What is the Marketplace / Exchange / Individual Health Insurance Marketplace / "Obamacare" / Affordable Care Act (ACA) Health Insurance?
The Individual Health Insurance Marketplace, sometimes called the “Federal Marketplace” or “Federal Exchange,” is a resource for individuals and families to shop for and enroll in a health insurance plan. It also provides information on programs that can help people pay for coverage.
What is a premium?
A premium is the amount you pay each month to keep your health insurance plan active.
What are out-of-pocket costs?
Out-of-pocket costs are your total expenses for medical care that are not paid by your health insurance plan.
What is a network?
A “network” is a group of doctors and hospitals that participate in a health insurance plan. Typically, you pay lower out-of-pocket costs if you go to doctors and hospitals that belong to your health insurance plan's network.
When is Open Enrollment for the Individual Health Insurance Marketplace?
“Open Enrollment” is a federally mandated period of time where consumers can sign up via healthcare.gov for health insurance on what is known as the Individual Health Insurance Marketplace. Open Enrollment runs from 11/1/2016-1/31/2017. After this period, you may NOT make changes to your health insurance options, unless you have a qualifying life event (i.e., new job, birth of a baby, divorce, marriage).
If you are currently a member of an Individual Health Insurance Marketplace plan that will not be sold on the NC or SC Marketplace in 2017 (for example, Aetna Leap-Carolinas HealthCare System- or UnitedHealthcare Compass), you may qualify for a Special Enrollment Period. Learn more.
What’s the deadline to buy an individual health insurance plan and have coverage start Jan. 1, 2017?
The deadline to buy an individual health insurance plan on the Individual Health Insurance Marketplace and have coverage start by 1/1/17 is 12/15/16.
If I buy an individual health insurance plan on the Marketplace, can I change my mind and enroll in a different plan?
You can change your mind and enroll in a different plan during Open Enrollment as long as you have not paid your first month’s premium. Once you’ve paid your first month’s premium, you can no longer change your plan unless you have a qualifying life event like a new job, marriage, birth of a baby or divorce.
If you qualify for a Special Enrollment Period, you may be able to change your plan after you’ve made your first payment. Learn more.
What plans are my Carolinas HealthCare System doctor(s) included in?
Depending on where you live, Carolinas HealthCare System doctors and hospitals are included in different Individual Health Insurance Marketplace plans.
For residents of Anson, Cabarrus, Mecklenburg, Stanly, Union, and Rowan counties (the Charlotte, NC metro area), the only Marketplace plan that includes Carolinas HealthCare System doctors and hospitals is Blue Local with Carolinas HealthCare System.
For residents of Gaston, Cleveland, and Lincoln counties in North Carolina, our doctors and hospitals are in network and preferred with these Marketplace plans:
- Blue Local with Carolinas HealthCare System
- Blue Advantage
For residents of Lancaster and York counties in South Carolina, starting January 1, 2017, Carolinas HealthCare System doctor's offices located in South Carolina will be included in all health insurance plans sold on the Individual Health Insurance Marketplace in SC for 2017, which include:
- BlueEssentials from BlueCross BlueShield of South Carolina
- Multi-State Plan from BlueCross BlueShield of South Carolina
Learn more about individual health insurance plan options on the Marketplace in South Carolina.
Why should I pick a plan that includes Carolinas HealthCare System doctors and hospitals in network?
Choosing a plan that includes Carolinas HealthCare System doctors and hospitals gives you in-network rates with:
- Access to top rated doctors;
- Innovative care from specialty centers like Levine Cancer Institute, Levine Children’s Hospital, and Sanger Heart and Vascular Institute;
- Plus, access to the largest primary care and urgent care network in the region.
Which plans are my prescriptions covered in?
You can use Healthcare.gov to find available plans in your area and look up your medications to determine your out-of-pocket cost and coverage amounts.
How much will a particular visit or service cost with the plan I choose?
If you need exact details about a particular plan and its coverage, please contact the insurance company. To reach BCBSNC, call 1-800-894-2880.
Why do I need health insurance?
The purpose of health insurance is to help you pay for care. It protects you and your family financially in the event of an unexpected serious illness or injury that could be very expensive. You need health insurance because you cannot predict what your medical bills will be. In some years, your costs may be low. In other years, you may have very high medical expenses. If you have health insurance, you will have peace of mind in knowing that you are protected from most of these costs.
What happens if I don’t buy health insurance?
The deadline to enroll in a Marketplace health insurance plan is January 31, 2017. Under the Affordable Care Act, if you can afford health insurance, but choose not to get it, you may be required to pay a fee — sometimes called a "penalty," "fine," or "individual mandate" — when you file your federal income taxes.
Once the Marketplace Open Enrollment period ends January 31, 2017, you will not be able to purchase health insurance on the Individual Health Insurance Marketplace until 2018, unless you have a qualifying life event (ie, marriage, have a child, move, etc.).
What if I can’t afford insurance?
Affordable coverage through the Individual Health Insurance Marketplace is available. After a tax credit, the cost of most plans premiums are cut by 76%. If you enroll by December 15, 2016, your coverage will start January 1, 2017.
How do I enroll in / purchase an individual health insurance plan on the Marketplace?
If you are ready to enroll in a health insurance plan, you can visit Healthcare.gov to complete your enrollment. Once you have enrolled you will receive information from your insurer on how to pay your bill.
If you need assistance enrolling, you can call and speak to one of our experienced insurance specialists by calling 866-271-0546.
Why is my Aetna Leap-Carolinas HealthCare System plan going away?
Aetna decided that they would not offer any individual health insurance plans on the Individual Health Insurance Marketplace in NC and SC for 2017.
I received a letter from CMS (or the Marketplace) saying I’ve been enrolled in a new plan. Why?
If you have an Aetna Leap-Carolinas HealthCare System individual health insurance plan, your plan won’t be offered again on the Individual Health Insurance Marketplace in SC for 2017. As a result, if you live in SC, the federal government has enrolled you in another plan.
Can I keep my Aetna Leap-Carolinas HealthCare System plan?
Aetna will not offer your current health insurance plan, Aetna Leap-Carolinas HealthCare System, on the Individual Health Insurance Marketplace in NC or SC in 2017. Aetna will offer an individual Aetna Leap-Carolinas HealthCare System plan?off the Marketplace.?You can buy this plan directly from Aetna, however, there are no subsidies or savings programs available to help lower your premiums or out-of-pocket costs like there are for individual plans sold on the Marketplace.