Oscar Bronze Classic Pcp Copay

1. Oscar Bronze Classic Next 2 Deductible: None; Oscar Bronze Classic PCP Copay Deductible: $6,000; Oscar Bronze HDHP Deductible: $5,200; State Resource Guides.
2. Oscar Bronze Classic Deductible: $6,000; Oscar Bronze Classic Next Deductible: None; Oscar Bronze Classic Next 2 Deductible: None; Oscar Bronze Classic PCP Copay Deductible: $6,000; Oscar Bronze HDHP Deductible: $5,200; State Resource Guides. California Health Insurance; Texas Health Insurance; Florida Health Insurance; Illinois Health Insurance.

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There are many types of Pennsylvania health insurance plans. “Catastrophic” and “HSA” plans will tend to be the least expensive options, but feature high out-of-pocket costs to the insured. “Comprehensive” plans offer lower out-of-pocket costs on the most common claims, but are the costliest type of coverage.

For families, typically, this is a very popular type of policy, and similar to employer-sponsored plans. Large unexpected medical bills can be easily covered, along with smaller day-to-day items such as physician visits for common colds, the flu, stomach viruses, and other non-serious conditions. HMO, PPO, EPO, and POS contracts are available for enrollment. Utilizing the provider network can easily save thousands of dollars of out-of-pocket medical expenses.

ER and Urgent Care claims are often covered by copays instead of a large deductible. Telemedicine visits have become very popular because of the 24/7 availability, ease of use, and low cost. Many carriers offer $0 copay for virtual and telemedicine visits. Medical advice can be received at your home, office, or another location. Prescription drugs can also be quickly prescribed. Often, after hours, Urgent Care facilities are not open and telemedicine visits are the best option. More serious diagnosis, such as COVID and other epidemics, typically require a face-to-face visit.

Pa comprehensive health insurance covers the standard inpatient major medical items such as room/board, intensive care, recovery and operating room, prescriptions, ambulance, and professional fees of doctors, surgeons and nurses. Outpatient expense benefits include facility/hospital fees for outpatient surgery, surgeon fees, emergency room fees, some mental and nervous disorders and X-ray and lab fees performed at network facilities. Service provided at non-network facilities is usually covered, but at a lower level.

Traditionally, office visits (primary care and specialist) and prescriptions (generic and non-generic) are included expenses although a copay is certain to apply. In Bronze-tier plans, a higher copay ($25-$50) is fairly customary, while Silver, Gold, and Platinum plans often feature copays of $10-$35. Specialist visit copays are much higher, and can reach $80-$150, depending on the policy and Metal-tier. Often, specialist visits may be subject to a deductible, coinsurance, or both. Limits to the number of covered non-deductible visits may also apply.

Mandated Preventative Expenses Have No Deductible Or Copay To Meet

Qualified wellness and preventive costs are covered at 100%, so there are no out-of-pocket expenses for those items. There are no waiting periods or co-payments, and benefits extend to children and teenagers. These enhancements were part of “The Affordable Care Act” legislation and are expected to remain, regardless of any potential Congressional change. Group plans through employers also provide free preventative benefits, with active wellness departments available to assist employees. Many employers provide financial incentives to their employees to take advantage of wellness perks.

Several specific Pennsylvania wellness/preventative coverages include mammograms, pap smears, PSA screenings, child immunizations and annual physicals. As you get older, additional treatments will be covered and the Department of Health and Human Services will periodically update and add new benefits. In recent years, many diagnostic tests and screenings have been added, and the list has become quite extensive.

Many covered women’s expenses have also been added. Some of the most utilized examples are anemia and cervical cancer screening, contraception, domestic violence counseling, breastfeeding information and counseling, sexually-transmitted disease counseling, and smoking-cessation interventions.

The Pa Insurance Exchange/ Marketplace (Pennie) may also make changes. One of the more controversial issues is the inclusion (or lack of inclusion) of federal/state funds paying for expenses related to abortion. Currently, the Exchange does not approve of those types of expenses. It is also not expected that any future legislation will attempt to challenge the status quo. Private plans also do not cover the cost of abortions or any related expenses. Note: Senior Pa HMO Medicare plans provide very extensive benefits. Many carriers offer Medigap plans in the Keystone State.

Companies That Offer Comprehensive Benefits

Many major Pennsylvania medical insurance companies offer policies that are benefit-rich and the list is quite extensive. Aetna, UnitedHealthcare (UHC), Independence Blue Cross, Keystone, Capital Blue Cross, Highmark, UPMC, Oscar, Ambetter, and Geisinger offer extremely competitive rates for their private or Group plans. This type of coverage is typically available in either a PPO (Preferred Provider Organization) or an HMO (Health Maintenance Organization). With a PPO, you can see any doctor or visit any hospital within the preferred network of providers. “Out of Network” providers will pay smaller benefits. Note: Financial subsidies are not offered on employer-provided plans.

Primary Care Physician Copays (PPC)

Listed below are the office visit (primary care physician) copays for Pa private non-Group plans. Specialist visits are also covered, although a higher copay and a deductible may apply. Plans not listed do not have a pcp office visit copay, or are HSA-eligible.

