Health Plans for
Individuals and Families

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Choose wisely. Choose Blue.SM

Benefits of buying a Blue Cross and Blue Shield of North Carolina (Blue Cross NC) health plan include:



100% preventive care coverage1


Online tools to help you find doctors, compare costs — and more


Health and wellbeing programs like Telehealth and our 24-hour nurse hotline


No referrals needed to see a specialist


Annual wellness visits


Plan options with coverage across 
the country and around the world2


DID YOU KNOW…

Nearly 50 percent of Blue Cross NC members with an individual ACA plan had premiums below $50 in 2019!
 

Source: Based on internal data for 2019. Final premium amount is after any applicable subsidy from the federal government is applied.

How to Shop for a Health Plan


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

 

Network


Each Blue Cross NC health plan has its own network of covered health care providers. The larger the network, the more in-network options you have for doctors, hospitals and other facilities. But plans with a larger network typically have a higher monthly premium. Plans with a local network are often less expensive and help you get coordinated care, but usually only the doctors and facilities of one major health system are in-network.

So, it’s important to weigh access versus cost when choosing your plan. While we also offer out-of-network coverage, you can save the most money by only seeing providers that are in your plan's network.

In the next section, you’ll see the health plans available in your county. Use the Find In-Network Doctors button to look up providers and hospitals that are covered by that plan’s network. 


Health Plan Options

Enter your county to see which health plans are available in your area:

 

Our ACA plans use the same formulary (a list of covered medications) and pharmacy network.

Use the Find a Drug button to see which medicines are covered and which tier they fall into. Tier 1 is often the least expensive, while Tier 5 and 6 are the highest-cost because they are often specialty medications.

Use the Find a Pharmacy button to search for in-network pharmacies.

 

Copayments, Deductibles and Coinsurance


When shopping for your health plan, you'll choose between two types: copayment plans and deductible/coinsurance plans. The type you select affects how you'll pay for care at 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.


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Metallic Levels


Our ACA health plans are available in three metallic levels: Bronze, Silver, and Gold. These levels were created by the ACA to show the value of coverage within a plan. They vary by how much of your medical costs a plan will pay on average. This can help you easily compare plans with different copayments, deductibles and coinsurance.

Gold

Bronze plans pay 60% of medical costs on average, and you pay 40%.3

Good for people who want protection from worst-case medical scenarios, like serious sickness or injury. While the monthly premium is lower, they’ll have to pay for most routine care themselves.

Silver

Silver plans pay 70% of medical costs on average, and you pay 30%.3

Good for people who are willing to pay a higher monthly premium than Bronze to have more of their routine care covered.

Gold

Gold plans pay 80% of medical costs on average, and you pay 20%.3

Good for people that use a lot of care and are willing to pay more in monthly premiums to have more costs covered when they get medical treatment.

Subsidies

To help make health insurance more affordable, the federal government offers financial assistance, also called subsidies, to individuals and families who qualify based on their income and household size. There are two types of subsidies available: Advanced Premium Tax Credit (APTC) and Cost Sharing Reductions (CSRs).

To qualify for a subsidy under health care reform, you must:

  • Be between 100% and 400% of the Federal Poverty Level (FPL)
  • Not be eligible for public coverage, such as Medicaid, the Children’s Health Insurance Program (CHIP), Medicare or coverage through the armed services
  • Not have affordable access to insurance through an employer ("affordable" is defined yearly by the federal marketplace based on the percentage of premium an employee is responsible for)

Learn more about subsidies from HealthCare.gov.

Use this online calculator to estimate the subsidy amount you could potentially qualify for from the federal government.

SUBSIDY CALCULATOR

 

Health and Wellbeing


As a Blue Cross NC member, you’ll enjoy benefits and programs that can help you improve your health and feel your best.

Telehealth

24/7 video consults with a doctor for minor health problems and mental health issues (available in English and Spanish).4

Health Line BlueSM

Talk to a specially-trained nurse anytime — day or night — to get your health care questions answered.5

Blue365®

Grab discounts on products tied to fitness, personal care, healthy eating, wellness, financial health, lifestyle and more.6

Coaching

Get one-on-one support to help you manage a long-term condition or deal with complex health issues.5

Catastrophic Health Plans


Are you under 30 or qualify for a hardship through the federal government? You may be eligible for catastrophic coverage.These plans have a high deductible and offer minimum coverage, but your monthly payments will be lower than most other plans.

Benefits include:

  • 100% preventive care coverage1
  •  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 features8:

  • 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 features8:

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

 


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Important Information

All Blue Cross NC individual ACA 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 and Cost Sharing Reductions are only available when plans are purchased through the Health Insurance Marketplace. 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. 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. All information discussed on this page pertains to Blue Cross NC individual-market, medical health insurance plans that are eligible for sale in 2020 and meet Affordable Care Act guidelines. The information contained does not apply to plans that are transitional, group, dental-only or other plan types. All details regarding plan benefits and design contained herein are for informational purposes only. Please see the product benefit booklet for all terms and conditions that apply.

