Health Care Reform and the Affordable Care Act

Learn How These Changes Will Affect YouBlueCross BlueShield of North Carolina


The Affordable Care Act (ACA) will make health insurance coverage available to more people in North Carolina and add more health care benefits. There are many new rules and regulations with health care reform that will impact you significantly. One of the biggest changes is that most people must have health care coverage or pay a penalty.

Health Insurance may not be as expensive as you think and you may be eligible for financial assistance that will help pay for your insurance plan. As a Blue Cross and Blue Shield of North Carolina Authorized Agent, First Pioneer Insurance Agency can show you ways to reduce costs and see if you qualify for assistance.

Open Enrollment for North Carolina Health Insurance coverage starts
  November 15, 2014.
Complete the form on this page to request a phone appointment!

The Cost Of Change

  1. Guaranteed Coverage
    Everyone - no matter his or her current health condition - is guaranteed access to health insurance. In fact, everyone is required to get insurance or pay a penalty.
  2. Essential Benefits
    The next big change applies to benefits. Under the Affordable Care Act, all individual and small group insurance policies must include 10 categories of essential health benefits. They are: Maternity care, Rehabilitative and habilitative services, Pediatric vision and dental coverage, Mental and behavioral health, Preventive and wellness services, Hospitalization, Laboratory services, Prescription drugs, Ambulatory services, and Emergency services.
  3. Change in the Way Premiums are Determined
    The third major change limits how much premiums can vary based on a person’s age, gender or health. In the past, premiums depended largely on age, gender and health status. Now, however, health status will not be a factor.

How Do Subsidies Work?

North Carolina residents under age 65 who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for tax credit subsidies. There are two types of federal subsidies to help reduce health care costs. They are Advanced Premium Tax Credits and Cost-Sharing Reductions.

  • Advanced Premium Tax Credits lower your monthly premium.
  • Cost-Sharing Reductions help lower out-of-pocket expenses including deductibles, co-pays and coinsurance at the place of service; like doctor and hospital visits.

Subsidies are determined by income and family size in relation to the established Federal Poverty Levels (FPL) and are only available to those who qualify. In order to receive your subsidy, you must apply through the Health Insurance Marketplace (also known as the Exchange). Our Health Agents can assist you with the application process so you can confirm your subsidy eligibility. You will be able to see what a new plan rate will look like once a subsidy is applied to your premium.

The graph below shows examples of household income and family size that may qualify for Advanced Premium Tax Credits. This type of subsidy is sent directly from the government to Blue Cross and Blue Shield and applied to your bill each month, thereby reducing your monthly premium.

NC Health Care Reform

Cost-Sharing Reductions are only available for households with incomes that are between 100% and 250% of the Federal Poverty Level (FPL). If you qualify, you will want to take advantage of both Cost-Sharing Reductions and Advanced Premium Tax Credits to use them both to maximize your savings.

NC Affordable Care Act

BCBSNC Individual Health Plans

Plans are grouped into four metallic levels: Bronze, Silver, Gold and Platinum. In order to take advantage of Cost-Sharing Reductions, you must choose a Silver plan. Blue Cross and Blue Shield of North Carolina (BCBSNC) is the only insurer in the state that has applied to serve all 100 North Carolina counties on the Health Insurance Exchange.

BCBSNC offers 27 plans on the Exchange, including plans at every metal level and catastrophic option(s) for those who qualify. Catastrophic plans have higher deductibles and will be available for consumers under age 30 and those who receive "hardship exemptions". Bronze plans cover 60% of health care expenses, Silver plans 70%, Gold 80% and Platinum 90%.

Buying Health Insurance Vs. Paying A Penalty

You might be thinking, I just cannot afford to buy health insurance at any cost. If you decide not to purchase health insurance, it is important to remember that you will pay the fee and you will not get any health insurance coverage. You will still be responsible for 100% of the cost of your medical care.

  • In 2014 the fee is 1% of your yearly income or $95 per person, whichever is higher, and the fee for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285.
  • The penalty is scheduled to increase every year. In 2016 the fee is 2.5% of your yearly income or $695 per person, whichever is higher.

After the initial enrollment ends on February 15th , 2015, you will not be able to get health care coverage through the Marketplace unless you have a qualifying life event like a job loss, birth, or divorce. You will have to wait until the next annual enrollment period.

Open Enrollment Starts November 15, 2014

If you enroll in a health insurance plan anytime between November 15 and December 15, 2014 and make your first premium payment, your new health coverage will start on January 1, 2015. We suggest you talk with one of our certified and licensed Health Agents who is informed of all the NC Health Care Reform changes. They know the many changes of the Affordable Care Act and can give you the answers you need.

There are no additional fees to work with a Health Agent at
First Pioneer Insurance Agency. Call 800-547-1495 today!

We have the information you need to understand your options during the State's Health Care Reform. We want to help consumers like you understand how you will be affected and provide support to make the best decision for your personal goals. Complete the form on this page for one of our Health Agents to contact you.

Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Contact Blue Cross and Blue Shield of North Carolina Authorized Agent, First Pioneer Insurance Agency for information on obtaining financial assistance requirements.