$10 – UPMC Advantage Gold $1,000/$10

$10 – Geisinger Marketplace Extra HMO 10/50/500

$10 – Geisinger Marketplace Extra HMO 10/50/4500

$15 – Ambetter Secure Care 5

$15 – Highmark my Direct Blue EPO Gold 800

$15 – Highmark my Blue Access EPO Gold 800

$15 – Keystone HMO Gold Proactive

$20 – Independence Blue Cross Personal Choice EPO Bronze Basic

$20 – Independence Blue Cross Personal Choice EPO Gold

$20 – Geisinger Marketplace All-Access HMO 20/40/1000

$20 – Highmark my Direct Blue EPO Gold 0

$20 – Capital Blue Cross Gold PPO 2150/10/20

$25 – UPMC Advantage Silver $3,500/$25

$25 – Capital Blue Cross Gold Simple PPO 0/0/25

$25 – Ambetter Secure Care 15

$25 – Ambetter Balanced Care 26

$25 – Oscar Silver Classic $0 Ded

$30 – Geisinger Marketplace All-Access HMO 30/60/4650

$30 – Geisinger Marketplace All-Access PPO 30/60/4650

$30 – Oscar Gold Classic

$30 – Oscar Silver Classic Next

$30 – Oscar Silver Classic Copay

$30 – Independence Blue Cross Personal Choice PPO Silver

$30 – Independence Blue Cross

$30 – Ambetter Balanced Care 11

$35 – Oscar Bronze Classic Next

$35 – Ambetter Balanced Care 12

$35 – Keystone HMO Gold

$40 – Capital Blue Cross Silver PPO 6000/20/40

$40 – Geisinger Marketplace All-Access HMO 40/80/8400

$40 – Geisinger Marketplace All-Access PPO 40/80/8400

$40 – Ambetter Balanced Care 24

$40 – Oscar Silver Saver 2

$40 – Keystone HMO Silver Proactive

$50 – Independence Blue Cross Personal Choice PPO Bronze

$50 – Keystone HMO Silver Proactive Lite

$50 – Capital Blue Cross Bronze PPO 8000/0/50

$50 – Highmark my Direct Blue EPO Silver 2900

$50 – Highmark my Blue Access EPO Silver 2900

$50 – Oscar Bronze Classic

$50 – Oscar Bronze Classic PCP Copay

$50 – Oscar Silver Classic

$50 – Ambetter Balanced Care 28

$60 – Highmark my Direct Blue EPO Bronze 3800

$60 – Highmark my Blue Access EPO Bronze 3800

Older Grandfathered Plans

An HMO may provide a broader coverage, but with smaller Network availability. HMOs also offer maternity protection on grandfathered plans, while older PPO plans often excluded that coverage. If you have an existing policy and are not happy with the network or provided benefits, you can sign up for a different plan during Open Enrollment (November and December). If maternity benefits are needed, all qualified policies offer immediate coverage, although out-of-pocket expenses will vary. Cesarean Sections and complications of delivery expenses are covered, subject to applicable deductibles, coinsurance, and copays.

Some of the most popular policies that are no longer available include HealthAmerica’s Copay 100% plan, Aetna’s HMO 20 and HMO 30 plans, UnitedHealthOne’s Copay Select plan, Capital Blue Cross’ Personal Blue plan and Blue Cross’ Keystone Health Plan East HMO. Of course, there are other comprehensive plans that may be your best option, depending on your specific situation. Pittsburgh health insurance is well represented by Highmark and UPMC, while Geisinger and Capital Blue Cross have several popular options in the middle of the state. Independence Blue Cross features many comprehensive plans for residents in the Philadelphia area.

Aetna, Celtic and UHC also offered discounted comprehensive coverage from 2009-2013 that covered a specific number of office visits. Premiums were reduced about 25% and these policies were always considered if they were available in your area. UHC and Aetna have developed updated compliant plans (not in Pa) while Celtic does not offer a viable option in the state. However, they continue to market plans through “Ambetter” in many other states.

We often compare the specifics of these types of plans to other types of coverage. The UHC “Copay Value” and Aetna “Value” plans were very popular options, but are also no longer offered. For persons that were uninsured, these types of policies were budget-oriented regardless of your age. You sacrificed some office visits, but your premium also reduced. Unitedhealthcare offers private short-term plans, while Aetna offers an extensive portfolio of Group and Senior products.

Which Types Of Coverage Are Not Comprehensive?

Temporary Plans – Short-term policies are very cheap, and are available at any time throughout the year, regardless of Open Enrollment periods. Approval often takes less than 24 hours and there is no waiting period of benefits to begin. However, preventative benefits are generally not included or must meet a deductible. Office visits and prescriptions, if included, may require a higher premium. An annual cap applies to the payout of medical expenses ($250,000-$2 million), and policies are not always guaranteed to be renewed, which can cause a large gap in coverage.

Limited Benefit Plans – Very limited and restrictive benefits with per-claim caps that result in large out-of-pocket expenses. For example, surgeries, length of hospital stay, and types of office visits may be subject to special guidelines, instead of unlimited coverage. Often, a stated number of dollars is paid for hospital stays or operations, although the amount will not cover all expenses. Depending on the policy, the amount may only cover 25%-50% of the expenses.

Accidental Plans – Although coverage for accidental injury to all family members is the primary benefit, additional benefits are limited or missing. This type of plan is often utilized as a supplement to other policies. Universities also frequently offer accidental coverage that is packaged with other contracts. However, benefits for sickness and chronic disease are not included. Many credit cards also offer free accidental death and dismemberment benefits.

Supplemental Plans – As the name suggests, this type of coverage is not designed to be your primary coverage, since benefits are very specific and limited. However, a supplemental plan can be very effective by filling in gaps of out-of-pocket costs, or providing extra income during a major hospital confinement. Plans can also be purchased without any other underlying coverage.

What About Low-Cost Policies Now?

Bronze-tier plans are the least-expensive options, but still provide all-inclusive benefits that you need, such as inpatient and outpatient hospital treatment. Maternity and mental illness are also covered, since they are a required mandated benefit. However, deductibles are higher, and large hospital bills are likely to result in the highest out-of-pocket expenses. Household that qualify for a larger federal subsidy, should strongly consider Silver-tier plan choices. When “cost-sharing” is applied, deductibles and out-of-pocket expenses can drastically reduce.

If you don’t have any dependents (or you have older dependents), and there are no existing medical issues, an HSA or a high-deductible policy may be worth your consideration. Each year, deductibles and maximum out-of-pocket expenses change, so during Open Enrollment, comparing all plan options is required. New carriers may enter the Marketplace with plans that feature lower rates in your area. Also, physicians and hospitals within proximity may become available with the introduction of new or expanded networks.

Monthly Rates For Selected Pa Comprehensive Medical Plans

Prices assume a family of five (45-year-old husband and wife with three children) with household income of $98,000

Sullivan, Wyoming, Susquehanna, and Bradford Counties

$352 – Ambetter Essential Care 1

$356 – Geisinger Marketplace All-Access HMO 40/80/8400

$379 – Ambetter Essential Care 10

$392 – Ambetter Essential Care 2

Philadelphia, Delaware, Bucks, and Montgomery Counties

$302 – Ambetter Essential Care 1

$331 – Ambetter Essential Care 10

$346 – Ambetter Essential Care 2

$397 – Independence Blue Cross Personal Choice EPO Bronze Basic

We take the time to review the advantages and disadvantages of that type of coverage, and what specific impact it has on your situation. We can also teach you what benefits are important when you are shopping for a new policy. To quickly request a free quote, please enter your zip code in the quote portion at the top of the page. Within minutes, you can review the best medical benefits available to residents of the Keystone State. Comprehensive healthcare plans in Pennsylvania are much easier to find compared to five years ago. And for many persons, they’re now also cheaper!

