Short-Term Health Insurance in North Carolina

Whether you’re moving to North Carolina or you already live there and find yourself without healthcare coverage, you’re probably wondering how to get health insurance during this transition.

That’s when short-term health insurance — which in North Carolina is defined as coverage that lasts less than 12 months, with the option to renew for up to 36 months — may be something to consider.¹

Is North Carolina Short-Term Health Insurance Right for Me?

Here are some pros and cons about short-term insurance to keep in mind as you weigh up the best option for your healthcare needs and budget:

Pros:

• Temporary plans are often less expensive than plans you get through the Affordable Care Act (ACA) Health Insurance Marketplace. They’re designed to have a low premium (although your deductible may be high; more on those costs below). So if you’re in good health and don’t anticipate needing medical care, this may be the most affordable option. (If you missed the Open Enrollment Period to sign up for a Marketplace plan, you could still qualify for what’s called a Special Enrollment Period if you have an exception, such as having a baby, getting married or losing your coverage.)²
• It’s easy to sign up for a short-term plan and get coverage quickly. That’s especially helpful if you missed out on the ACA Open Enrollment deadline to enroll in your state, or you’re waiting for a new employer’s health insurance to start. With a short-term plan, you’ll have some coverage almost immediately in the event of a medical emergency.³ 

What You Need to Know

Temporary plans are often less expensive than plans you get through the Affordable Care Act (ACA) Health Insurance Marketplace. They’re designed to have a low premium (although your deductible may be high; more on those costs below)

If you have a preexisting condition or a chronic condition that requires frequent doctor’s visits and medical procedures and/or medication, a short-term plan may not be ideal.

In North Carolina, there are also several state-specific requirements for temporary health plans.

Cons:

• If you have a preexisting condition or a chronic condition that requires frequent doctor’s visits and medical procedures and/or medication, a short-term plan may not be ideal. That’s because the high deductible for a short-term plan means you may need to pay a lot yourself before your insurance carrier will start paying. Also, some insurers offering short-term plans don’t cover people with a preexisting condition.⁴ 
• Short-term plans don’t cover all 10 “essential health benefits” that must be included in any plan you buy through the ACA Health Insurance Marketplace, which in North Carolina is operated by healthcare.gov. If you need these benefits, you may want to go with an ACA plan, even though the premiums will be higher.⁵
• There may be limits on what your short-term plan will cover even if you’ve met the deductible. For example, if your policy has a $300,000 limit and the cost of your care goes beyond that, you’re responsible for the balance.⁶

People who choose a temporary plan are often in one of these situations:

• You’re switching jobs and/or waiting for benefits to begin at a new job (by federal law, this waiting period may be as long as 90 days),⁷
• You’re waiting for your ACA coverage to start. The Open Enrollment Period is usually in the fall, but actual coverage doesn’t start until the following January 1.
• You’re turning 26 and aging off your parents’ plan and need coverage. 
• You missed the Open Enrollment Period and need coverage until enrollment opens again.
• You need coverage but don’t qualify for Medicare, Medicaid or disability coverage.
• You’re retiring but haven’t reached the age at which Medicare will cover you.⁸

In North Carolina, there are also several state-specific requirements for temporary health plans. These include:

·  Coverage of a minimum in-patient hospital stay of 48 to 96 hours after giving birth, if the plan provides maternity coverage benefits.

·  Coverage for inpatient care following a mastectomy.

·  Coverage for emergency care without prior authorization.

·  Provisions for grace periods, reinstatements, payment timeframes, and claims information must be included in your policy.

·  All clinical treatment options must be discussed with the patient.⁹

How Much Do Short-Term Health Insurance Plans Cost in North Carolina?

The cost of any plan you choose will vary depending on the terms of your  coverage.

All plans include four main expenses:

·  Premium: The amount you pay monthly to keep your coverage.¹⁰

·  Deductible: The total you spend out-of-pocket on covered healthcare expenses before your plan’s coverage kicks in. After you reach your deductible, you usually pay only a copayment.¹¹

·  Copayment: A set cost you pay for medical services after reaching your deductible.¹²

·  Coinsurance: After you’ve met your deductible,you’re responsible for a percentage of your healthcare costs; this your coinsurance. Your insurer pays the rest. Depending on your medical expenses and the plan you’ve chosen, this can end up being a significant cost.¹³

It’s important to know all of these figures, but coinsurance in particular can be an unexpected cost. Don’t assume that all your costs are covered after you meet your deductible; be sure you understand what percentage you’re still responsible for. 

For example, let’s say your doctor orders an MRI for you and it costs $2000. Your coinsurance is 20%, but you haven’t met your deductible for the year — perhaps you still have $1000 left to pay to meet it. So you would still need to pay that amount ($1000) plus 20% of the remaining amount of the cost of the MRI ($200 of $1000, your coinsurance). Your total out-of-pocket cost would then be $1200 for the MRI.

Some insurance companies offer coverage that does not include a copayment for urgent care, specialist or primary care visits. In that case, you would need to pay the full amount for each visit until you reach your deductible. However, a plan that may have a slightly higher monthly premium may have a copayment option. So if you see a doctor more often, you’re likely to end up saving money in the end.

Although no one can predict an injury or illness, considering all these variables can help you figure out what your out-of-pocket costs are likely to be. That makes it easier to compare different plans and understand what might be the best fit for you and your budget.

How Can I Buy Short-Term Insurance Plans in North Carolina?

As mentioned above, North Carolina residents can buy a short-term plan with coverage for up to 12 months and have the option to renew coverage for a total duration of 36 months. You can buy a plan directly from an insurer or use a broker who can help you compare plans.

Insurers that offer short-term plans in North Carolina are:

• Companion Life
• Everest Prime
• Independence American Insurance Company
• LifeShield GAP plan
• National General
• United Healthcare/Golden Rule

Next Steps  

Although short-term health insurance isn’t a one-size-fits-all solution, it can be helpful for those who need health coverage for a short period of time. And it can give you peace of mind that if an emergency or a serious illness should happen, you’ll have some protection from medical expenses. Just be sure to read your policy very carefully before you buy so you know exactly what’s covered and what’s not.