACA in March 2010, there was no limit to how much health insurers could charge you for coverage.

The ACA's provisions precisely place a cap on maximum out-of-pocket costs. Once you reach that set amount, you won't have to pay extra expenses anymore. Capping what you pay overall is one of the most effective ways to control the policyholder's cost of health insurance.


Each insurance plan – whether it's for an individual, a small business, or a family of four – clearly specifies the medical care that it covers on a "benefits sheet." This document is a synopsis of your health plan that you can reference when you have questions about what procedures you'll pay for out-of-pocket.

Still, many people underestimate how much they'll really need to use their insurance every year. What often confuses consumers is that a single insurer can offer various combinations of premiums, discounts, and deductibles.

Next, let's go over the different types of health plans you might see so you don't make the same mistake.

Basic types of health insurance

Policyholders paying for health insurance is one part of the cost of coverage. Still, there are also critical differences in how your insurance carrier will reimburse medical practices for the care you already received.

Health insurance, in general, comes in three main varieties, such as:

  • Health maintenance organizations (HMO)
  • Preferred provider organizations (PPO)
  • Exclusive provider organizations (EPO)

They're loosely referred to as "networks" in the insurance industry; however, the best network depends on your health status and whether or not you'll be visiting a physician frequently.


An HMO primarily provides healthcare "in-network," meaning that the plan will specify which medical facilities will accept the insurance. Also, if you need to go "out-of-network" to see a specialist, you'll need to get a referral from a primary care physician.


A PPO is different in that in-network healthcare services cost less than HMO in-network care. The catch is that these plans come with higher premiums for the most part, but you don't need a referral from a doctor to see a specialist.


EPO Insurance combines the best of both HMOs and PPOs. Generally, these plans cost more because the network is smaller since EPOs negotiate cost savings directly with health providers to offer discounted services.

That said, with so many choices out there, is it any wonder that there are numerous misconceptions about health insurance? Here are the most common flubs.

Most common misconceptions about health coverage

These are the most common misconceptions that could be a problem down the road.

  • Large out-of-pocket expenses
  • Changes in health insurance law
  • The high price of quality coverage

Before making a final choice on health insurance in North Carolina, keep in mind that these factors may affect your decision.

Large out-of-pocket expenses

Before the ACA became the law, out-of-pocket costs were outrageous and sometimes downright predatory, but the ACA changed that once and for all. Still, you may get stuck with huge medical bills to pay out-of-pocket. That's why you have to pick the right PPO or HMO for your health needs. You don't want to happen to run out of coverage when you need the most expensive treatments.

Changes in health insurance law

There have been several misnomers about "Obamacare" that have affected the general public's opinions of the law from the start. The biggest misconception by far is that the law mandates that you receive specific health care, not carry your own health insurance.

You always have the option to choose your doctor, but health insurance law nationwide now requires that all adults carry some form of health insurance.

There's no longer a penalty for not having health coverage, but north Carolina residents don't have to worry about that anymore since congress abolished the mandate several years ago.

The high price of quality coverage

It's a myth that the best coverage is always the most expensive. But what if you're in tremendously excellent health, work out every day, don't smoke, and don't have a family history of chronic illnesses?

In this situation, is it wise to pay the most for health insurance that you won't necessarily need as much as someone not in good health? The answer is this: not necessarily if you can't afford a high monthly premium.

What's the best online tool to find health insurance in North Carolina? streamlines the search for health insurance for North Carolina residents who need a quick way to compare rates. Often, the biggest challenge is to differentiate a plan on the federal health insurance marketplace and a private insurance plan.

Since your health needs vary on a case-by-case basis, you'll need to be able to choose from a wide variety of health plans.

The platform makes it simple to find coverage, requiring only a zip code and basic contact information.

The only information you'll need to input includes:

  • Gender
  • Date of birth
  • Pre-existing health conditions
  • Marital status
  • Tobacco use
  • Major life events (e.g., moving to a new state)

The site will also require a general estimate of your household income based on the amount you stated on your most recent taxes.

Visit the homepage to start looking for health insurance in North Carolina today!

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The plans represented on are Medicare Advantage HMO, PPO and PFFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal. If you are paying Medicare Part B premium, you must continue to pay it to maintain coverage.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

Every year, Medicare evaluates plans based on a 5-star rating system.

Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

Based on median Medicare Advantage benefit amounts for dental available across multiple plans and metro areas. Not all benefits available in specific plans or regions.

This information is not a complete description of benefits. Contact the plan for more information.

Limitations, copayments, and restrictions may apply.

[Benefits, premiums and/or copayments/coinsurance] may change on January 1 of each year.

Advertised Pricing:

There are several factors that impact your monthly premium; including your age, geographical location, annual income, dependents, and the type of plan you choose. Monthly premiums do not include out-of-pocket costs.

The advertised price may not be typical. It was generated using the Kaiser Family Foundation's subsidy calculator that was accessed on September 16, 2020. The following parameters were used: 21 year old adult, non-tobacco user, annual income of $24,700 in 2020, no children, and no available coverage through a spouse's employer. The resulting monthly premium was $30 per month (or $360 per year after $2,751 in subsidies) for a Bronze Plan. Even when using the same parameters, the resulting premium and subsidy calculations may be subject to change.