“Obamacare” for North Carolina – PPACA



Speak with an authorized agent, Call 910-509-2966
Open Enrollment Dates: 10/1/13 – 3/31/14.

Residents of North Carolina should be aware of all the new health insurance changes that will take affect this year now that the Patient Protection and Affordable Care Act  has now been signed into law. Because this is a new law that is passed, we want North Carolinians to be prepared for the health care changes and that no one misses the chance to apply for subsidies that are available.

ObamaCare has all new plan designs and rates for 2014, we are now taking online applications.

FAQs about the PPACA
1) Is Obamacare a new insurance plan?

No, Obamacare is not a new insurance plan.  It is simply a name that the public recognizes for the PPACA (Patient Protection and Affordable Care Act), a law passed in 2010.  While there are many changes resulting from the PPACA, individuals and groups will still purchase insurance plans issued by private insurance companies, not the government.

2) How do I apply for subsidies?

Your free health insurance quote is just moments away. Along with your rate quote, you will have a chance to review subsidies that may be available to you. You can apply online to see the final rate that you will pay, with no obligation to buy. Your health insurance coverage can start 1/1/14 if you apply by 12/15/13. You can receive online rates today by clicking the blue button on the right side of the page.

3) What’s the difference between Obamacare, the Affordable Health Care Act and health care reform?

If you are watching the news or reading the local Wilmington Star News newspaper you are starting to pick up on the popular buzz words about healthcare reform that seem to reference the same topic. Obamacare, the Affordable Health Care Act and health care reform are all names that refer to the health care changes initiated by the Obama administration. The Affordable Health Care for America Act was a bill that was created by the United State House of Representatives in November 2009 and is the official name of the Obama’s health care reform, also known by the public as Obamacare.

4) Will my North Carolina health insurance increase due to the ObamaCare changes?

It depends. Review the employer or Medicaid health insurance options below for more details.

Individual Health Insurance:

Individual health insurance rate increases will vary widely in 2014.  If your plan has a grandfathered status, you may find premium increases below those plans of non-grandfathered status.  Grandfathered plans do not fall into the “metal tiers” of the new plans offered beginning 1/1/14.  As such, they will not be subject to all of the requirements of the new plans.   Non-grandfathered plan members will be required to migrate to an Obamacare compliant plan design at renewal in 2014.

Employer or Group Sponsored Health Insurance:

You may see the cost of your plan rise if you already receive coverage from your employer in North Carolina. Although some businesses are trying to push for higher deductibles and copays which ultimately puts the healthcare cost onto the employees. But the healthcare reform does put some new limits on the amount the insurers can charge in North Carolina. The overall goal of the healthcare system is to help lower the healthcare costs.


Obamacare does plan to broaden the Medicaid program to cover anyone with an annual income of up to 138% of the poverty level, which is about $15K a year for individuals. On February 13, 2013, states were able to choose to opt-out of the Medicaid expansion.  The state of North Carolina voted not to expand Medicaid. If you are unsure if you qualify for Medicaid in North Carolina, please visit the NC Department of Health and Human Services.

5) Is there a tax credit for middle class families?

There is a middle class tax credit that will be available for people earning up to $90K per year for a family of four and who purchase health insurance through one of the online health insurance exchanges that will be setup in 2014.

6) What is a health insurance exchange or marketplace?

It’s an online collective where individuals, families and small businesses in North Carolina can purchase health insurance coverage. Every state will have the option on how they would prefer to setup the exchange. Each state will be able to setup a federal health insurance exchange, a state-federal partnership exchange or a state-based exchange.  For 2014, North Carolina has chosen to partner with the federally run exchange.

7) What insurance carriers will be offering insurance on the North Carolina exchanges?

For 2014, only Blue Cross & Blue Shield of North Carolina, and Coventry Health will have health plans available on the exchange or marketplace.  The Coventry plans will have a limited number of counties in which coverage can be purchased.

8) Do I have to buy my insurance from the exchange or marketplace?

Not necessarily. The Marketplace is just one of the ways people can shop for health coverage. People can still get coverage through their employer or directly from an insurance company. However, you will have to buy coverage through the Marketplace to apply for subsidized coverage.

9) When will the health care changes be implemented?

Here is an overview of the changes effective 1/1/14:

  • Maximum out-of-pocket premiums will be determined based on family size and the federal poverty level.
  • Insurance companies are no longer allowed to charge higher rates based on preexisting conditions or gender.
  • The tax on uninsured individuals comes into effect.
  • Insurers may no longer establish annual spending caps.
  • All individuals with an income of up to 133% of poverty level will qualify for coverage in states where Medicaid is expanded.

For a complete timeline of past and future changes brought about by the PPACA, you may go to www.healthcare.gov.

10) What are the penalties for not having health insurance?

The Obamacare healthcare plan says that every American must have health insurance. Taxes will be applied against those who do not purchase insurance by January 1, 2014.

Below is a list of people who can be exempt from the penalty:

  • People between jobs that have not insurance, lasts up to 3 months
  • Those with religious objections
  • Illegal immigrants
  • Inmates
  • Members of an Indian Tribe
11) How much is the penalty for not having health insurance?

Residents of North Carolina that do not have coverage will have to pay $95 annual tax per adult, there is a $285 maximum penalty per family or up to 1% of the family income, whichever is greater.  This penalty will increase annually.

12) Does Obamacare affect Medicaid?

Medicaid is a service that provides healthcare to lower income Americans. Obamacare plans to expand this service while each state had the option to opt-out of the Medicaid expansion, North Carolina has not voted to expand Medicaid coverage. Because the state of North Carolina did not expand the Medicaid coverage, the Medicaid qualifications will stay the same and those that do qualify will continue to receive benefits.

13) Does Obamacare affect Medicare?

Medicare is a health care service for the aged. It’s a federal administered system of health insurance that is available to Americans over the age of 65.  The main changes to Medicare will help eliminate fraud and reduce payments made to the Medicare Advantage programs offered by private insurance companies in North Carolina. The Medicare reduction in cuts is expected to be about $716 billion, although Obamacare is trying to fill the coverage gap in the Medicare prescription drug benefit.

14) What is a grandfathered health insurance plan?

This is a plan that was purchased on or before March 23, 2010.  If this plan has covered at least one person from that date forward then the grandfather health insurance plan may be exempt from the changes of the Affordable Health Care Act until a new policy year begins.

15) What are the “essential health benefits”?

The essential health benefits include coverage for things like maternity, newborn care, hospitalization, ambulatory care and prescription drugs. All of these benefits must be included in any health insurance plan that is sold to an individual or business in the state of North Carolina. The North Carolina health insurance plan must offer a minimum of 10 categories of essential benefits within its state package.

16) Is free health insurance coverage available?

The Affordable Health Care Act does not offer free coverage. Everyone will still have to pay for health insurance unless you qualify for Medicaid or Medicare in the state of North Carolina. If you don’t qualify, it’s very important that you apply now for subsidies to see if you are eligible based on your income level. In 2014, Americans with an annual income of 100 to 400% of the federal poverty level will be eligible for subsidies. For more information, you can check subsidy eligibility online now or speak with an authorized agent in Wilmington, NC. Please Call Us:  910-509-2966!

17) Do I have to have health insurance?

Under the Affordable Health Care Act you are required to have health insurance in the state of North Carolina as of 1/1/14. Please see the list below of exemptions for those that don’t have to have health insurance.

Exemptions Include:

  • People between jobs that have not insurance, lasts up to 3 months
  • Those with religious objections
  • Illegal immigrants
  • Inmates
  • Members of an Indian Tribe



Additional Information & Resources