Key Considerations for Selecting a Health Plan this Open Enrollment Season
In Partnership With Blue Cross and Blue Shield of North Carolina
In Partnership with Blue Cross and Blue Shield of North Carolina
Health insurance can be complicated. Whether someone is purchasing health insurance for the first time or simply needs some help navigating the Health Insurance Marketplace®, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is here to help. When selecting a plan, it’s important to consider costs and coverage, and understand when to enroll.
Consider total health care costs
When shopping for a plan, there are two types of costs to consider – the plan premium, or the amount an individual pays to their insurance company each month, and out-of-pocket expenses, like copays, deductibles and any other costs not covered by their insurance plan.
Individuals should calculate what they can afford for premiums, deductibles, and out-of-pocket costs. Remember, health insurance can help avoid unexpected and potentially devastating medical expenses. No one plans to become sick or have an accident that requires expensive care.
In addition, many individuals qualify for savings or a subsidy on their monthly premiums based on income. About 86% of Blue Cross NC’s current customers with individual Affordable Care Act (ACA) plans qualify for subsidies for their 2025 plans. Subsidies vary by plan and household income. The federal American Rescue Plan Act (ARPA) expanded these subsidies to more individuals, lowering premiums to no more than 8.5% of customers’ household incomes. In 2022, these expanded subsidies were extended for three years, through the federal Inflation Reduction Act (IRA). For more information on subsidy eligibility, visit bluecrossnc.com/shop-plans/health/subsidies.
Understanding coverage
Individuals should consider their personal health needs and the amount of care they typically use. For example, a bronze plan is good for those who want protection from worst-case medical scenarios, like a serious illness or injury. This type of plan can have low monthly premiums but covers less. A silver or gold plan will have higher monthly premiums and cover more routine care and regular prescription drug costs.
Individuals that have a preferred doctor or hospital should make sure they are covered in the plan’s network. When someone sees the same provider regularly, they can get to know each other and feel more comfortable when they need something.
In 2025, Blue Cross NC will continue to offer its broad network preferred provider organization (PPO) plan, Blue Advantage®, in every county of the state[2]. And in Charlotte, Blue Cross NC is collaborating with local health systems to offer Blue LocalSM and Blue HomeSM plans that feature a smaller network of high-quality providers, at a lower cost than a similar broad network PPO plan. These plans’ average monthly rates are $100 to $200[3] lower than similar PPO plans. In addition, Blue Cross NC will offer Blue Care® , a health maintenance organization (HMO) plan, in select counties to give individuals more choices for in-network providers, doctors, facilities and hospitals in North Carolina.
For those who don’t go to the doctor often, that’s OK. Blue Cross NC has tools to help individuals select an in-network Primary Care Physician.
When to enroll
For individuals under age 65, Open Enrollment for ACA plans began on November 1, 2024, and will end on January 15, 2025. Individuals purchasing health insurance through the marketplace must select a plan during Open Enrollment, which begins every year in November. To ensure coverage for 2025, individuals should enroll by January 15.
For individuals with qualifying life events, such as job changes, marital status updates, moving or having a baby, special enrollment periods are available. Visit bluecrossnc.com/members/knowledge-center/special-enrollment-period for more information regarding special enrollment period requirements.
For more information about Blue Cross NC plans, visit bluecrossnc.com/shop-plans/health.
