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North Carolina Health Insurance

North Carolina Medical Insurance Overview

Despite the fact that North Carolina contains a lot of strengths in regard to its health care, there are a few residents who actually lack proper health insurance.  This takes away from their overall ability to obtain some of the most basic services in order to stay as healthy as possible.  In 2010, the Patient Protection and Affordable Care Act went into effect, which was designed to bring basic health care services to millions of individuals.  Some of the features of this act have already gone into effect; however, others will begin to gradually do so until the year 2020.

Health Care Issues
Currently, North Carolina ranks in 31st place in terms of overall health as opposed to the other states in the nation. Set forth by the United Health Foundation, this rating looks at many different factors, including the following:

  • Air pollution
  • Obesity
  • Access to health insurance

There are many strengths involving this, which include the following:

  • Low prevalence for excessive drinking
  • High rate of HPV immunizations for younger women
  • High percentage of immunization coverage for children

At the same time, there are a few weaknesses as well, which include the following:

  • Large disparity in health status by level of education
  • Low per capita health funding
  • High infant mortality rate

Understanding the State’s Uninsured Population
According to reports, North Carolina residents between the ages of 19 and 25 make up the largest portion of those who are uninsured. However, thanks to the Patient Protection and Affordable Care Act, these individuals will be able to remain on the health insurance plans of their parents until they turn 26 years old.

Here are some additional statistics thanks to the Henry J. Kaiser Family Foundation:

  • Approximately 14% of North Carolina’s general population lacks health insurance.
  • Around 13% of children who live in homes with incomes of 100% or less than the federal poverty level do not have health insurance.
  • 24% of adults in North Carolina who earn 100% or less than the federal poverty level do not have health insurance.

Group Health Plans
Forty-seven percent of the residents of North Carolina have health insurance thanks to some sort of a group health plan, which typically provides the best deals in terms of health insurance options and costs.  Approximately 48.1% of businesses throughout the state currently offer health coverage to all of their employees.  Individuals who are not able to obtain insurance through a group health plan generally have to resort to going through someone such as a trade union representative.

Signing Up
Typically, employees are required to wait until some form of an enrollment period begins before they can register for a health insurance plan provided by their place of employment. Registering for one of these plans usually requires some sort of monetary commitment that involves some money being deducted from an employee’s weekly or bi-weekly paychecks to help pay for premiums.  Always take as much time as you need to thoroughly research everything regarding the available plans before making any kind of a final decision.

Furthermore, there are also other factors that you should consider as well, which include the following:

  • Dependents
  • Coverage options
  • Pre-existing conditions

Pre-Existing Condition Exclusion Periods
In the event that you have a pre-existing condition of any kind, chances are you may be required to wait up to 12 months before all of your health insurance benefits can take effect. HIPAA regulations, however, expressly prohibit any kind of exclusion period from being imposed on someone under the age of 19, even if they suffer from a pre-existing condition.

Waiting/Affiliation Periods
These periods are essentially amounts of time in which individuals must wait before their particular health insurance policy goes into effect. Generally, this period can never last any longer than two months; however, if you are a late enrollee, this period will be able to last for up to three months. No affiliations can be applied on top of exclusion periods, and all of these periods always take place simultaneously.

Individual Health Plans
Approximately 4% of North Carolina’s population is covered through some sort of an individual health insurance plan, which is best for those who are either unemployed, self-employed, or working for an employer who does not offer any kind of health benefits to their employees.  The only real downside to these plans is restrictions are much more lax in terms of what providers can and can’t do.  For around $64 per month, a young and healthy person will be able to obtain basic coverage with a high deductible.

Continuation Coverage
Individuals who find that they have lost their health insurance coverage for any reason will find that they can continue their coverage through the Consolidated Omnibus Budget Reconciliation Act, otherwise known as COBRA. This will cover you for up to 18 months after the day that you initially lost your original coverage; however, your eligibility will determine on the overall size of the businesses that you previously worked for.

North Carolina Health Benefits Exchange
Initially, North Carolina had planned to establish a state-federal partnership for a health exchange; however, it was eventually decided that the state itself would be the ones responsible for running the exchange. This exchange has also met all of the benefits that have been established under the Affordable Care Act.

State Insurance Programs
North Carolina has a host of different health insurance programs designed to provide assistance to those who are unable to acquire insurance by any other means, such as an individual plan or group plan. There are many different factors that are taken into consideration in order to determine eligibility, such as age, gender, income level, and more.
Here are some of the most common programs offered:

Inclusive Health/Inclusive Health – Federal Option
These plans are designed to assist residents who suffer from pre-existing conditions with obtaining coverage that is both affordable and comprehensive. Monthly premiums are also required to be paid for these plans, which can cost between $71 and $3,558.

Medicaid
This is a program that helps to assist lower-income individuals and families with services such as the following:

  • Health checkups
  • Family planning
  • Speech/hearing
  • Doctor visits
  • Home health care

Individuals who enroll within three months will be able to receive retroactive benefits.

North Carolina’s Health Choice
This plan is designed to provide benefits to uninsured children who come from families with moderate incomes. Services such as the following are covered:

  • Lab/x-ray work
  • Prescription drugs
  • Surgical services
  • Dental
  • Vision
  • Hospice cars
  • Therapies

Medicaid for Pregnant Women
This is a plan that covers services including the following:

  • Prenatal care
  • Delivery
  • Pregnancy complication treatment

Eligibility for this program is determined by factors such as income level and age.

Baby Love
This program is designed to offer coverage to both infants and pregnant women. While eligibility is determined by income level, all who enroll for this program must have an income level either at or below 185% of the federal poverty level.

Women, Infants, and Children (WIC)
This is a program that helps lower-income mothers provide their children with many different nutritional needs. Furthermore, it also helps both mothers and their children obtain all of their necessary immunizations.

Breast & Cervical Cancer Control Program
This is a program that helps to cover cancer screening services such as clinical breast exams, pap smears, ultrasounds, and mammograms.

WISEWOMAN
This program provides assistance to women who suffer from various chronic illnesses. Testing services such as the following are covered:

  • Cholesterol level
  • Blood pressure
  • Heart disease risk factor

Eligibility factors for this program include income level and County of residence.

Medicare and Senior Insurance Counseling (SHIIP)
This program is designed to help seniors aged 65 and older who reside in North Carolina. Other eligibility factors include the following:

  • Suffer from end-stage renal disease or other disability
  • Worked in a job covered by Medicare for the past 10 years
  • Spouse has worked in a job covered by Medicare for the past 10 years

SHIP counsels participants on the benefits available under the Medicare program.

Partnership for Prescription Assistance
Designed to assist those who lack sufficient prescription drug coverage, this program provides approximately 475 different options that help individuals meet the costs of the prescriptions that they need.

VA Medical Benefits Package
Veterans who have served in any branch of the United States military will be able to take advantage of this service. Covered are the following:

  • Pre-existing conditions
  • Primary care
  • Preventative care

Coverage is offered to vets who have completed 24 consecutive months of service and have received an honorable discharge.

National Association of Mental Illness (NAMI) Helpline
This is a helpline that provides assistance to individuals who suffer from mental illnesses of any kind. Operated entirely by volunteers, information is constantly provided regarding services and treatment options.

The Health Insurance Portability and Accountability Act (HIPAA)
Initially passed in 1996, HIPAA imposes strict restrictions on health insurance providers. For more information, you are encouraged to visit the official website of the United States Department of Labor.

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