Individual Health Insurance

 

 

Healthcare Coverage That Meets Your Needs

Choosing the right health insurance coverage for you and your family is an important decision. We understand, and want you to feel confident in your choice.

As your local BlueCross BlueShield of North Carolina insurance agent we are happy to provide you with the knowledge and support that you need to find the insurance plan that is right for you.

 

Types of Affordable Care Act Plans

Affordable Care Act (ACA) health plans from BlueCross BlueShield of North Carolina 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. Plans vary based on how much of your medical costs that a plan will pay on average.

Offering three plan levels allows consumers to choose a plan with copayments, deductibles and coinsurance that meets their needs and budget.

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

Good for people who want protection from worst-case medical scenarios, like serious illness 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%

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


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

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.

What are Copayments, Deductibles and Coinsurance?

When shopping for your health plan, you’ll choose between two types: copayment plans and deductible/coinsurance plans. The plan you choose will affect how you’ll pay for care at the doctor, pharmacy or hospital.

Copayments

A fixed dollar amount that you pay for a covered service at the time you receive it. Plans with copays tend to be more expensive. But, you’ll know the cost of the visit before you go.

Example: Your plan charges a $20 copay for a regular doctor visit. This visit will only cost your $20 copay.


Deductibles

The amount you owe for covered health care before your health insurance company starts to pay.
Example: You have a plan with a $3,000 deductible.  You’ve paid $2,000 toward it, and just had an MRI that costs $1,500. You will pay $1000 to reach your deductible and a portion of the remaining $500 based on your coinsurance percentage.


Coinsurance

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 is split between you and the insurance company.

Example: You get a $100 bill for a chest X-ray and you have a 30% coinsurance amount, you’ll need to pay $30 and the insurance company will pay the rest.

Types of Health Insurance Subsidies

To help make health insurance more affordable, the federal government offers financial assistance, in the form of subsidies, to individuals and families who qualify based on income and household size.

There are two types of subsidies: Advanced Premium Tax Credit (APTC) and Cost Sharing Reductions (CSRs).

To qualify for a subsidy under the Affordable Care Act (ACA), 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)

Subsidy Calculator

1 – Source BlueCross BlueShield of North Carolina – Health Plans for Individuals and Families

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