North Carolina Health Insurance

In North Carolina, medical underwriting is allowed without restriction. A preexisting condition is a medical condition for which medical advice or treatment was recommended or given prior to coverage under this plan. There is a 12 month look back and exclusionary period for preexisting conditions for those without prior health coverage.

Inclusive Health, also known as the North Carolina Health Insurance Risk Pool (NCHIRP), provides affordable, individual health insurance coverage for North Carolinians who do not have access to an employer health plan and face higher premiums due to a pre-existing medical condition. It will also offer coverage to individuals who are federally defined HIPAA eligibles or qualify due to loss of employment due to the effects of international trade under the Health Coverage Tax Credit.

The North Carolina General Assembly created the North Carolina Health Insurance Risk Pool in 2007. It serves as North Carolina’s alternative mechanism for those who’ve exhausted their COBRA continuation coverage. Individuals with 18 months of prior continuous coverage may qualify for coverage under Inclusive Health and are not subject to Inclusive Health’s pre-existing condition waiting period. 

Just like most traditional employer-sponsored health plans, Inclusive Health covers a broad range of services, including preventive care, urgent care, outpatient services, a prescription drug benefit and other common health care services.

Other Options:

North Carolina offers the North Carolina Health Choice program to children whose family income is up to 200% of the Federal Poverty Level. Children must be under 18 years old, residents of North Carolina and U.S. citizens or legal residents, and uninsured including being eligible for Medicaid. Please visit the North Carolina Health Choice website for more detailed information at http://www.dhhs.state.nc.us/dma/cpcont.htm#faq. 

 

There is also a program for low-income pregnant women. This program offers assistance to pregnant women in the form of receiving medical care, support services such as transportation, housing, job training, and day care, and childbirth and parenting classes, nutrition counseling, psychosocial counseling, and home visits for high-risk pregnancies. Please visit the North Carolina Baby Love program website for more detailed information at http://www.dhhs.state.nc.us/dma/babylove.html.

North Carolina offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death or divorce. 

Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements.

Children

Children (ages 1-5)-133% of the Federal Poverty Level
Children (Ages 6-19)-100% of the Federal Poverty Level

 

Pregnant Women and Infants

Pregnant Women-185% of the Federal Poverty Level

Infants (ages 0-1)-185% of the Federal Poverty Level

 

Parents

Non-Working Parents-42% of the Federal Poverty Level
Working Parents-57% of the Federal Poverty Level

 

Other populations

Medically Needy Individuals- 34% of the Federal Poverty Level

Medically Needy Couples- 33% of the Federal Poverty Level

Supplemental Security Income Recipients- 74% of the Federal

Poverty Level

Aged, blind, and disabled- 100% of the Federal Poverty 

 Level

 

Covered Services
Inpatient hospital services, outpatient hospital services, prenatal care, vaccines for children, physician services, nursing facility services for persons aged 21 or older, family planning services and supplies, rural health clinic services, home health care, laboratory and x-ray services, pediatric and family nurse practitioner services, nurse-midwife services, federally qualified health-center, early and periodic screening, diagnostic, and treatment services for children under age 21.

 

Co-payments vary.