Health Insurance Plans

The best option for the vast majority of North Carolinians without employer-sponsored health insurance, including those who are self-employed, is enrolling in plans through the Marketplace created by the Affordable Care Act.

The Affordable Care Act, or ACA, was designed to give individuals and families greater access to affordable health insurance options that may not be available otherwise unless offered through an employer. ACA legislation created the Marketplace, which is where you can enroll in coverage either independently or with the help of an agent.

It depends on a variety of factors. Unfortunately, there is not a one-size fits all answer to this question. Your monthly cost, or premium, is most heavily determined by whether or not you get a subsidy. Additionally, factors such as number of applicants, age and location play a major role. The best way to determine cost is to get a quote or speak to one of our agents.

Subsidies are what makes the Affordable Care Act plans affordable. To put it simply, a health insurance plan that is subsidized has a cost that is either partially or entirely paid for by the government based on a variety of factors. The size of the subsidy is determined by income, household size, age and location. The only way to truly know your cost is to get a quote or speak with one of our experienced agents.

To get a subsidy you cannot:

• Be offered coverage through an employer or a spouse's employer.
• Make greater than the 400% of the Federal Poverty Limit.

To get a subsidy you must:

• File taxes annually and estimate on your application an adjusted gross income above the poverty line.
• File taxes with your spouse if you are married.
• Be a legal citizen of the United States.

To find out if you qualify for a subsidy, get a quote or speak with one of our experienced agents.

Not at all! You will still receive your full tax return like any other year as long as your application is submitted correctly.

Prescriptions ARE covered under the ACA plans, but at varying levels. If you have prescriptions to take every day, the Gold plan in most cases is going to be the option that saves you the most money long-term. Each situation is different however, and it is important to decide what is best for YOU.

A health insurance premium is the monthly subscription cost to be enrolled in coverage.

A deductible is the cost threshold of qualified expenses that must be met before the insurance company will start paying for expenses.

For example, with the Gold 3000 plan ($3,000 deductible):

• An elective surgery costs $8,000 - the first $3,000 is paid out of pocket and the insurance will pay 80% of the remaining $5,000 that is due. The total cost is $4,000 of the $8,000.
• An elective surgery that costs $16,000 – the first $3,000 is paid out of pocket and the insurance will pay 80% of the remaining $13,000 that is due. The total cost is $5,600 of the $16,000.

Coinsurance is the percentage of qualified costs that the insurance company pays after you meet your deductible. It varies by policy. After the deductible is met:

• Bronze - 60%
• Silver - 60%
• Gold - 80%

Copayments are what you are required to pay to see a doctor or specialist. It is a fixed amount that varies depending on your policy. 

• Bronze - Primary care doctor - $45 ; Specialist/Urgent Care - $115
• Silver - Primary care doctor - First three visits free, then $50 ; Specialist/Urgent Care - $150
• Gold - Primary care doctor - First three visits free, then $5 ; Specialist/Urgent Care - $30
• *Some may qualify for an enhanced plan with even lower copayments. Get a quote and see if you qualify.

An out-of-pocket max (OOP) is the absolute maximum that an enrollee will have to pay in qualified expenses in one calendar year.

The only expense that doesn’t qualify to count towards the out-of-pocket max figure is copayments at doctors' offices. Prescription costs DO count towards the OOP Max.

For example, with the Gold 3000 plan ($8150 OOP Max):

• An elective surgery costs $28,500 – the first $3,000 is paid out of pocket and the insurance will pay 80% of the remaining $25,500 that is due. The total cost is $8,100.
• An elective surgery costs $30,000 – the enrollee pays a total of $8,150.
• An elective surgery costs $100,000 – the enrollee pays a total of $8,150 .

• Dates of birth for all applicants
• Number of household members
• Total household income
• Phone number or email address
• Zip code and county for your home address
• Get a quote

• Names of all in household
• Dates of birth of all in household
• Address
• SSN of all applicants
• Household income information
• If naturalized, all immigration documentation
• Apply now

Enrolling in health insurance can be extremely confusing and time-consuming. If even one item or question is answered incorrectly, you could end up paying more than you need to every month or have to restart the application from scratch. Enrolling through an agency removes a lot of the stress and makes signing up easier.

Additionally, throughout the year we offer aid in policy maintenance to ensure your coverage stays intact. The health insurance Marketplace and BlueCross will both be frequently sending letters and emails and you may have questions. If you enroll at FNB, we will help you understand what’s going on and personally reach out to you if a problem arises to be sure that your coverage is there when you need it most. What we offer is peace of mind.

Lastly, we are your contact if you need to make any changes or ask questions about how best to utilize your policy. Having access to our staff will save you time, energy and possibly money. If you enroll with us, we become your resource to ensure you’re getting the maximum benefit from your health insurance plan for as cheap as possible.

As always, the answer to this question is "it varies." While the gold plan is generally much pricier, there are some major benefits to consider:

• Prescriptions – There is a $500 difference in the prescription deductible translating to a direct cost savings off the top. Additionally, after meeting the deductible, the Gold Plan’s cost for basic prescriptions is about half that of the Bronze (tier 1 and tier 2.)
• Specialists/Urgent Care – Every visit you will save $85.
• Surgeries – The $4,500 deductible and 20% coinsurance gap makes a massive difference. For example, a $10,000 surgery would cost $8,150 on a bronze plan but only $4,400 on a gold plan.