The North Carolina Health Insurance Marketplace allows consumers to purchase quality individual, family and small business medical coverage at affordable rates. Pre-existing conditions are covered without any waiting periods or surcharges, and applications for 2021 policies can not be turned down for past or present medical conditions. There are many NC subsidized plans that allow you to obtain comprehensive or catastrophic benefits. HSAs, student, small-business, and self-employed coverage is also offered.

Both 'on' and 'off' Exchange policies can be reviewed and applied for. You are not obligated to enroll in a federally-subsidized plan. If you have reached age 65, a separate Senior Open Enrollment allows you to compare (and enroll) Many available Medigap plan options. Medicare Supplement and Advantage policies can reduce out-of-pocket expenses that original Medicare does not pay for. Part D prescription drug coverage is also included in many Advantage plans, and also available separately. Many additional costs can be covered, although you must be enrolled in Parts A and B to apply for a supplementary policy.

The Obamacare federal subsidy provides savings of thousands of dollars every year to NC residents that qualify. The Affordable Care Act (ACA) has added 10 'essential benefits' that are included on all policies. However, it is possible to qualify for a 'catastrophic' policy, that will place a deductible on most non-preventative benefits, and thus, make available very basic cheap North Carolina healthcare. NOTE: Catastrophic plans are offered to applicants under age 30, or any person that can show 'financial hardship.' However, since these plans are ineligible for instant tax-credit subsidies, often 'Bronze-Tier' plans cost less, and provide richer benefits.

For example, A 25 year-old applicant in Charlotte (Mecklenburg County) that makes $27,000 per year, can enroll in the Bright Health Bronze 8550 for $58 per month, or the BCBS of NC Blue Home Bronze 8550 ($72 per month). Although a 'catastrophic' plan is available, the price is substantially higher. The BCBS of NC Blue Home Catastrophic plan costs $180 per month since it is not eligible for a federal subsidy. The Bright Catastrophic 3 plan costs $160 per month. There is often a difference in specialist and Urgent Care copays that also must be considered.

Blue Cross and Blue Shield of NC offers a Silver-tier plan (Blue Home Silver Enhanced 4000) with a limited provider network, for $192 per month. The primary-care physician (pcp) office visit copay is $10 while the specialist office visit copay is $50. Generic drugs are also subject to only a $10 copay (after deductible is met). The Urgent Care copay is $50. The Tier 2 drug copay is $25 although the deductible also must be met. Tier 3 and Tier 4 drug copays are $40 and $80, and also subject to the deductible.

'Free Coverage'

Thousands of thousands of residents currently qualify for 'free' coverage either through meeting Medicaid income guidelines, or qualifying for maximum subsidies that pay all of the premium. State workers and retirees can also expect some help, despite occasional delays in sending their ID cards. Since the financial aid is based on income, retired persons can often qualify for significant amounts of assistance, despite large amounts of assets. However, the determination also must consider the age of the applicant, and how many dependents are in the household.

If you are age 65 or older, or Medicare-eligible, you might still qualify fr assistance. If you are blind or disabled, or needing long-term care, you may also qualify for Medicaid benefits. However, all applicants must be residents of the state and prove residency. A valid social security number is also required (or in the process of applying) and you must be a US citizen. Any applicant is automatically eligible if they receive work first cash assistance, supplemental security income (SSI), or assistance for the aged or disabled.

A 'gap' still exists for many young low-income residents that make too much money to qualify for Medicaid (Division Of Medical Assistance) but not enough money to qualify for federal subsidies to help pay the premium. More than 200,000 persons between 18-34 fall into this category. It is expected that future legislation will address this issue and provide a low-cost alternative. Federal subsidies are based on projected household income for the upcoming year, which can often help unemployed individuals, or persons that are laid off and actively seeking employment. It is possible that future Trump Administration initiatives may provide several new medical plan options.

How To View Rates

We make it easy for you. Of course, the quotes we provide are always free with no obligation. We created a section in the top portion of every page that allows you to enter your current zip code. Instantly, you can view the best options in your area and request to view live prices. There are 16 'rating' areas in the state and you can view prices in all counties. If you move from one county to another, it's important to verify that your doctors, specialists or hospitals remain inside the provider network. If you move to nearby South Carolina, Virginia, or any other state, you will need to re-enroll, since plans, prices, and networks will be different.

NC Companies Offering Marketplace Plans

The 'Marketplace' is another name for the 'Exchange.' The participating carriers for on-Exchange coverage are Blue Cross and Blue Shield of NC, Ambetter (Durham and Wake Counties), Bright Health (Charlotte and Winston-Salem areas), Oscar (Asheville area), UnitedHealthcare (rating areas 2, 7, 9, 13, and parts of rating areas 1, 11, and 15), and Cigna (Chatham, Orange, Nash, and Johnston Counties). Federated Mutual, Aetna, National Foundation Life, and First Carolina Health Care no longer participate. Previously, First Carolina would have provided plans in Lee, Richmond, Scotland, Montgomery, Hoke and Moore counties. They now offer Small Group benefits.

UnitedHealthcare previously declined to offer 'on-Exchange' plans, although many of their products are available as Group or ancillary plans. Their short-term plans, marketed under the trade name 'Golden Rule,' remain very popular. Temporary coverage in NC is available for up to 364 days, and may be renewed for up to three years. ST plans provide an inexpensive option to secure benefits quickly, and cover multiple family members outside of the OE period.

BCBS policies are available in all 100 counties in the state. It is hoped that additional companies will also become available in the future, although the Affordable Care Act legislation will have to be tweaked. Currently, there are many NC counties where only one insurer offers plans. The NC Dept. Of Insurance publishes the names of any new carriers that will enter the Marketplace next year. Nationally, UnitedHealthcare, Aetna, and Humana have drastically reduced the number of states they offer 'on-Exchange' plans. If future Trump Administration options become available, we will provide rates and reviews.

Previously, Carolinas Healthcare System and BCBS jointly offered coverage under the trade name Blue Local. And UnitedHealthcare (UHC), although not currently offering Exchange plans, is one of the largest companies in the US, and already has a large market share for plans issued outside of the Marketplace. UHC also underwrites an extremely competitive short-term plan that provides cheap medical coverage for consumers needing temporary benefits that can be quickly implemented. Often, applications are approved within 24 hours, especially for indemnity plans.

NOTE: Several carriers are licensed to offer products in the state but are not authorized to issue Marketplace plans. Some of these plans may include short-term, limited benefit, or critical-illness contracts. Also, carriers often offer small and large group employer coverage, but not private Exchange policies. The companies are: Aetna, Humana, All Savers, National Foundation Life, Federated Mutual, and FirstCarolinaCare. When you secure benefits through an employer, you are not eligible for federal subsidies to help you pay the premium. However, often, Group policy premiums are partially paid by the employer. When you retire, typically, you can keep these plans, although the premium may change. Also, some ancillary benefits may not be offered, although they can be purchased privately.

