North Carolina & The Affordable Care Act

What The Affordable Care Act Means For North Carolinians
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For more information about the Affordable Care Act, visit

In 2007, 16.5 percent of North Carolinians reported they were unable to see a doctor when necessary due to cost. Between 2003 and 2009, the health insurance premiums for North Carolina families increased 55 percent to an annual average cost of $13,087. This amount represents nearly 30 percent of the median annual household income in the state. Single policyholders saw their premiums increase by 37 percent between 2003 and 2009. [1] Of the North Carolina residents who do have health insurance, 47 percent are covered through employment. Public programs such as Medicaid and Medicare insure 32 percent of the population, and four percent of North Carolinians purchase individual private policies. This leaves nearly 1.6 million, 17 percent of the state’s population, uninsured. [2]

Who are the uninsured in North Carolina?

North Carolina’s children are uninsured at a rate of 10 percent across all income levels. This figure rises to 14 percent for children in households with incomes less than 139 percent of the Federal Poverty Level. For non-elderly adults living in these lower income households, the rate of uninsured in 47 percent. [3] Hispanics, excluding those who are age 65 or older and eligible for Medicare, are uninsured at a rate of 42 percent in North Carolina. Among non-elderly Blacks, the uninsured rate is 23 percent, and 15 percent of the non-elderly White population lacks health insurance. [4]

How does the Affordable Care Act affect North Carolinians?

The Affordable Care Act (ACA) requires states provide access to an online marketplace, also called an exchange, where individuals and small businesses may compare, select and purchase private health insurance policies that offer a minimum level of coverage. States have the option of establishing their own exchange, operating an exchange in cooperation with the federal government, or turning all administration of the health care marketplace over to the federal government.

In November 2012, outgoing North Carolina governor Beverly Purdue announced the state would seek to create an exchange for North Carolina in partnership with the federal government. Purdue reasoned that this move would give the administration of Governor-elect Pat McCrory more options when deciding how best to comply with provisions of the ACA. On February 15, 2013, Governor McCrory announced that North Carolina’s exchange would be run solely by the federal government, rather than as the partnership envisioned by his predecessor.

Under ACA, all new policies, and in-force policies upon renewal, must cover a package of essential health benefits, including hospitalization, emergency services and mental health treatments. Annual wellness checkups and other preventative screenings must be covered with no co-payments or deductibles. Residents may not be denied health insurance for pre-existing health conditions, and insurers may not place a lifetime cap on benefits. Households with incomes at or below 400 percent of the Federal Poverty Level may be eligible for tax credits to offset premium costs.

North Carolina’s health insurance exchange

North Carolinians are be able to compare and purchase health insurance policies through the federal health insurance marketplace, Policies offered to North Carolina residents cover essential health benefits based on Blue Cross and Blue Shield of NC’s Blue Options plan. Plans are offered in four categories of coverage levels, with the least expensive plan, the bronze tier, covering 60 percent of medical costs. Plans in the silver tier cover 70 percent of costs. Gold plans cover 80 percent. The most expensive tier, platinum, covers 90 percent of medical costs. The federal website offers information about available tax credits and subsidies. For assistance by phone, consumers may reach the call center 24-hours a day at 1-800-318-2596.

Small Business Health Options Program (SHOP)

Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.

Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.

For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. North Carolina small business owners may access SHOP through For more information about the ACA and small businesses, visit the U.S. Small Business Administration.

Certified in-person enrollment organizations

The U.S. Department of Health and Human Services has approved the health centers below in North Carolina for assistance in outreach and enrollment.

For the most current list, visit the U.S. Department of Health and Human Services.

External resources for North Carolina residents

See the full list of external resources from CBS Charlotte.



Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on

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