Coverage Basics

Learn More, Get Covered

Financial Help | Enrollment Assistance | What plans cover | Plan Selection.

Accessing affordable, high quality health insurance in North Carolina is easier than ever. Under the new health law, all Americans have new rights, new benefits, and new responsibilities. Individuals and families can shop, compare, and select a health insurance plan using the federal Health Insurance Marketplace at www.healthcare.gov.

Over 90 percent of those who have signed up have received financial assistance.

For coverage starting in 2015, the Open Enrollment Period is November 15, 2014 – February 15, 2015. You must enroll by December 15, 2014 for a plan to start January 1st, 2015. You will be able to create an account, apply for financial assistance, compare plans, and enroll in coverage. You can even get local in-person assistance with your application. A network of certified enrollment experts covers the entire state.

Renewals: For individuals renewing coverage, be sure to go online and update your information – you may have access to a new plan or your financial assistance may change.

Estimate financial assistance

Individuals and families can get help paying for their coverage. Financial help for individuals and families includes tax credits to help pay for private health insurance on a monthly basis, or no-cost coverage through North Carolina’s Medicaid and Health Choice for kids.

To qualify for help, you must be a resident and U.S. citizen or legal immigrant. The type and amount of financial help you receive is based on household income, family size, and age. Learn more about financial assistance. 

Get help with your application

North Carolina’s network of certified in-person assisters and community partners can help you with your application – absolutely free. You can call the North Carolina In-Person Assister Hotline to schedule an appointment, or make an appointment online.

Visit our Enrollment Checklist page for the full list of steps.

 

Choose a plan that works for you

Select a plan that works for you. Check out our comprehensive guide here.

Every plan offered through the Marketplace covers essential health benefits, including doctor visits, hospital stays, maternity care, emergency room care, prescriptions, preventive care, mental health services, vision coverage for kids and more. Some plans even cover alternative care. And you'll be able to compare plans side by side so you can make the best choice for you.

Individuals and families can:

  • Get health insurance if you have a pre-existing condition
  • Search for plans that cover your current doctors and other health providers
  • Compare plans by cost, benefits, carriers, and more
  • Apply for help to pay monthly health coverage costs (premiums)

Health plans offered on the Marketplace are required to offer the same minimum set of coverage services, known as essential health benefits.

Essential Health Benefits

The essential health benefits include at least the following items and services:

  • Ambulatory patient services (care without being admitted to a hospital)
  • Emergency services
  • Hospitalization (such as surgery)
  • Pregnancy, maternity, and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services
  • Additional benefits

Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.

Additional benefits include:

  • Birth control benefits
  • Breastfeeding benefits
  • Dental coverage