Current Rates

For quoting purposes, our first sample household is a husband and wife (both age 50) with two teenage children. They live in the Raleigh area (Wake County) and the household income is $55,000. The federal subsidy tax credit has automatically been applied to all premiums. Deductibles are typically 'per person' with a maximum of two per family. Silver-tier plans include cost-savings adjusted lower deductibles and out-of-pocket expenses. Rates for plans shown below are monthly:

Family Of Four -- Ages 50, 50, 18, and 16 With $70,000 Income Living In Raleigh (Wake County)

$0 -- Bright Health Bronze $0 Primary Care -- Pcp copays are $0. Deductible is $7,200, and maximum out-of-pocket expenses are $8,550 with 50% coinsurance.

$0 -- BCBS Of NC Blue Home Bronze 8550 -- The federal subsidy exceeds the cost of the policy, so the premium is reduced to $0. Deductible is $8,550, and maximum out-of-pocket expenses are $8,550 with 0% coinsurance.

$0 -- Bright Health Bronze 8550 -- The federal subsidy exceeds the cost of the policy, so the premium is reduced to $0. Deductible is $8,550, and maximum out-of-pocket expenses are $8,550 with 0% coinsurance. $25 pcp office visit copay for first two visits and $50 Urgent Care copay (deductible applies).

$103 -- Ambetter Essential Care 1 -- Deductible is $8,300, and maximum out-of-pocket expenses are $8,300 with 0% coinsurance. Generic drug copay is $25.

$121 -- BCBS Of NC Blue Home Bronze 7550 -- Deductible is $7,550, and maximum out-of-pocket expenses are $8,550 with 50% coinsurance. Pcp and specialist office visit copays are $60 and $120. Urgent Care copay is $120. Tiers 1, 2, 3, and 4 copays (after the deductible) are $10, $25, $40, and $80.

$128 -- Bright Health Bronze $0 Medical Deductible -- Pcp and specialist office visit copays are $50 and $100. Urgent Care copay is $50. Deductible is $0, and maximum out-of-pocket expenses are $8,550 with 50% coinsurance.

Single 35 Year-Old Male Or Female With Income Of $30,000 Living In Raleigh (Wake County)

$77 -- Bright Health Bronze 8550 -- $25 copay for first two pcp office visits. $25 generic drug copay. Deductible is $8,550, and maximum out-of-pocket expenses are $8,550 with 0% coinsurance.

$82 -- BCBS Of NC Blue Home Bronze 8550 -- Deductible is $8,550, and maximum out-of-pocket expenses are $8,550 with 0% coinsurance.

$89 -- Bright Health Bronze $0 Primary Care -- Pcp office visit copay is $0. Urgent Care copay is $50. Deductible is $7,200, and maximum out-of-pocket expenses are $8,550 with 50% coinsurance. $25 generic drug copay.

$92 -- BCBS Of NC Blue Home Bronze 7000 -- Deductible is $7,000, and maximum out-of-pocket expenses are $7,000 with 0% coinsurance. HSA-eligible.

$112 -- Ambetter Essential Care 1 -- Deductible is $8,300, and maximum out-of-pocket expenses are $8,300 with 0% coinsurance. $25 generic drug copay.

$117 -- BCBS of NC Blue Home Bronze 7550 -- $60 and $120 office visit copays with $120 Urgent Care copay. Deductible is $7,550, and maximum out-of-pocket expenses are $8,550 with 50% coinsurance. Tier 1, Tier 2, Tier 3, and Tier 4 drug copays (after deductible) are $10, $25, $40, and $80.

Family Of Three -- Ages 45, 45, and 18 With $55,000 Income Living In Charlotte (Mecklenburg County)

$15 -- Bright Health Bronze 8550 -- $25 copay for first two pcp office visits. $25 generic drug copay. Deductible is $8,550, and maximum out-of-pocket expenses are $8,550 with 0% coinsurance.

$48 -- Bright Health Bronze 6400 -- $25 copay for pcp office visits. $25 generic drug copay. $50 Urgent Care copay. Deductible is $6,400, and maximum out-of-pocket expenses are $8,550 with 40% coinsurance.

$52 -- Bright Health Bronze $0 Primary Care -- Pcp office visit copay is $0. Urgent Care copay is $50. Deductible is $7,200, and maximum out-of-pocket expenses are $8,550 with 50% coinsurance. $25 generic drug copay.

$69 -- BCBS Of NC Blue Home Bronze 8550 -- Deductible is $8,550, and maximum out-of-pocket expenses are $8,550 with 0% coinsurance.

$100 -- BCBS Of NC Blue Home Bronze 7000 -- Deductible is $7,000, and maximum out-of-pocket expenses are $7,000 with 0% coinsurance. HSA-eligible.

$142 -- Bright Health Bronze $0 Medical Deductible -- Pcp and specialist office visit copays are $50 and $100. Urgent Care copay is $50. Deductible is $0, and maximum out-of-pocket expenses are $8,550 with 50% coinsurance.

Can I Pay Monthly And Send Premiums In Mail?

Yes, you can. Although many policies had to be paid via electronic withdraw in previous years, direct monthly billing is available. Checks, debit cards and EFT are also accepted for the first payment and subsequent ongoing payments. You may change your billing mode with a simple request, although it's best to allow your broker or carrier to handle the paperwork. A grace period is also provided with all 2021 plans. However, once a plan has officially lapsed, if reinstatement is not offered by the carrier, similar coverage may not be available until the next Open Enrollment period.

Which Parts Of The State Have The Least Expensive Prices?

BCBS Of North Carolina Offers Healthcare In All Counties

As earlier mentioned, there are 16 'rating areas' that include all 39 counties. Two territories with some of the cheapest prices are rating areas 11 and 13. They consist of the following counties: Alamance, Person, Orange, Lee Durham, Chatham, Caswell, Franklin, Johnston and Wake.

Rating areas 3 and 16 feature some of the highest premiums. They consist of the following counties: Allegheny, Ashe, Watauga, Wilkes, Beaufort, Carteret, Craven, Dare, Hyde, Jones, Lenoir, Pamlico, Tyrell and Washington. The number of counties in each rating area will also vary. For example, in rating area 7 (Greensboro), the only included counties are Guilford, Randolph, and Rockingham. However, rating area 1 (Asheville) includes 17 counties and rating area 12 includes 11 counties. Rating area 4 (Charlotte) includes the following counties: Anson, Cabarrus, Mecklenburg, Rowan, Stanly, and Union. Durham, (and the county) the fourth largest NC city, is located in Rating area 11, along with the following counties: Alamance, Caswell, Chatham, Lee, Orange, and Person.

