North Carolina Health Insurance (NC)

In response to the passage of the 2010 Patient Protection and Affordable Care Act, each of the states is reviewing its existing insurance regulations in order to comply with the new federal mandates. Major changes already affect how children may access insurance protection, including the provision that children may no longer be excluded from coverage due to pre-existing conditions. Additionally, children may remain on their parents’ health policies up to age 26 even if they are no longer in school or if they have married.

Adults with pre-existing conditions are temporarily protected by high-risk pools in the states, an arrangement that will be replaced on January 1, 2014 by health care exchanges, which will be competitive marketplaces where consumers can purchase policies.

General Insurance Regulations

In North Carolina insurers must renew health policies if the premiums are being paid. Premium rates bay be set according to health status, but renewal cannot be denied on that basis. Currently, pre-existing condition exclusions are allowed for a period of up to 12 months, although 3-6 months is more typical in the state. The look-back period for pre-existing conditions is only 3 months. All coverage may be denied, with the exception of Blue Cross Blue Shield.

Health Care Exchange

Like many of the states, North Carolina is continuing to study its options for the establishment of a health care exchange. Although three bills failed in the legislature in 2011, the North Carolina Department of Insurance continues to make plans for a state-run exchange.

Pre-Existing Condition Insurance

The Pre-Existing Condition Insurance Plan in the state is run by the North Carolina Health Insurance Risk Pool (Inclusive Health) and offers monthly premiums that range from $69 to $548. Services covered include both primary and specialty care, as well as hospital stays, and prescription medications. According to the applicable plan, deductibles run from $1000 to $4500, with the out-of-pocket annual limits ranging from $4500 to $5950.


Eligibility for both Medicaid and the Children’s CHIP-funded Medicaid Expansions are figured by income as a percentage of the Federal Poverty Level. Infants under one year of age in North Carolina are Medicaid eligible at 185% FPL and CHIP qualified at 200%. The 1-5 age bracket is 133% and 200% respectively, and the 6-19 group may draw Medicaid at 100% FPL.

Pregnant women qualify for Medicaid at 185% FPL, parents at 37%, and non-elderly disabled Social Security recipients at 100%.


Approximately 15 percent of North Carolina residents draw Medicare benefits, with more than 1.4 million accessing prescription drug coverage.

Additional prescription medication assistance is available through the NCRx program, while the NC Alzheimer’s Support Program helps elderly Medicare recipients with Alzheimer’s to arrange for long-term care.

The State Health Insurance Information Program offers counseling and education to Medicare recipients to assist them in making better, more informed health care choices.