Your coverage will automatically renew. Your coverage may be canceled by Blue Cross NC for fraud or intentional misrepresentation of material fact on your application or for nonpayment of premiums. Coverage for dependent children ends at the end of the month they become age 26. Members will be notified 30 days in advance of any change in coverage. To be eligible for a catastrophic health plan, you must be under 30 years of age when the plan begins or qualify for a hardship exemption through the federal government. 

The policy form number for Blue Value, Blue Local with Wake Forest Baptist Health, Blue Local with Atrium Health, and Blue Home with UNC Health Alliance is ACAPOS-I, 5/19. The policy form number for Blue Advantage is NGFPPO-I, 5/19. All plans may not be available in all geographic areas. This web page contains information only. It is not your insurance policy. Your policy and application are your contract. If there is any difference between this web page and the policy, the provisions of the policy will control.

Blue Cross NC has collaborated with Atrium Health to bring you Blue Local with Atrium Health. It is a health insurance plan offered by Blue Cross NC that provides access to Atrium Health’s limited network of providers. Atrium Health is an independent company and is solely responsible for the physicians and medical facilities it owns/operates and does not offer Blue Cross NC products or services.

Blue Cross NC has collaborated with Wake Forest Baptist Health to bring you Blue Local with Wake Forest Baptist Health. It is a health insurance plan offered by Blue Cross NC that provides access to Wake Forest Baptist Health’s limited network of providers. Wake Forest Baptist Health is an independent company and is solely responsible for the physicians and medical facilities it owns/operates and does not offer Blue Cross NC products or services.

Blue Cross NC has collaborated with UNC Health Care to bring you Blue Home with UNC Health Alliance. Blue Home with UNC Health Alliance is a health insurance plan offered by Blue Cross NC that provides access to a limited network of providers. UNC Health Care is an independent company that is solely responsible for the physicians and medical facilities it owns and operates. UNC Health Care does not offer Blue Cross or Blue Shield products or services.

Blue Cross NC offers several decision support tools, such as Find a Doctor, to aid members in making decisions around their health care experience. These tools are offered for member convenience and should be used only as reference tools. Members should consult their own legal counsel, tax advisor or personal physician as applicable throughout their health care experience.

The federal government determines eligibility and subsidy amount for health insurance plans purchased on the federally-facilitated Marketplace. Details can be found at HealthCare.gov.

  1. Preventive care services as defined by recent federal regulations are covered at no charge to you. Coverage for certain preventive care services (such as routine physical exams, well-baby and well-child care and immunizations) is limited to in-network benefits only. However, state-mandated preventive services are available out-of-network, for which members will pay deductible and coinsurance, plus charges over the allowed amount. Visit BlueCrossNC.com/Preventive for more details.
  2. Covered in more than 200 countries and territories worldwide through Blue Cross Blue Shield Global®Core. NOTE: Not all plans have statewide coverage and not all plans are available in all counties.
  3. Source: https://www.healthcare.gov/choose-a-plan/plans-categories/
  4. Telehealth benefits available to all plans either from Blue Cross NC or through the provider network. Blue Cross NC provides the telehealth program for your convenience and is not liable in any way for the goods or services received. Blue Cross NC reserves the right to discontinue or change the program at any time without prior notice. Decisions regarding your care should be made with the advice of a doctor. Depending on your plan, selected programs may not be available to you at this time. Check with Blue Cross NC Customer Service to determine your eligibility. Blue Cross NC has contracted with a third-party vendor independent from Blue Cross NC to bring you telehealth benefits.
  5. Blue Cross NC offers Health Line Blue and other wellness programs as a convenience to aid members in improving their health; results are not guaranteed. Blue Cross NC contracts with Optum, an independent third-party vendor, for the provision of certain aspects of our wellness programs and is not liable in any way for goods or services received from Optum. Optum does not offer Blue Cross or Blue Shield products or services. Blue Cross NC reserves the right to discontinue or change our wellness programs at any time. These programs are educational in nature. They are intended to help members make informed decisions about their health and comply with their doctor’s plan of care. Decisions regarding care should be made with the advice of a doctor.
  6. 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 your Blue Cross NC. Any disputes regarding these products and services may be subject to the Blue Cross NC grievance process. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. BCBSA does not recommend, endorse, warrant or guarantee any specific Blue365 vendor or item.
  7. Final determination of hardship eligibility for catastrophic health plans can only be obtained through the Health Insurance Marketplace at HealthCare.gov.
  8. Example plans shown are for illustrative purposes only and are subject to change based on personal circumstances.

U21561, 10/19