These insurance companies offer plans compliant with the Affordable Care Act in NC:
BlueCross BlueShield of North Carolina, a.k.a BCBSNC
BCBSNC is the only insurance company that offers plans that are compliant with the Affordable Care Act (a.k.a. ACA) in all NC counties. They have 5 medical provider networks which are Blue Advantage, Blue Value, Blue Local and Blue Home. The Blue Advantage network has the largest medical network in North Carolina. The county you live in determines which provider networks are available.
Referrals are not required to see a specialists. Telehealth care options are available for behavioral and physical health 24/7.
Aetna CVS
In network hospitals are Mission Health, Atrium Health, CaroMont Health, Cone Health, Wake Forest Baptist Health, Duke Health, WakeMed, Cape Fear Valley Health and Vidant. Visit www.aetnacvshealth.com for additional information and to search providers.
North Carolina (Asheville, Charlotte, Eastern NC, Fayetteville, Triad and Triangle):
- Access to one state-wide network in 70 counties across the state.
- HMO (Health Maintenance Organization) PCP referrals are required
- Premium Payment in CVS Retail Locations
Ambetter Health Insurance
Ambetter Health Insurance offers HMO (Health Maintenance Organization) plans in Alamance, Alexander, Allegahany, Bladen, Caswell, Chatham, Cumberland, Davidson, Davie, Durham, Forsyth, Franklin, Granville, Guilford, Lee, Harnett, Hoke, Iredell, Johnston, Montgomery, Moore, Lee, Orange, Person, Randolph, Richmond, Robeson, Rockingham, Sampson, Scotland, Stokes, Vance, Wake, Warren, Wilkes and Yadkin Counties. This means if you go to an out of network provider the insurance company will not pay for your medical services unless they are coded as an emergency. Ambetter does not require you have a referral from your PCP (Primary Care Physician) before you visit a specialist. Duke and Wake Med hospitals are in-network with Ambetter. To determine if your medical providers and preferred hospitals are in their provider network speak with your agent or go to their website www.ambetterofnorthcarolina.com.
Their plans include:
Myhealthpays Rewards, which allows policyholders to earn up to $500 for health activities like getting a flu shot, having a wellness exam and completing an Ambetter Wellness survey. The rewards are given in the form of a prepaid Visa card and can be used to pay premiums, co-pays or buy food at Walmart.
Telehealth, which is a 24-hour phone or video access to in-network providers for non-emergency health issues.
Amerihealth Caritas
Amerihealth Caritas offers HMO policies Alexander, Alleghany, Ashe, Avery, Buncombe, Burke, Caldwell, Catawba, Cherokee, Clay, Davidson, Davie, Forsyth, Graham, Guilford, Haywood, Henderson, Iredell, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Randoph, Rockingham, Rutherford, Stockes, Surry, Swain, Transylvania, Watauga, Wilkes, Yadkin and Yancey counties.
Wake Forest Baptist, Mission, Duke LifePoint and Iredell hospitals are in network with Amerihealth. Amerihealth offers extra benefits like a Health Rewards Card and free Weight Watcher memberhips.
Cigna
Cigna offers HMO plans in the Raleigh/Durham area in Alamance, Durham, Franklin, Granville, Johnston, Lee, Orange, Person, Vance, Warren and Wake counties. With their rural expansion they also offer plans in Montgumery, Moore, Richmond, Scotland, Hoke, Robeson, Cumberland, Harnett, Bladen, Sampson, Duplin, Onslow, Wayne, Greene, Wilson, Pitt, Edgecomb, Nash, Halifax, Northampton, Hertford, Gates, Chowan, Perquimans, Pasquotank, Camden, Currituck, Bertie, Martin, Cateret. Jones, Pamilico, Craven, Lenoir, Beaufort, Hyde, Dare, Tyrell, Washington, Cherokee, Graham, Clay, Macon, Swain, Jackson, Translyvania, Haywood, Madison, Buncombe, Henderson, Polk, Rutherford, McDowell, Yancey Mitchell, and Avery counties.
Oscar Health Insurance
Oscar offers HMO policies in the Asheville area. Their service area includes Buncombe, Haywood, Henderson, Madison, Transylvania, Macon, McDowell, Jackson, Polk and Yancey counties. In network hospital include Mission, Angel, Highlands-Cashiers and Transylvania.
United Healthcare Insurance
Offers HMO policies that may or may not require policy holders to get a referral before a visit to a specialist. They offer plans in Alexander, Bladen, Brunswick, Buncombe, Burke, Caldwell, Columbus, Cumberland, Durham, Franklin, Guilford, Harnett, Haywood, Henderson, Hoke, Iredell, Jackson, Johnston, McDowell, New Hanover, Orange, Pender, Randolph, Richmond, Robeson, Rutherford, Sampson, Scotland, Transylvania and Wake Counties. In network hospitals include Advent Health Hendersonville, Angel Medical, Annie Penn, Betsy Johnson, DLP Rutherford Regional, Haywood Regional Memorial, Harris Regional, Highlands Cashiers, Highpoint Regional, Johnston Memorial, Margaret R.Pardee Memorial, MH Mission, Moses Cone, Randolph Health, Rex, Translyvania Regional and UNC.