Health Plans for Individuals and Families

More health insurance plans and more choices than ever before means more reasons to choose Blue Cross and Blue Shield of North Carolina.

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Shopping for health insurance invites a lot of questions:

  • How much will it cost?
  • Can I still see my doctor?
  • What benefits does it include?
  • Are my prescription drugs covered?

We can help you answer those questions and help you find a health insurance plan that suits you best.

Benefits of Buying a Blue Cross NC Plan



All fully insured health plans are ACA (Affordable Care Act) compliant


100% preventive care coverage2


Online tools to find doctors and compare health care costs


Health and wellness programs like our free 24/7 nurse health support line


Voted one of the world's most ethical companies3


Plans with coverage statewide, across the country and around the world1

How to Shop for a Health Plan


When you're shopping for a health plan, there are four things to think about:

 

Network


The larger the network, the more doctors and drugstores there are in that network. Larger networks tend to have fewer limits when you need to find a doctor or prescription drugs. But, it also means the health plan may cost more.

Keep in mind that even though we offer out-of-network coverage too, you'll save the most money when you see a doctor or visit a pharmacy in your plan's network.

If you have a doctor you'd like to keep seeing, you can use our Find a Doctor search tool to be sure your doctor is in that network. You can also look up the cost of a medication with our Find a Drug tool.

Please enter your zip code and county to view networks available
for your area:


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Copayments, Deductibles and Coinsurance


Health plans are available with a couple of payment combinations and options. The type you choose determines how much you'll pay for care when you go to the doctor, pharmacy or hospital.

Copayments

A copayment is a fixed dollar amount you pay for a covered service at the time you receive it.

For example, you may have a plan that charges a $20 copay for a regular doctor visit. All you'll need to pay is your $20 copay. Plans with copays tend to be more expensive. But, you'll know the cost of the visit before you go.

Deductibles

A deductible is the amount you owe for covered health care before your health insurance company starts to pay.

For example, let's say you have a $3,000 deductible and you've paid $2,000 toward it. You just had an MRI that costs $1,500. You'll have to pay $1000 to reach your deductible. After that, you'll only pay part of the remaining $500 based on your coinsurance percentage.

Coinsurance

Coinsurance is your share of costs for health care expenses based on a percentage of those costs.

After you've met your deductible, you may be charged coinsurance for health care services. The cost of the service will be split between you and your insurance company.

So, if you get a $100 bill for a chest X-ray and you have a 30% coinsurance amount, you'll need to pay $30 and your insurance company will pay the rest.

Metallic Levels


As you shop, you'll notice all of our plans are available in three metallic levels: bronze, silver, and gold. As part of the ACA health care reform, these levels were created to show the value of coverage within a plan.

The levels vary by how much of your medical costs a plan will pay on average. This can help you compare plans with various deductibles, copayments and coinsurance.

Gold

Bronze plans pay 60% of medical costs on average.5, 6

Good for people who typically don't need a lot of medical care and want lower premium payments.

Silver

Silver plans pay 70% of medical costs on average.5, 6

Good for people who are relatively healthy and want to balance monthly premium payments with out-of-pocket expenses.

Gold

Gold plans pay 80% of medical costs on average.5, 6

Good for people who go to the doctor or receive medical care regularly and are okay with a higher monthly premium to have more health care costs covered.

Subsidies

To help make health plans more affordable, the federal government offers subsidies and cost sharing reductions for plans purchased on the Health Insurance Marketplace. A subsidy (financial aid) from the federal government is available to help low and middle-income Americans with their health insurance premiums. The amount of the subsidy is based on you/your family's earnings and household size4.

These subsidies can help you afford a health plan that you may have considered outside of your budget.

Start shopping to see if you qualify for a subsidy.

86% of those who enrolled in a health plan on the Health Insurance Marketplace qualified for subsidies in 20157.

 

 

Health and Wellness


As a member, you'll have access to an array of benefits and programs designed to make it easy to stay fit and healthy.

Health Line BlueSM

Health Line BlueSM connects you to a trained nurse, 24/7, to get your healthcare questions answered.

Blue365®

Blue365 has great deals on fitness gear, personal care, gym memberships, family activities, vision and hearing products9.

Healthy OutcomesSM

Healthy OutcomesSM wellness program10 and fully integrated case management, condition care.

Coaching

Assistance with health issues with one-on-one coaching.

Catastrophic Health Plans


Are you under 30 or qualify for a hardship through the federal government? You may be eligible for catastrophic coverage.11

Catastrophic plans have a high deductible and offer minimum coverage at a lower price. These plans have the most restrictions, but your monthly payments will be lower than most other plans.

