Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced new actions to keep health care affordable for North Carolinians. The North Carolina Department of Insurance (NCDOI) approved a 3% average rate increase for individual customers and families who enroll in Affordable Care Act (ACA) plans in 2025. This increase is lower than the estimated national average rate increase of 7%¹.

“The average rate increase of 3% on our ACA plans is less than half the national average. We have worked hard to keep our ACA plans as affordable as possible, but we know any increase is too much for many families.” said Dr. Tunde Sotunde, president and CEO of Blue Cross NC. “The cost of health care – including prescription drugs – is still too high. It will take all of us, including health systems and pharmaceutical companies, to make health care more affordable.”  

2025 Offerings

In 2025, Blue Cross NC will continue to offer its broad network preferred provider organization (PPO) plan, Blue Advantage^®, in every county of the state². And in many areas, Blue Cross NC is collaborating with local health systems to offer plans that feature a smaller, curated network of high-quality providers, at a lower cost than a similar broad network PPO plan.  

• In the Triad, Triangle, and Charlotte regions, Blue Cross NC will continue to offer Blue Local^℠ and Blue Home^℠ plans. These plans’ average monthly rates are $100 to $200³ lower than similar PPO plans.  
• In the Wilmington, Hickory, and Gastonia areas of the state, Blue Cross NC will continue to offer Blue Value^℠ plans. These plans’ average monthly rates are $80 to $100³ lower than similar PPO plans.  

New for 2025, Blue Cross NC will offer a broad network health maintenance organization (HMO) plan, Blue Care^®, in all counties without a Blue Local^℠ or Blue Home^℠ plan. Blue Care^® will offer only statewide coverage, except for out-of-network or out-of-state urgent care and emergency services which will be covered at the in-network benefit level.

How Rates are Determined

Rates are primarily determined by members’ collective medical and pharmacy costs. Rates vary based on location, age, and plan. For individual ACA customers, individual premium amounts depend on federal premium subsidy levels, which will be determined by the Centers for Medicare and Medicaid Services in October. 

While the statewide average rate increase for Blue Cross NC ACA plans is 3%, regional rate changes range from an average of -0.5% to 6.8%. Individual premiums will be available in October. Open enrollment for individual under-65 ACA plans begins on November 1, 2024, and ends on January 15, 2025.

About 86% of Blue Cross NC’s current customers with individual ACA plans qualify for subsidies for their 2025 plans. Subsidies vary by plan and household income. The federal American Rescue Plan Act (ARPA) expanded these subsidies to more individuals, lowering premiums to no more than 8.5% of customers’ household incomes. In 2022, these expanded subsidies were extended for three years, through the federal Inflation Reduction Act (IRA).

Blue Cross NC will continue offering renewal of what are considered “transitional plans” in 2025, for both individuals and small groups. These are plans purchased between March 2010, when the ACA was signed, and October 2013, when regulations went into effect. Transitional plans do not meet ACA requirements but are allowed by federal law. The plans cannot be sold to new customers. 

For more details on this update read the full press release in our Media Center.