Perhaps the principal reason for higher prices in those areas is actual cost of medical care, including office visits, cost of hospital room and board, procedures, treatment and overall facility charges. The lack of competition may also be contributing to the rate disparity. Also, in areas where free preventive benefits are not highly utilized, often prices are higher. Whether it is being uninsured, or lack of knowledge that compliant plans cover routine physicals, mammograms and OBGYN visits, many rural parts of the state don't take advantage of many free services.

What Are The Four Categories Of Plans That Are Available?

Exchange policies are divided into four groups that are based on their 'cost-sharing.' This is the anticipated out-of-pocket expenses consumers will pay for their healthcare. The four categories are Platinum, Gold, Silver and Bronze. The expenses include deductibles, copays and coinsurance. Regardless of your income, you can freely change from one tier to another each year. You may also change carriers.

Platinum plans are the most expensive, since their cost-sharing ratio is only 10%. However, the Bronze plans have a cost-sharing ratio of 40%, and thus, their premiums are typically the lowest of all available policies. There is also an additional 'catastrophic' option for persons under age 30 and other applicants that meet specific low-income financial guidelines.

However, since catastrophic options are not eligible for federal subsidies, often, Bronze-tier plans are much more cost-effective. For example, consider a 25 year-old with $27,000 of income, that resides in the Raleigh area (Zip code 27601 in Wake County). Shown below are monthly rates, with the federal subsidy reduction already included. It's quite evident that in this scenario, a catastrophic contract is not cost-effective.

$59 -- Bright Health Bronze 8550
$63 -- BCBS of NC Blue Home Bronze 8550
$69 -- Bright Health Bronze $0 Primary Care
$72 -- BCBS Of NC Blue Home Bronze 7000
$89 -- Ambetter Essential Care 1
$92 -- BCBS of NC Blue Home Bronze 7550
$161 -- Bright Health Catastrophic 3 $0 PCP Visits

Silver-tier plans are often the most cost-effective options of all Metal policies. Unique 'cost-sharing' specifically helps lower and moderate income households (less than 250% of the Federal Poverty Level guidelines) by reducing deductibles, copays, and coinsurance. Thus, instead of these plans paying an expected 70% of all medical expenses, often it is as much as 94%, if the FPL ratio is between 150% and 200%.

What NC Policies Can Be Purchased On The Exchange?

Although options vary, depending on your county of residence and other factors, the cheapest available plans are:

Catastrophic Tier

BCBS of NC Blue Local Catastrophic

BCBS of NC Blue Home Catastrophic

BCBS of NC Blue Advantage Catastrophic

Bright Health Catastrophic 3 $0 PCP Visits

Bronze Tier

BCBS of NC Blue Home Bronze 8550

BCBS of NC Blue Home Bronze 7000

BCBS of NC Blue Home Bronze 7550

Ambetter Essential Care 1

Ambetter Essential Care 10

Cigna Connect 8550

Bright Health Bronze 8550

Bright Health Bronze 6400

UnitedHealthcare Balance Bronze 3 Free Visits

Oscar Bronze Classic

Oscar Bronze Classic PCP Copay

Silver Tier

BCBS of NC Blue Home Silver 6300

BCBS of NC Blue Home Silver 4000

BCBS of NC Blue Value Silver 6300

BCBS of NC Blue Value Silver 4000

Bright Silver 5000

Bright Silver $0 Primary Care

Bright Silver 3000

Ambetter Balanced Care 29

Ambetter Balanced Care 12

Ambetter Balanced Care 11

Oscar Bronze Classic Pcp Copay Online

Ambetter Balanced Care 25

Cigna Connect 5500

Cigna Connect 3500

UnitedHealthcare Balance Plus Silver 3 Free Visits

Oscar Bronze Classic

Oscar Bronze Classic PCP Copay

Gold Tier

BCBS of NC Blue Advantage Gold 2500

Ambetter Secure Care 5

Cigna Connect 2000

Bright Gold 2500

Oscar Gold Classic

UnitedHealthcare Balance Gold 3 Free Visits

Platinum Tier

No plans offered

HSA Options

If you currently have an existing non-Marketplace HSA (Health Savings Account), unless you have been notified otherwise, it is probably a 'grandfathered' plan or a policy purchased four years ago. Therefore, you can keep the policy along with the separate side account that you make qualified deposits into. Although specific benefits such as maternity may not be covered (grandfathered plans only), these plans are allowed to be kept in force. Group HSA contracts are also quite popular, although they are required to meet all ACA Legislation mandates. Once you become eligible for Medicare, although deposits are no longer allowed, accumulated funds can be used to pay for qualified expenses.

None of the provisions of the contract will be changed, although each year, new maximum deposit limits may be established. How to get the best HSA plans and other related topics are covered by us through a separate article. This type of plan helps you organize and take charge of your personal medical treatment. The maximum allowed contribution is $3,500 per person, and $7,000 per family. The $1,000 catch-up option remains the same. Minimum deductibles are $1,350 per person, and $2,700 per family. The maximum out-of-pocket expenses are $6,750 per person, and $13,500 per family. We have listed the available NC HSA-eligible plans below:

BCBS Blue Home Bronze 7000

Bright Bronze 7000 HSA

Ambetter Essential Care 2 HSA

Ambetter Balanced Care 25 HSA

Oscar Bronze HDHP

NC Short-Term Health Insurance

Temporary coverage is very inexpensive, and offered by many carriers, including UnitedHealthcare, National General, Companion Life, Everest, and Independence American. Plans do not meet all ACA guidelines and are not eligible for federal subsidies. However, these types of temporary policies are popular for applicants that missed Open enrollment or want a more affordable healthcare option. Several examples are listed below. Rates shown are monthly.