Plan benefits include:

  • 100% preventive care coverage2
  •  Essential Health Benefits covered after deductible is met
  •  Plans meet ACA bronze-level requirements

 

Example Plans


If you're healthy, see a doctor less than a couple of times a year and don't have a specific doctor you want to keep, you may want to consider a plan with these features12:

  • Network: Smallest
  • Deductible: High
  • Doctor's office visits: Not covered until full deductible is met (coinsurance may be required)
     

If you go to your doctor many times a year, want to keep seeing your doctor and have a chronic condition like diabetes, you may want to consider a plan with these features12:

  • Network: Largest
  • Deductible: Low
  • Doctor's office visits: Covered (copay and/or coinsurance may be required)
     

 


Get a Free Rate Quote

Important Information

All Blue Cross NC individual market plans may be purchased through the Health Insurance Marketplace as a Qualified Health Plan (QHP) or through other sources, such as directly from Blue Cross NC. Advanced Premium Tax Credits (APTC) and Cost-Sharing Reductions are only available when plans are purchased through the Health Insurance Marketplace (visit healthcare.gov and choose the option to get coverage). If you apply through Blue Cross NC, you'll be able to go to the Health Insurance Marketplace to get any APTC or Cost-Sharing Reductions you're eligible for. The Health Insurance Marketplace displays all QHPs available for sale in a given state by all issuers and may contain more QHPs than displayed on this site.6 The Health Insurance Marketplace allows individuals to apply via its website, in-person or by phone. 

This website is operated by Blue Cross and Blue Shield of North Carolina and is not the Health Insurance Marketplace website. This website does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov. 

The policy form number for Blue Advantage and Blue Select is NGFPPO-I, 5/16. The policy form number for Blue Value, Blue Local with Carolinas HealthCareSystem, and Blue Local with Duke Medicine and WakeMed is ACAPOS-I, 5/16. You must be under 30 years of age when the plan begins or qualify for a hardship exemption through the federal government to be eligible for a catastrophic plan. 

Find out more about the premium rate increase (pdf) for individual and family plans. 

All plans may not be available in all geographic areas. 
 

  1. Covered in more than 200 countries and territories worldwide through BlueCard® program. Blue Cross and Blue Shield Association. Not all plans have statewide coverage and not all plans are available in all counties.
  2. Certain preventive care services are covered at 100% before deductible when received in an in-network office or out-patient setting. Other covered services may be subject to deductible and coinsurance. When you receive preventive care out-of-network, you may pay more. Visit bcbsnc.com/preventive for a full list of preventive services.
  3. Blue Cross NC is one of the World's Most Ethical Companies (2012, 2013, 2014, 2016). Ethisphere Institute reviewed nominations from companies in more than 100 countries and 36 industries..
  4. Final determination of eligibility and/or amount of government financial assistance can only be obtained through the Health Insurance Marketplace.
  5. The Center for Consumer Information and Insurance Oversight. Centers for Medicare and Medicaid Services. "Actuarial Value and Cost-Sharing Reductions Bulletin." Accessed April 29, 2013.
  6. These are approximate values with a +/- 2% variation and based on approximate values for standard medical expenses.
  7. Pear, Robert. "86 Percent of Health Law Enrollees Receive Subsidies, White House Says." New York Times, March 10, 2015. http://www.nytimes.com/2015/03/11/us/11-7-million-americans-have-insuran...
  8. Blue Cross NC offers programs as a convenience to aid members in improving their health; results are not guaranteed.
  9. Blue365® offers access to savings on items that Members may purchase directly from independent vendors, which are different from items that are covered under the policies with Blue Cross NC. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither Blue Cross NC nor BCBSA recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior notice. This program is provided by BCBSA and not Blue Cross NC.
  10. Blue Cross NC offers Healthy Outcomes programs as a convenience to aid you in improving your health; results are not guaranteed.  Blue Cross NC contracts with Optum, an independent third party vendor, for the provision of certain aspects of Healthy Outcomes programs and is not liable in any way for goods or services received from Optum.  Optum does not provide Blue Cross and Blue Shield products or services.  Blue Cross NC reserves the right to discontinue or change Healthy Outcomes programs at any time.  The programs are educational in nature, and are intended to help you make informed decisions about your health, and to help you comply with your doctor's plan of care. Decisions regarding your care should be made with the advice of your doctor.
  11. Final determination of hardship eligibility can only be obtained through the Health Insurance Marketplace.
  12. These are just examples and are subject to change based on personal circumstances.

 

U11025, 10/15