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Individuals in North Carolina looking to find affordable health insurance coverage to bridge the gap until the next ACA open enrollment for themselves, their families, or a business have many insurance options to consider.
If you’ve never heard of short term medical insurance (STM), please take a couple moments to review the video explaining it below.
One way to think about STM is as a temporary way to bridge the uninsured gap until you can obtain ACA coverage in the next open enrollment period or from an employer.
Short term medical insurance covers unforeseen accidents and illnesses and helps provide a layer of financial protection.
After the Affordable Care Act plans were launched in 2013, STM plans became an insurance option for those needing insurance outside of the government’s open enrollment period.
They’ve been helpful for people who missed the window to sign up for an ACA plan, were dropped from an employer (or parents’) plan, or are retired and waiting for Medicare benefits to start. It is also referred to as “gap coverage” and unlike ACA plans, you can purchase an individual or family health insurance plan in North Carolina at any time of the year on an open market.
Prior to the Affordable Care Act becoming law, short term medical insurance plans in North Carolina could last up to a year and there were fewer restrictions on reapplying for a new plan depending on your state. From April 2017 to October 2018, the length of short term plans became limited to a 3-month duration. There was also the ACA tax penalty for those who had short term medical insurance since it did not meet the requirements of the Affordable Care Act.
The landscape has changed. There are big changes within the STM industry recently that are worth noting: starting in 2019 the tax penalty for having one is gone and you can now purchase an online health insurance plan in the state of North Carolina for up to 364 days, and you can obtain back-to-back policies for up to 36 months.
North Carolina short term medical insurance plans are primarily intended to provide coverage for:
Accidents and Illnesses
Getting coverage outside of open enrollment
For many people, short term medical insurance is a great way to have temporary affordable protection to bridge the uninsured gap to open enrollment.
One of the biggest distinctions with North Carolina short term medical care plans is that they do not cover pre-existing conditions, maternity, and comprehensive mental health services.
Prescription drugs are also not typically covered by most STM plans. Because these are not factored into the plan, the premium prices end up being lower cost.
When you buy a short term medical insurance plan online in North Carolina you have many options from a variety of healthcare providers. There is no one size fits all solution because businesses, individuals, and families have different needs and circumstances.
You can select different the levels on your deductible, coinsurance, and copay depending on your budget. For cheaper monthly payments, you can choose a plan with a higher priced deductible. The tradeoff is that you’ll pay more out of pocket on medical expenses before receiving any benefits from the plan.
In order to offset some of the out of pocket costs associated with using a North Carolina major medical policy, you can look into Health Benefit Indemnity Plans that offer cash reimbursement for covered medical events.
When shopping for a North Carolina short term medical insurance plan, there is an underwriting process you go through during which you are asked about your medical history. This is to assess your current health situation, which will help determine if you qualify for a plan.
In a typical STM plan, medical expenses related to pre-existing conditions would not be covered.
This does not apply for new conditions that develop while you have an STM plan - these would be covered for the length of the term.
With most short term plans, when you apply for a new North Carolina policy, during the underwriting process it would be determined that the new conditions would no longer be covered (because they have now gone from “new” to “pre-existing”).
We strongly recommend that people buy an additional pre-ex waiver where available so if they need an additional short-term plan beyond their current one, they still have coverage for these conditions.
The Milliman Medical Index found that the average cost of health insurance for a family of four in North Carolina is over $28,000!
ACA compliant health plans first came onto the insurance market in the 2013 open enrollment period for the 2014 plan year. Before that the average monthly cost for individual health insurance was $159. Since then the numbers have steadily increased - by 123%.
For family plans the increase is even higher, coming in at 174% higher from 2013 to 2018 according to healthcare research.
In 2018, the average cost of an individual ACA plan was $440 per month, which comes out to $5,280 a year, which is a lot of money for anyone, no matter their income.
In fact, ACA plans are completely out of reach for many individuals who are not eligible for the subsidy to even consider buying now.
To help make it more affordable, many people rely on government subsidies as well as Medicaid programs for those below 138% of the Federal Poverty Level (FPL) in states that expanded Medicaid. North Carolina did not expand Medicaid so it will be below 100% of FPL.
North Carolina Health Facts:
Whether you are a healthy individual, family, or run a business, it’s still important to have insurance. You never know when you may need it, that’s just the nature of life - and why insurance was first conceived. What kind of health insurance is right for you depends on your specific situation. For uninsured individuals and families with chronic conditions, three companies are offering plans through the ACA health exchange marketplace in 2020 are:
You will end up paying more monthly with one of their policies, but at least all your conditions will be covered. If the out of pocket costs of those policies you see online are too expensive for your budget or you are outside the open enrollment period like we are most of the year, look into ways to help with the cost such as the government subsidies available and/or Medicaid programs.
If on the other hand, you are an individual or family with a clean bill of health and only want to be covered in case of accidents and illnesses, or just need temporary health insurance between jobs, or coverage until the next open enrollment period, consider purchasing a North Carolina short term medical insurance plan. You can get a free online health insurance quote to compare different plans before committing to buy and you can also cancel them anytime after purchase.
There are many plans on the market that cost much less than an ACA plan, just make sure to read all the fine print about what it covers (and not covers) so you know it’ll work for you.
Click the button below to compare free North Carolina short term medical insurance quotes.
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SHORT TERM HEALTH INSURANCE AND LIMITED BENEFIT MEDICAL INDEMNITY INSURANCE ARE INSURANCE OUTSIDE OF THE AFFORDABLE CARE ACT (OBAMACARE). THEY DO NOT COVER PRE-EXISTING CONDITIONS AND DO NOT INCLUDE ALL TEN OF THE MINIMUM ESSENTIAL BENEFITS OF OBAMACARE. LIMITED BENEFIT MEDICAL INDEMNITY INSURANCE IS DESIGNED TO PROVIDE ADDITIONAL BENEFITS TO SUPPLEMENT MAJOR MEDICAL INSURANCE. IT IS NOT AVAILABLE IN SOME STATES LIKE NEW JERSEY AND YOU MAY NOT BE PERMITTED TO PURCHASE IT IN OTHER STATES WITHOUT PROOF OF MAJOR MEDICAL INSURANCE.
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The health insurance market has changed significantly over the years. Learning Center Articles reflect the market at the time they were published and may no longer be applicable.”