North Carolina Health Insurance
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Facts and Figures
-
Place in State
Health Report Card 32nd - Insured 7,661,232
- Uninsured 1,553,000
-
Insurance
Carriers 11 -
Number of
Primary Care Physicians 14950 -
Number of
Hospitals 115 -
Average Cost of
Health Insurance* $827
Breakdown of Insureds
- Employer-sponsored health insurance 59%
- Private plans 6%
- Medicaid 17%
- Medicare 16%
- Others 2%
Insurance Carriers
- Aetna
- Assurant Health
- Celtic Health
- CIGNA
- Golden Rule Insurance Company
- Great American Health Insurance Company
- Humana
- John Alden Life Insurance
- Standard Security Life Health Insurance
- WellPath Select, Inc. Health Insurance
- WorldIns ExpressMed Health Insurance
State Health Report Card
In the past five years, the percentage of children in poverty
increased from 18.3 percent to 27.6 percent of persons under age 18.
In the past ten years, diabetes increased from 6.4 percent to 9.8
percent of adults. There are now 711,000 adults with diabetes in the
state.
In the past ten years, obesity increased from 21.8 percent to 28.6
percent of adults; now, there are nearly 2.1 million obese adults in
North Carolina.
While smoking has decreased from 26.1 percent to 19.8 percent of
adults in the past ten years, more than 1.4 million adults still smoke
in the state.
North Carolina Health Insurance Laws and Regulations
North Carolina health insurance plans are required to be sold with a guaranteed renewability clause. With this, policy-holders can renew their coverage when the need arises as long as they pay their premiums and honor their contracts. Health insurers cannot cancel an existing coverage in case you get sick or injured. Newborns and newly-adopted children are covered automatically under their parents’ health insurance, as long as their plans covers dependents. Coverage can last up to 31 days, giving parents enough time to look for a more permanent solution. When writing new North Carolina health insurance plans, insurers can exclude coverage for a pre-existing condition. This period can last for up to twelve months. Health insurance companies in North Carolina are allowed to deny an application for coverage based on factors they see fit. Prices can also be determined using similar factors. Blue Cross Blue Shield do not have this option since they are tasked to accept all applications. Small businesses (two to fifty employees) are qualified to access group health insurance plans being offered to other small businesses in the state. However, certain guidelines must be met in order to maintain coverage like having a minimum number of participants. Group policies cannot be terminated based on a group member’s health condition. North Carolina health insurance quotes for group coverage can vary according to the risk factors of its members. Self-employed workers can choose either individual or group health plans. This is possible even if there are no other employees in the business. A portion of the premiums for individual plans may deducted from your tax liability.
Heath Care Reform
With the new health care law, children under the age of 26 can choose to stay under their parent’s North Carolina health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In North Carolina, 75,201 young adults have insurance coverage through this provision as of June 2011.
The new health care law allowed 114,012 Medicare policyholders in North Carolina to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 108,198 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $602 per person or a total of $65,161,683 was saved in north Carolina.
Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 2,889 individuals in North Carolina have benefited from this new law.
When looking at North Carolina health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. Around 2,157,000 private policyholders in New Carolina will get greater value for their premium payments because of this 80/20 rule.
Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all North Carolina health insurance with no deductibles or co-pays. In 2011, 1,161,976 Medicare subscribers and 1,564,000 individuals with private policies received such services in North Carolina.
Under the new law, insurance companies are no longer allowed to impose an annual dollar limit – a cap on the yearly spending for your benefits, or a lifetime dollar limit – a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 3,091,000 North Carolina residents have benefited from this law.
If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of North Carolina received a total of $5 million.
All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In North Carolina, 175 community health centers received a total of $54.2 million to fund these improvements.
In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. North Carolina has already received a total of $135.8 million to support its policies, programs, and communities to help its residents lead healthier lives.
State Government Insurance Programs Offered
Inclusive Health North Carolina Health Insurance Risk Pool www.inclusivehealth.org
866-665-2117
Inclusive Health: Covers a broad range of services, including Preventive care, Urgent care, Outpatient services, a Prescription drug benefit and other common health care services. May have a 6 to 12-month waiting period for pre-existing conditions. Lifetime benefit maximum of $1,000,000. InclusiveHealth-Fed: Covers broad range of benefits, including primary and specialty care, hospital care, and prescription drugs. Eligibility: InclusiveHealth: Must not be eligible for Medicaid, Medicare, or any group insurance. Must be a legal resident of the U.S. and have been a continuous resident of North Carolina for at least 30 days. Must have been denied health insurance due to pre-existing medical reasons, offered coverage by an insurer but with a conditional rider limiting coverage, exhausted 18 months of COBRA, or with higher premiums, or you were diagnosed with a qualifying medical condition. Also qualified to enroll are HIPAA or HCTC-eligibles who do not need to fulfill 30-day North Carolina residency requirement. InclusiveHealth-Fed: Must be a U.S. citizen or lawfully present in the U.S. Must have been uninsured for at least 6 months prior to applying. Must have had a problem getting insurance due to a pre-existing condition.
Medicaid www.ncdhhs.gov/dma/medicaid/
800-662-7030
919-855-4400
(for Wake County)
TTY: 919-733-4851
Coverage: Doctor bills, Hospital bills, Prescriptions, Dental, Vision, Medicare premiums, Nursing home care, In-home care, Mental health care, Most medically necessary services for children under age 21, Personal care services, Medical equipment, and other home health services. Eligibility: Must be a U.S. citizen or legal permanent resident and live in North Carolina. Income limits for the following: Pregnant women and infants ages 0–1: See “Pregnant Women and Infants” Children ages 1–5: 200% FPL. Children ages 6–18: 100% FPL. Aged, blind, and disabled: Singles and couples living up to 100% FPL with asset limit of $2,000 for singles and $3,000 for couples. Parents/Caretakers living with children ages 0–18, and children under age 21: $362/month for 1 household member; $472/month for 2; $544/month for 3; $594/month for 4; $648/month for 5. Asset limit of $3,000. Medically-needy: $242/month with asset limit of $2,000 for singles; $317/ month with asset limit of $3,000 for couples. Working Disabled: 150% FPL and must be ages 16–64 and disabled by Social Security standards. Asset limit of $21,192.
North Carolina’s Health Choice www.ncdhhs.gov/dma/ healthchoice/
800-662-7030
919-855-4440
(for Wake County)
Coverage: NCHC: Physician and clinic services, X-ray & lab, Surgical services, Prescription drugs, Dental, Vision & hearing, Durable medical equipment, Therapies (physical, speech, hearing, occupational) Hospice care, Home health care, Inpatient/outpatient mental health services and substance abuse treatment. Eligibility: NCHC: Income limit of 200% FPL. Must not be eligible for Medicaid or have any other health insurance. Must be under age 19, and be a U.S. citizen or lawful alien and North Carolina resident.
Medicaid for Pregnant Women www.dhhs.state.nc.us/dma/ medicaid
919-707-5700
TTD: 877-452-2514
Medicare is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in aMedicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.
Medicare www.medicare.gov
800-633-4227
Medicare is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.
Women-Infant- Children (WIC) www.nutritionnc.com/wic
919-707-5800
Women-Infant-Children is funded by the federal government and offers nutrition program for women, infants, and children. Benefits include health screening, medical history, body measurement, nutrition assessment and education, breast feeding support and education, hemoglobin check, and vouchers for food supplements. Eligibility: 1. Must be a resident of North Carolina. 2. Must have nutritional or medical risk. 3. Must be pregnant or postpartum women and children not more than 5 years. 4. Must not exceed income limits of 185% of the FPL.