North Carolina health insurance exchange guide

This guide provides an overview of the North Carolina health insurance exchange, including the history of the exchange, how the exchange will operate, and exchange information for North Carolina residents and small businesses.

North Carolina health insurance exchange introduction

Beginning in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses became available through new state health insurance exchanges (also called health insurance marketplaces). 

Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies will only be available for coverage purchased through state or federal health insurance exchanges. 

All states have three options for setting up a state health insurance exchange:

1. Build a state-based exchange

2. Enter into a state-federal partnership exchange

3. Default to a federally-facilitated exchange (the Health Insurance Marketplace)

North Carolina uses the federally-facilitated health insurance exchange.

North Carolina health insurance exchange - history

In 2011, Governor Beverly Perdue indicated intent to establish and operate a state-based health insurance exchange. However, all three bills that were introduced in the 2011-2012 session to establish a state-based health insurance exchange failed. After this, the North Carolina Department of Insurance (NCDOI), the North Carolina Department of Health and Human Services (NCDHHS), and the North Carolina Institute of Medicine (NCIOM) led exchange planning in the state. In November 2012, Governor Perdue announced the state’s intent to establish a state-federal partnership health insurance exchange. 

However, in February 2013, newly-elected Governor Pat McCrory issued a statement announcing that North Carolina would abandon efforts to establish a partnership exchange and default to the federally-facilitated exchange.

North Carolina health insurance exchange - What is it?

The North Carolina health insurance exchange will be operated through a federally-run health insurance exchange called the Health Insurance Marketplace. According to HealthCare.gov, North Carolina residents will be able to access information about all the plans available through the exchange. The SHOP exchange will also be available to small businesses with 100 or fewer employers.

According to an estimate by HealthCare.gov, 1,346,601 or 17% of North Carolina’s non-elderly residents were uninsured in 2014, of whom 1,252,882 (93%) qualified for either premium tax credits to purchase coverage in the Marketplace or for Medicaid if North Carolina participates in the Medicaid expansion.

North Carolina insurance exchange - What plans are available?

All plans offered through the North Carolina health insurance exchange will meet the ACA definition of a qualified health plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB) to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%), and Platinum (plan pays 90%).

North Carolina health insurance exchange - Role of insurance professionals & navigators

The North Carolina health insurance exchange follows federal guidelines for insurance professionals selling policies through the exchange and for navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the North Carolina Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN). 

The North Carolina Health Insurance Exchange Navigator program will assist consumers in making choices about their healthcare options and accessing their new healthcare coverage, including access to premium tax credits for some consumers. The federal government will run the navigator program in North Carolina.