What You Need to Know:

Many colleges and universities in North Carolina require students to have health insurance and offer student health insurance plans to enrollees.

If you don’t purchase the school’s student insurance plan and the college you attend requires it, you’ll need to submit a waiver that shows you have adequate coverage.

You can stay on your parents’ health plan until you’re 26, or you can purchase an individual plan just for you.

If you’re heading off to college, North Carolina has many health insurance options to help you get the coverage you need. They include:

• Plans available through the Federal Health Insurance Exchange
• Short-term health insurance
• Catastrophic coverage
• Medicaid
• Children’s Health Insurance Program (CHIP)

Figuring out which plan is right for you depends on multiple factors, including your income, whether you have a preexisting health condition, the amount of coverage you want and more. Here are some things you should know about health insurance options for North Carolina students to help you select the plan that’s best for you.

Why Do North Carolina Students Need Health Insurance?

Many North Carolina schools require students to maintain health insurance during the academic year.¹ But even if your college or university doesn’t, having adequate coverage can help you avoid having to pay high medical bills if you need to be treated for an illness or injury while you’re at school.

Without health insurance, you’re responsible for paying 100% of your medical bills  —  whether you see a physician, need a prescription medication, or have to receive emergency care. If you’re covered, you’ll pay just a fraction of the total cost of your medical bills, which could save you a lot of money.

What to Consider When Searching for Student Health Coverage in North Carolina

Want to purchase health insurance before you start school? Here are some things to think about as you search for the plan that best meets your needs and budget.

Will You Attend School In State or Out of State?

If you live in North Carolina, you shouldn’t have a problem finding a doctor who accepts your existing insurance plan. But if you come from out of state, it’s important to find out if there are providers near your school that accept your current health insurance. If you see a healthcare provider or go to a hospital that doesn’t accept your health insurance, you might get stuck owing the whole bill — even though you have coverage.

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Can Someone Claim You as a Dependent?

In general, a parent or guardian can claim you as a dependent under two conditions:

• If you’re under age 19, or
• If you’re a full-time student under age 24 and live with your parents when you’re not at school.²  

Keep in mind if someone can claim you as a dependent, you won’t be eligible for federal subsidies — no matter how much money you make. This rule applies if you purchase an individual plan through the federal Health Insurance Marketplace.³ 

Will You Stay on Your Parents’ Plan or Enroll in your Own Plan?

You can remain on your parents’ employer-based or Marketplace health plan until you’re 26.⁴ Or, you can purchase your own insurance separately.

What Plans Are Cheaper?

The price of health insurance varies significantly depending on what policy you choose. Medicaid and Children’s Health Insurance Program are the least expensive options but are only available to qualifying low-income individuals.⁵  According to the current guidelines, a family of four with a monthly income of $2,904 to $4,607 would be considered low income.⁶

If you don’t qualify for Medicaid or CHIP, you may be eligible for a tax credit to lower your monthly health insurance premium on a Marketplace plan. You may also qualify for cost-sharing reductions that reduce your out-of-pocket expenses when you receive medical care.⁷

If you’re strapped for cash and can’t fit a Marketplace plan into your budget, consider short-term insurance or catastrophic coverage. While these types of plans typically have low monthly premiums, they offer less coverage.

What Plans Offer Better Health Insurance Coverage?

Qualifying health plans under the Affordable Care Act (ACA) offer the most comprehensive coverage and are required to cover 10 essential health benefits, including emergency care, pediatric services, prescription medication, maternity care and more.⁸ These plans are typically the most expensive ones you can buy, but many people qualify for a premium tax credit or subsidy that makes them more affordable.⁹

You could also buy a private health insurance plan directly from an insurer. Covered services vary by plan. So review the available benefits carefully. When choosing a policy, remember plans with lower monthly premiums typically have higher out-of-pocket costs. Plans with higher monthly premiums have lower out-of-pocket costs.

What If You Skip Health Insurance?

If you choose not to buy health insurance, you may not be able to attend the school of your choice. You could also put your finances at risk. Without health insurance, you’re responsible for paying for all of your medical bills out-of-pocket.

What Are Health Insurance Rules in North Carolina?

North Carolina doesn’t have a state exchange where residents can purchase health insurance.¹⁰ You can enroll in a health insurance plan on the federal exchange at healthcare.gov or through a certified partner website.¹¹

How Do You Get Covered Under Your Parents’ Plan in North Carolina?