40-Year-Old Male (Mecklenburg County)

$87 -- $10,000 deductible and $1 million maximum benefits (Everest)
$89 -- $10,000 deductible and $2 million maximum benefits (UnitedHealthcare)
$105 -- $5,000 deductible and $1 million maximum benefits (Companion Life)
$123 -- $2,500 deductible and $1 million maximum benefits (Everest)
$137 -- $2,500 deductible and $2 million maximum benefits (UnitedHealthcare)

50-Year-Old Female (Wake County)

$132 -- $10,000 deductible and $2 million maximum benefits (UnitedHealthcare)
$162 -- $5,000 deductible and $2 million maximum benefits (UnitedHealthcare)
$164 -- $5,000 deductible and $1 million maximum benefits (Companion Life)
$203 -- $2,500 deductible and $2 million maximum benefits (UnitedHealthcare)
$250 -- $2,500 deductible and $1 million maximum benefits (Everest)

50-Year-Old Married Couple (Wake County)

$224 -- $10,000 deductible and $2 million maximum benefits (UnitedHealthcare)
$276 -- $5,000 deductible and $2 million maximum benefits (UnitedHealthcare)
$297 -- $5,000 deductible and $1 million maximum benefits (Companion Life)
$344 -- $2,500 deductible and $2 million maximum benefits (UnitedHealthcare)
$501 -- $2,500 deductible and $1 million maximum benefits (Everest)

Senior Medigap Health Insurance Coverage In North Carolina

For residents that have reached age 65 and are Medicare-eligible, many Medigap plans are offered by highly-rated companies. Medicare Supplement options along with Advantage plans (that replace original Medicare benefits) help pay many of the out-of-pocket expenses that otherwise may not be covered. Part D prescription drug plans can also be purchased, although many Advantage contracts include these benefits. Supplement plans are standardized, while Advantage contracts often differ in out-of-pocket maximums, deductibles, office visit copays, and level of prescription, dental, and vision coverage.

NOTE: The Open Enrollment period for existing customers (October 15th to December 7th) is different than the OE period for applicants under age 65. A separate seven-month Open Enrollment is available for persons that become Medicare-eligible. Also, additional information regarding all topics, including durable medical equipment, disability guidelines, and assistance in paying premiums, can be found at the NC Seniors Health Insurance Information Program. (SHIIP)

Two of the most popular Supplement options are Plans F and N, which are comprehensive policies that cover the Part A deductible, hospice care, and coinsurance, skilled nursing facility coinsurance, and blood. Shown below are sample monthly rates (Attained Age) for a 65-year old non-smoking female. Prices can vary, depending on your zip code. Also, additional discounts may reduce the illustrated premium. Prices shown are estimated, and subject to the most recent updates. Note: Not all Advantage and Part D prescription drug plans (below) are offered in all counties. Advantage plan rates and benefits also can also vary in different counties.

Plan A

$85 -- Aetna
$85 -- CSI Life
$88 -- Continental Life
$89 -- New Era Life
$89 -- Assured Life
$90 -- Heartland National Life
$91 -- Globe Life
$93 -- Lumico Life
$97 -- Western United Life
$99 -- Guarantee Trust Life
$99 -- Companion Life
$101 -- Union Security
$102 -- Shenandoah Life
$104 -- Everest
$104 -- Thrivent
$105 -- State Farm
$107 -- Cigna
$108 -- Great Southern Life
$111 -- Aetna
$112 -- BCBS Of NC
$116 -- United American
$119 -- Medico
$119 -- Greek Catholic Union
$124 -- United World Life
$130 -- Coventry
$135 -- Americo
$136 -- Humana
$150 -- Oxford Life
$221 -- Colonial Penn

Plan B

$99 -- Continental Life
$103 -- Aetna
$131 -- First Health Life
$135 -- Globe
$148 -- Humana
$151 -- Coventry
$178 -- United American
$183 -- Colonial Penn

Plan C

$124 -- Americo
$126 -- Union Security
$133 -- Atlantic Coast Life
$135 -- Western United Life
$136 -- Everest
$161 -- State Farm
$194 -- Humana
$194 -- Sentinel Security
$203 -- United American
$215 -- Constitution Life
$215 -- Standard Life And Casualty

Plan F

$112 -- Nassau Life
$115 -- Aetna
$116 -- Independence American
$118 -- Central States
$118 -- New Era Life
$121 -- Capitol Life
$123 -- United States Fire
$123 -- Pekin Life
$124 -- Accendo
$127 -- Union Security
$128 -- Lumico Life
$130 -- Thrivent
$132 -- Pan-American Life
$133 -- Great Southern Life
$137 -- Everest
$139 -- Erie
$143 -- Assured Life
$150 -- Cigna
$152 -- Aetna
$158 -- Medico
$162 -- State Farm
$169 -- USAA
$198 -- Humana
$194 -- United American
$252 -- Gerber

Plan F (High Deductible)

$30 -- United American
$32 -- New Era Life
$35 -- United World Life
$38 -- Great Southern Life
$39 -- Colonial Penn
$41 -- National Health
$43 -- Cigna
$46 -- Medico
$56 -- Humana

Plan G

$94 -- Independence American
$96 -- United States Fire
$96 -- Union Security
$97 -- Aetna
$98 -- Capitol Life
$100 -- BCBS Of NC
$101 -- Assured Life
$102 -- Companion Life
$102 -- Atlantic Coast Life
$103 -- Lumico Life
$103 -- Thrivent
$103 -- New Era Life
$105 -- Accendo
$108 -- Sentinel Security
$115 -- United World Life
$117 -- Cigna
$128 -- USAA Life
$128 -- Americo
$131 -- Medico
$140 -- Aetna
$185 -- Humana

Plan N

$73 -- Individual Assurance
$79 -- Western United life
$78 -- Assured Life
$78 -- Union Security
$79 -- Continental Life
$80 -- Greek Catholic Union
$82 -- Lumico Life
$82 -- Everest
$83 -- Thrivent
$84 -- Shenandoah Life
$84 -- Aetna
$87 -- United World Life
$88 -- Sentinel Security
$88 -- Mutual Of Omaha
$89 -- Manhattan Life
$89 -- Great Southern Life
$92 -- Cigna
$94 -- Colonial Penn
$94 -- Americo
$95 -- USAA
$98 -- State Farm
$121 -- BCBS Of NC
$139 -- Oxford Life

NC Medicare Advantage Plans (Mecklenburg County)

MA plans are an alternative option to secure Medicare healthcare benefits for Seniors. Approved carriers offer Parts A and B though their Advantage plan, along with many other benefits. Typically, prescription drug coverage is included along with excess benefits such as vision, hearing, dental, and podiatry. Premiums are generally lower than Supplement plans.

AARP Medicare Advantage Patriot (HMO-POS) -- $0 monthly premium and no Rx coverage. Plan H5253-040-0. $3,600 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $25 (Specialist), and the Urgent Care and ER copays are $25-$40 and $90.

AARP Medicare Advantage Plan 1 (HMO-POS) -- $27 monthly premium and $50 Rx deductible. Plan 5253-037-0. $3,600 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $30 (Specialist), and the Urgent Care and ER copays are $30-$40 and $90.

