Health Insurance Overview
North Carolina residents now have more options than ever for health insurance coverage. With the recent Medicaid expansion, many previously uninsured adults can now get free or low-cost coverage. Others can find affordable plans through the federal marketplace at HealthCare.gov.
Medicaid in North Carolina
North Carolina expanded Medicaid in December 2023, extending coverage to adults ages 19-64 with income up to 138% of the federal poverty level. This historic expansion covers:
- Adults ages 19-64 with income up to about $20,120 (individual) or $41,400 (family of 4)
- Children under 19 with income up to 216% of poverty level
- Pregnant women with income up to 196% of poverty level
- Seniors and individuals with disabilities who meet criteria
Benefits of NC Medicaid
NC Medicaid provides comprehensive coverage including:
- Doctor and specialist visits
- Hospital care (inpatient and outpatient)
- Prescription drugs
- Mental health and substance abuse services
- Preventive care and screenings
- Maternity and newborn care
- Dental and vision (for some enrollees)
How to Apply for NC Medicaid
You can apply for North Carolina Medicaid through:
- Online: Apply at ePass (epass.nc.gov)
- Phone: Call 1-888-245-0179
- In Person: Visit your local Department of Social Services office
Health Insurance Marketplace
North Carolina uses the federal Health Insurance Marketplace at HealthCare.gov. If you don't qualify for Medicaid, you can find quality coverage with potential subsidies through the marketplace.
How to Enroll
- Visit HealthCare.gov
- Create an account and complete your application
- See if you qualify for Medicaid or subsidies
- Compare plans and select your coverage
- Pay your first premium to activate coverage
Average Costs and Subsidies
North Carolina residents can access significant financial help for marketplace coverage:
- Premium Tax Credits: Available for incomes 100-400% of poverty (and beyond with enhanced subsidies)
- Cost-Sharing Reductions: Lower deductibles and copays for Silver plan enrollees under 250% poverty
- Medicaid: Free or very low cost for those who qualify
Frequently Asked Questions
Did North Carolina expand Medicaid?
Yes! North Carolina expanded Medicaid in December 2023. This means adults ages 19-64 with income up to 138% of the federal poverty level (about $20,120 for an individual) can now qualify for Medicaid coverage. This expansion is expected to cover over 600,000 additional North Carolinians.
How do I apply for NC Medicaid?
You can apply for North Carolina Medicaid online at ePass (ncdhhs.gov/epass), by phone at 1-888-245-0179, or in person at your local Department of Social Services office. Applications are processed year-round with no enrollment period restrictions.
What is the income limit for Medicaid in North Carolina?
With Medicaid expansion, adults ages 19-64 can qualify with income up to 138% of the federal poverty level - approximately $20,120 for an individual or $41,400 for a family of four in 2024. Children qualify at higher income levels, and pregnant women qualify up to 196% of poverty.
When is open enrollment for health insurance in North Carolina?
Open enrollment for marketplace coverage at HealthCare.gov runs from November 1 to January 15 each year. Medicaid applications are accepted year-round. Special enrollment periods are available if you experience qualifying life events like job loss, marriage, or having a baby.
Need Help Finding Coverage in North Carolina?
Our licensed agents can help you navigate the new Medicaid expansion or find the best marketplace plan for your needs.
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