If you’re under 26, your parents can cover you on their Marketplace or employer-sponsored plan, whether you’re going to school in state or out of state.¹² If you’re already on their plan, you can stay on it. If not, your parents can add you during an Open Enrollment Period, which typically lasts from November 1 through January 15. They may also be able to add you afterward during a Special Enrollment Period if they meet certain criteria, such as losing a job or moving to a new residence.  

If you’re on your parent’s Marketplace plan, you’ll be covered until December 31 of the year you turn 26.¹³ If you have coverage through their employer’s health insurance, you can typically remain on the plan until you turn 26. However, it’s a good idea to have your parents call the insurance carrier or their employer’s benefits departments to confirm your eligibility. Why? The plan may have different rules.¹⁴ 

How Do You Get Covered Under Your School Plan in North Carolina?

All eligible students who attend one of the state’s 17 University of North Carolina (UNC) System colleges or universities¹⁵ must have health insurance.¹⁶ You can enroll in the UNC System Student Health Insurance Plan, which is administered by Blue Cross Blue Shield of North Carolina (BCBSNC), or purchase health insurance from a different provider.^{17 18}

If you don’t enroll in the Student Blue plan, you must submit a waiver request for each semester you attend school.¹⁹ If you waive student health coverage, you must provide proof that your plan meets the school’s minimum requirements, and your policy must be effective by September 1 for the fall semester and February 1 for the spring semester.²⁰

Private universities in the state, such as Duke and Wake Forest, also have a student health insurance requirement.^{21 22} Like UNC’s public university system, both schools offer Student Blue insurance through BCBSNC. Students may also submit a waiver if they choose to purchase a different plan.^{23 24}

While you’ll need to make sure the coverage you have meets the requirements of the school you’re attending, you don’t have to worry about paying a penalty if your plan isn’t considered qualifying coverage under the ACA (often referred to as Obamacare). In 2017, Congress passed a tax bill that took effect in 2019 and eliminated the penalty that was originally part of the ACA.²⁵

How Do You Get Covered Through the Affordable Care Act in North Carolina?

In general, there are two ways you can get coverage through the ACA. Your parents can add you to their Marketplace plan or you can purchase an individual plan through the Marketplace. 

Remember, if your parents can claim you as a dependent and you get an individual plan, you won’t be eligible for federal subsidies that could reduce the cost of your premium.²⁶

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How do You Get Covered through Medicaid or CHIP in North Carolina?

Both programs offer free or low-cost health insurance to children and teens in North Carolina. Medicaid is available to people age 21 and under.²⁷ The Children’s Health Insurance Program is available to children ages 6 to 18.²⁸ Income and age determine eligibility for both programs.

How do you apply? There are three ways:^{29 30} 

• Online on the state website.
• In person at your local Department of Social Services
• Mail an application to your local Department of Social Services

What Are Other Options for Coverage in North Carolina?

If you don’t qualify for Medicaid or CHIP and can’t afford a traditional health plan through the Marketplace, you have two other options: catastrophic coverage or short-term insurance.

You can buy catastrophic coverage on the North Carolina Marketplace at healthcare.gov.³¹ These plans have high deductibles, which means you’ll have to pay several thousand dollars before the plan will start covering medical expenses. However, catastrophic coverage does pay for three primary visits each year even if you haven’t met your deductible. It also covers some preventive services, such as vaccinations and health screenings, at no cost.³²

North Carolina offers short-term plans meant to be temporary until you can get coverage under a traditional plan. It’s available for up to 3 months with a 1-month extension. Unlike plans purchased through the Health Insurance Marketplace, short-term health insurance is not required to include the 10 essential health benefits outlined in the ACA, and it generally doesn’t cover preexisting conditions. Unlike plans purchased through the Marketplace, short-term health insurance doesn’t need to meet the essential service requirements outlined in the ACA, and it generally doesn’t cover preexisting conditions.³⁴

What Are Resources for North Carolina Students?

If you’re looking for student health insurance and you’re not sure where to start, here are a few resources to help with your search:

• UNC System colleges and universities
• The federal Marketplace at healthcare.gov
• Certified partner websites
• North Carolina Medicaid and CHIP 

Next Steps

Since many schools in North Carolina require students to have health insurance, it’s a good idea to start planning now. Do your research and compare your school’s student health plan (if it offers one) with other options before you get to campus. It’s important to find a plan that provides the coverage you need at a price you can afford.