The Cost of Health Insurance in North Carolina

How much does health insurance cost? This is a question we hear a lot.

If you are looking for an exact dollar amount, click here to get a quote for North Carolina health insurance. Otherwise, keep reading to learn how insurers determine the cost of health insurance, and why your health insurance more than pays for itself…

North Carolina health insurance is very similar to car insurance. It is a means of managing a risk. Just as you pay for car insurance to ensure your vehicle and protect yourself in the event of an accident, you also pay for health insurance to protect yourself in the event you become injured or ill.

In the past, the cost of health insurance was determined very similarly to car insurance, and things such as your medical history (i.e. driving record) were taken into account. Those with pre-existing conditions (i.e. accidents) in their record were seen as a higher risk and charged a higher premium than those without.

Thanks to The Affordable Care Act, today, pre-existing conditions are no longer factored into the cost of health insurance in North Carolina or any other state in the U.S.

For consumers, obtaining North Carolina health insurance is a means of managing financial risk – the risk that you will face unaffordable expenses for medical care in the event of an injury, illness or medical emergency. For insurers, the cost of health insurance is also determined based on financial risk – the risk that they will pay out more in medical expenses than they have received in consumer payments (i.e. premiums).

Just as with car insurance, the cost of health insurance will be determined by the level of coverage you desire. In other words, how much financial risk you would like to mitigate for yourself and pass on to the insurer. Insurance plans where you are asking the insurer to help cover the lowest percentage of medical expenses (take on the least amount of risk) will have the lowest costs.

Below are four potential financial risks that you should consider when looking at the cost of health insurance plans. In most cases, the cost of health insurance is much less expensive than the cost of going without it!

Risk #1:  A Doctor Visit or Specialist Visit

A visit to a primary care physician can cost several hundred dollars. A referral to a specialist can cost several hundred dollars more. If you have a health insurance plan that covers doctor or specialist visits, the cost of the plan could more than pay for itself in the savings you will see.

Most low-cost North Carolina health insurance plans will not cover any percentage of the cost of a doctor visit, or visit to a specialist, until after the full deductible has been met. This is the trade-off for having a lower monthly premium. Plans with moderate-to-high premiums (that cost a bit more) will pay for the majority of the expense of a doctor visit, with the consumer required to pay a small, predictable co pay.

Risk #2: Expensive Prescription Medicines

If you have an illness, you will likely receive a prescription for medication. Some specialty drugs can cost upwards of hundreds of dollars to fill, and multiple prescriptions only compound this expense.

As with doctor visits, most low-cost North Carolina health insurance plans will not cover any percentage of the cost of a prescription until after your deductible has been met. Plans with moderate-to-high premiums (that cost a bit more) will either set a low-level cap on the amount you must pay out-of-pocket before coverage begins (i.e. $200), establish a small co pay (i.e. $10 for generic, $25 for name brand), or else pay the entire cost of the medication. The greater the cost you are asking the insurance carrier to cover, the more expensive the premium will be.

Risk #3: The Need for an Emergency Room Visit or Hospital Stay

A visit to the ER or hospital is extremely costly, especially if you are admitted and stay overnight. The best way of managing this risk is by selecting a plan with a low deductible. A deductible is the amount of money you will be responsible for paying before your insurer begins covering a percentage of your medical expenses. Just one hospital stay can easily eat-up your deductible. An extended hospital stay can also exhaust your out-of-pocket maximum expense limit, requiring the insurer to begin covering 100% of all additional medical expenses for the remainder of your stay, and the rest of the insured year.

If you don’t have insurance, there is no limit on the amount you will have to pay out-of-pocket, and you will be responsible for 100% of all charges for the hospital visit, and any follow-up doctor, specialist or other medical expenses thereafter.

North Carolina health insurance plans with the lowest premiums will have the highest deductibles, meaning you will take on more of the expense of your medical care before your insurance provider helps pay. If you want to mitigate your potential expenses, especially if you have received costly medical care in the past, it may make sense to pay a higher premium and get a much lower deductible.

Risk #4:  A Major Illness or Injury

Heart surgery, cancer, or rehabilitation therapy can lead to tens-of-thousands of dollars in medical bills. A major illness or injury cannot be anticipated – but you can protect yourself.

All health insurance plans have an out-of-pocket maximum. Anything beyond this maximum, and the insurance company will pay for 100% of covered medical costs with no set limit on the dollar amount. Without health insurance, you could easily find yourself struggling to pay thousands of dollars in medical bills.

North Carolina health insurance plans are available through the WNC Health Insurance/The Asheville Blue Cross and Blue Shield of North Carolina® Store. We offer coverage throughout all of North Carolina. Call or visit us today to talk to one of our licensed agents about the cost of health insurance plans in North Carolina, and to receive assistance in selecting a plan that best fits your budget.