AARP Medicare Advantage Plan 2 (HMO-POS) -- $0 monthly premium and $95 Rx deductible. Plan 5253-038-0. $4,500 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $35 (Specialist), and the Urgent Care and ER copays are $30-$40 and $90.

AARP Medicare Advantage Choice (PPO) -- $38 monthly premium and $50 Rx deductible. Plan H2228-018-0. $3,900 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $35 (Specialist), and the Urgent Care and ER copays are $30-$40 and $90.

AARP Medicare Advantage Walgreens (HMO) -- $0 monthly premium and $435 Rx deductible. Plan H5253-110-0. $6,700 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $45 (Specialist), and the Urgent Care and ER copays are $30-$40 and $90.

Aetna Medicare Eagle Plan (PPO) -- $0 monthly premium and no Rx coverage. Plan H5521-241-0. $6,500 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $30 (Specialist), and the Urgent Care and ER copays are $0-$30 and $90.

Aetna Medicare Value Plan (HMO) -- $0 monthly premium and $0 Rx deductible. Plan H3146-001-0. $5,500 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $25 (Specialist), and the Urgent Care and ER copays are $0-$25 and $90.

Aetna Medicare Premier Plan (PPO) -- $0 monthly premium and $150 Rx deductible. Plan H5521-081-0. $7,000 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $35 (Specialist), and the Urgent Care and ER copays are $0-$35 and $90.

Aetna Medicare Premier Plus Plan (PPO) -- $0 monthly premium and $150 Rx deductible. Plan H5521-170-0. $5,000 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $25 (Specialist), and the Urgent Care and ER copays are $0-$25 and $90.

Aetna Medicare Value Plus Plan (HMO) -- $20 monthly premium and $195 Rx deductible. Plan H3146-006-0. $5,500 maximum out-of-pocket limit. Office visit copays are $0 (Primary) and $20 (Specialist), and the Urgent Care and ER copays are $0-$20 and $90.

Blue Medicare Medical Only (HMO) -- $0 monthly premium and no Rx coverage. Plan H3449-012-0. $4,400 maximum out-of-pocket limit.

Blue Medicare PPO Enhanced (PPO) -- $59 monthly premium and $0 Rx deductible. Plan H3404-003-1. $5,900 maximum out-of-pocket limit.

Blue Medicare Choice (HMO) -- $0 monthly premium and $0 Rx deductible. Plan H3449-026-601. $3,900 maximum out-of-pocket limit.

Blue Medicare Essential Plus (HMO) -- $0 monthly premium and $195 Rx deductible. Plan H3449-023-1. $4,200 maximum out-of-pocket limit.

Cigna HealthSpring Advantage (HMO) -- $0 monthly premium and no Rx coverage. Plan H9725-005-0. $4,900 maximum out-of-pocket limit.

Cigna HealthSpring Preferred (HMO) -- $0 monthly premium and $0 Rx deductible. Plan H9725-001-0. $4,900 maximum out-of-pocket limit.

Cigna HealthSpring PreferredPlus (HMO) -- $29 monthly premium and $0 Rx deductible. Plan H9725-006-0. $3,900 maximum out-of-pocket limit.

Cigna HealthSpring TotalCare (HMO D-SNP) -- $0 monthly premium and $0 Rx deductible. Plan H9725-003-0.

Erickson Advantage Freedom (HMO-POS) -- $60 monthly premium and $200 Rx deductible. Plan H5652-006-0. $4,200 maximum out-of-pocket limit.

Erickson Advantage Liberty With Drugs (HMO) -- $25 monthly premium and $250 Rx deductible. Plan H5652-008-0. $6,700 maximum out-of-pocket limit.

Erickson Advantage Liberty Without Drugs (HMO) -- $0 monthly premium. Plan H5652-002-0. $6,700 maximum out-of-pocket limit.

Erickson Advantage Signature With Drugs (HMO-POS) -- $195 monthly premium and $0 Rx deductible. Plan H5652-001-0. $2,900 maximum out-of-pocket limit.

Humana Gold Plus -- $265 monthly premium and $0 Rx deductible. Plan H1036-263-0. $6,700 maximum out-of-pocket limit.

Humana Gold Plus SNP-DE -- $0 monthly premium and $0 Rx deductible. Plan H1036-167-0.

Humana Gold Plus -- $21 monthly premium and $160 Rx deductible. Plan H1036-137-0. $3,400 maximum out-of-pocket limit.

Humana Gold Choice -- $86 monthly premium and $215 Rx deductible. Plan H8145-063-0.

HumanaChoice -- $82 monthly premium and $360 Rx deductible. Plan H1390-002-0. $6,700 maximum out-of-pocket limit.

HumanaChoice -- $0 monthly premium. Plan H1390-001-0. $5,400 maximum out-of-pocket limit.

HumanaChoice -- $50 monthly premium and $160 Rx deductible. Plan H5216-211-0. $6,700 maximum out-of-pocket limit.

Lasso Healthcare -- $0 monthly premium and no Rx coverage. Plan H1924-001-0. MSA Plan.

Liberty Advantage -- $26.40 monthly premium and $435 Rx deductible. Plan H6351-001-0.

Liberty At Home -- $56 monthly premium and $0 Rx deductible. Plan H6351-003-0.

Liberty Advantage Gold -- $175 monthly premium and $0 Rx deductible. Plan H6351-002-0.

UnitedHealthcare Dual Complete -- $0 monthly premium and 15% Rx coinsurance. Plan H5253-041-0.

UnitedHealthcare Dual Complete RP -- $0 monthly premium and $0 Rx deductible. Plan R1548-001-0.

UnitedHealthcare Assisted Living Plan -- $20.40 monthly premium and $200 Rx deductible. Plan H5253-043-0.

UnitedHealthcare Nursing Home Plan (HMO) $26.40 monthly premium and $435 Rx deductible. Plan H5253-042-0.

UnitedHealthcare Nursing Home Plan (PPO) $23.80 monthly premium and $435 Rx deductible. Plan H0710-042-0.

NC Part D Prescription Drug Plans

Plans should be carefully reviewed since copays and out-of-pocket expenses can greatly vary for generic, non-generic, preferred, non-preferred, and specialty drugs. The current medications you take can greatly influence which plan is the most cost-effective, despite a higher premium. Illustrated below are available plans, deductible, and estimated monthly premium.

WellCare Value Script -- $445 deductible and $17.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $7, and $43. 28,439 members in the state.

WellCare Medicare Rx Select -- $365 deductible and $26.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $3, and $47. 20,096 members in the state.

