A Guide to Health Insurance in North Carolina (NC)

If you are trying to learn more about North Carolina Health Insurance then it is a good idea to consider the various alternatives that are available to you in the Old North State.

Choosing the right health insurance in North Carolina is an important decision, because it can potentially have major repercussions for your financial health, as well as your actual health.

There are two main types of Comprehensive North Carolina Health Insurance Plans that are available to you:

1/ Traditional Comprehensive North Carolina Health Insurance

Another term for this that is very commonly used by insurance companies is ‘Major Medical’.

This type of policy will cover you for such items as visits to your Doctor, diagnostic tests in the surgery or hospital, surgery, hospitalization and the prescription drugs that you may need to treat any conditions you find you are suffering from.

With these types of policy you will have to meet various out of pocket expenses, even though you have insurance, including deductibles, co-payments and co-insurance.

You will generally be able to choose which hospital you have treatment in under a traditional Comprehensive North Carolina Health Insurance Plan, and the amount that the policy will pay out for various treatments will be the normal, or customary charge that this service should cost in your particular area, as decided ultimately by your insurance company.

It used to be common for traditional policies like this to limit the amount of benefits that could be paid out in a single year, and also over the entire lifetime of the customer.

In fact, a study by Price Waterhouse Coopers into these limits found that over 50% of policies had such limits in 2009, and that up to 25,000 people had been excluded from cover because they had exceeded them.

The Affordable Care Act that started being enforced in January 2011 (though will not be fully operational until January 2014) has now meant that the insurance companies cannot set these limits in their policies.

2/ Managed Health Care Plans

These differ from traditional comprehensive plans in that they are an attempt by the insurance companies to manage all angles of the health care equation in an attempt to cut costs and gain more control over the process.

To that end you will find that some very common Managed Health Care Plans in North Carolina such as PPO Benefit Plans, HMO Point of Service and HMO Plans work in quite a different way.

Rather than having the individual health insurance customer decide where they get treatment or who their Doctor should be, managed care plans work by having more limited choices in the health care professionals that you can consult with. This is designed to lower costs and get more control over how much the health insurance company in North Carolina has to pay out for treatments.

To this end if you sign up for a managed care plan then you will generally have a primary care physician (PCP) allocated to you, and if you need treatment then you will have to get it from a narrower network of hospitals and clinics that the insurance company will already have struck deals with.

Often with these types of arrangements you will not be able to seek treatment outside the network, but the flip side is that your premiums should be lower as costs are reduced.

It is a good idea to seek out North Carolina Health Insurance Quotes from both of these types, and then make a realistic assessment based on the limits of the networks available, the immediate monthly premiums that you would have to pay, and any on-going out-of-pocket expenses that you may be required to pay for when you get treated.


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