WellCare Wellness Rx -- $445 deductible and $15.30 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $6, and $43. 20,652 members in the state.

WellCare Classic -- $445 deductible and $24.90 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $3, and $30. 23,041 members in the state.

WellCare Medicare Rx Saver -- $445 deductible and $26.50 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $5, and $40. 46,708 members in the state.

WellCare Medicare Rx Value Plus -- $0 deductible and $76.60 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $4, and $47. 16,787 members in the state.

Cigna Secure-Essential Rx -- $445 deductible and $23.00 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $2, and 18%. 9,290 members in the state.

Cigna Secure Rx -- $445 deductible and $24.90 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $2, and $30. 5,390 members in the state.

Cigna-Extra Rx -- $100 deductible and $60.00 per month. Preferred generic, generic, and preferred brand prescription drug copays are $4, $10, and $42. 6,991 members in the state.

Humana Walmart Value Rx Plan -- $435 deductible and $13.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $4, and $47.

Humana Premier Rx Plan -- $435 deductible and $61.00 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $4, and $42.

Humana Basic Rx Plan -- $435 deductible and $26.00 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $1, and 25%.

Express Scripts Medicare Choice -- $250 deductible and $86.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $2, $7, and $42.

Express Scripts Medicare Value -- $435 deductible and $40.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $3, and $25.

Express Scripts Medicare Saver -- $435 deductible and $23.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $4, and $30.

SilverScript Choice -- $365 deductible and $24.60 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $1, and $47.

SilverScript Plus -- $0 deductible and $76.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $2, and $47.

AARP MedicareRx Preferred -- $0 deductible and $77.20 per month. Preferred generic, generic, and preferred brand prescription drug copays are $5, $10, and $45.

AARP MedicareRx Saver Plus -- $435 deductible and $26.30 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $6, and $27.

AARP MedicareRx Walgreens -- $435 deductible and $34.10 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $5, and $40.

Blue Medicare Rx Enhanced -- $0 deductible and $121.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $3, $6, and $30.

Oscar Classic Bronze Insurance

Blue Medicare Rx Standard -- $305 deductible and $89.60 per month. Preferred generic, generic, and preferred brand prescription drug copays are $4, $8, and $37.

Basic Blue Rx Standard -- $435 deductible and $26.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $3, $7, and $25.

Cigna-HealthSpring Rx Secure-Extra -- $100 deductible and $57.90 per month. Preferred generic, generic, and preferred brand prescription drug copays are $4, $10, and $42.

Cigna-HealthSpring Rx Secure -- $435 deductible and $27.00 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $2, and $30.

Cigna-HealthSpring Rx Secure-Essential -- $435 deductible and $22.10 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $2, and 18%.

WellCare Wellness Rx -- $435 deductible and $13.70 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $6, and $43.

WellCare Classic- $435 deductible and $25.40 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $3, and $31.

WellCare Value Script- $435 deductible and $16.70 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $7, and $43.

WellCare Medicare Rx Select- $365 deductible and $21.90 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $3, and $47.

WellCare Medicare Rx Saver- $435 deductible and $27.80 per month. Preferred generic, generic, and preferred brand prescription drug copays are $0, $2, and $28.

WellCare Medicare Rx Value Plus- $0 deductible and $71.80 per month. Preferred generic, generic, and preferred brand prescription drug copays are $1, $4, and $47.

Updates From The Past:

UnitedHealthcare is coming! UHC will offer subsidized plans on the NC Exchange. They will join Blue Cross Blue Shield and Coventry, who both were available to consumers in 2014. Although BCBS participated in every county, UHC has not indicated which counties it will offer individual and family plans.

We believe that UnitedHealthcare will capture a fairly significant market share. Typically, their prices are very attractive in most states, and they were able to effectively 'sit out' and watch other companies before entering the Marketplace.

North Carolina Blue Cross and Blue Shield 2015 health insurance rates will increase by about 13% for Marketplace plans for individuals and families. Naturally, not all plans will see double-digit increases. However, grandfathered plans that don't conform to Affordable Care Act mandates (generally issued in 2010 and earlier) will see prices go up as much as 15%-19%, depending on the issue date and type of policy.

As of mid-January (the second Open Enrollment deadline), almost 500,000 persons have applied for coverage. More than 100,000 persons signed up for new policies and Bronze-tier and Silver-tier contracts continue to be the most popular option. After February 15th, a special approved exemption will be needed to purchase coverage that complies with ACA guidelines.

More than four out of every five person applying for coverage is paying less than $100 per month (subsidies included). Also, this year, an average of about 25 policy options are available in each county, which is a 40% increase from last year. Of course, with more available carriers, the number of choices has increased.

Humana will be offering both on and off Marketplace coverage. Carriers must file their intent with the DOI and specific plan and price information will be provided later in the summer. Other companies will state their 2016 intentions, and also provide detailed policy information within the next few months.

NC Marketplace rates are increasing for most carriers. Although not yet approved by the Department of Insurance, we have listed below several of the requested premium increases for popular plans that would become effective January 1.

50.7% -- Time Individual Medical
26.7% -- Blue Cross And Blue Shield Blue Value
26.4% -- Blue Cross and Blue Shield Blue Local
25.8$ -- Aetna POS-PD
17.7% -- Blue Cross and Blue Shield Blue Select
13.2% -- Coventry NC Group PPO
12.5% -- UnitedHealthcare Compass
11.3% -- HumanaOne PPO

Blue Cross and Blue Shield of North Carolina has revised their initial rate increase estimates. Instead of a 26% increase, the average rate hike will be approximately 35%. Higher medical costs and more expensive claims than anticipated were cited as reasons. However, customers with grandfathered plans and group policies through employers are not impacted by the latest increase. Also, NC regulators may not approve the proposed changes. A decision is expected within the next 60 days.

Open Enrollment begins on November 1, and fewer carriers are offering plans in North Carolina, along with the most other states. The issue is the large underwriting losses that companies are experiencing. Once the Presidential election is over, Congress will have to work together and tweak the ACA Legislation. Offering plans without maternity and other mandated benefits will be discussed. Aetna and UnitedHealthcare also will not be offering on-Exchange plans in 2017. September 23rd is the last day carriers can decide which areas they will be offering plans.

Blue Cross Blue Shield of NC has requested a 22.90% rate increase (average) for 2018 policies. More than 500,000 persons are currently enrolled in BCBS plans, which represents more than 95% of the available private market share. Cigna has requested a 32% rate increase (average). Cigna's market share is approximately 21,000 persons.