ACA Plans for NC in 2021

In North Carolina for 2021, there will be five  ACA compliant health plans to choose from. They are BCBSNC, Ambetter, Cigna, Bright Health and Oscar. They each have a selected set of counties that they are available in. They are all aligned with very specific networks of care.

Choosing the right plan takes some time. Everyone has different needs. Not all the information is easy to understand at Agents you call at know nothing more than what you can see for information. They are not agents in NC.  They do not know the nuances of each companies plans and networks. It is easy to choose the wrong plan. Price is not always the best way to buy health insurance. Use costs are very important to consider.

Health insurance agents at Health Plans Carolina are free to use. We are authorized with all the major carriers. We do understand the nuances of the networks. The price is the price whether you enroll yourself or we do it for you. We make sure you stay enrolled. Let us help you make the right decision the first time!

New Plans In Wake and Durham counties for 2021

This year in Wake and Durham counties, BCBSNC is still no longer associated with Duke and Wake Med hospitals. They are out of network and very expensive to use. The network for BCBSNC is the UNC Physicians Health group in association with REX hospital. This is a limited network.

Bright Health will be the new company in the Triangle. They will be using the Duke/Wake Med and Wake Community partners networks. They will be a direct competitor to Ambetter but will have a larger network. They started in the Charlotte,Winston Salem, Greensboro area in 2020 and are expanding here for 2021. This should be a strong launch into the Triangle this year!

Returning in 2021 is Ambetter. They are owned by Centene, the largest provider of ACA insurance plans in the country. Their network includes the Duke and Wake Med Hospitals and doctor groups. This is a larger network than BCBSNC in the Triangle but smaller than Bright’s . Ambetter is also expanding out of the Triangle into new counties for 2021.

Cigna will still be in the market in more counties with the UNC network only. They promise aggressive rates for 2021.  Oscar is entering the NC market but only in Asheville.

Health Plans Carolina are active agents for all four companies. Let us help you navigate this new and changing landscape for 2021. Not all relevant information is publicly listed on the website. Agents are free to use, the price is the same no matter how you buy. Let us make this decision a much more informed one and a much easier process to enroll. Agents Rock!

AEP (Annual Enrollment Period) for Over 65 Medicare Advantage Plans is Underway

The AEP or Annual enrollment period for Over 65 health insurance is underway. It starts Oct 15th and ends on December 7, 2019 for any 2020 changes. This is the only time of the year you may make changes to your Medicare Advantage health plans or Part D drug plans without a special circumstance for 2020.

It is important even if you like your plan, to take a few minutes and review the plans for any network or pharmacy changes. Call us and we can quickly review your plan and make sure you are on the best plan possible for your individual needs.

Turning 65 and Still Working???

This is a great article about the pros and cons of signing up for Medicare at 65 if you are still working. Thanks Benefit Pros!

For most Americans, Medicare coverage starts at age 65, at which time every covered person qualifies for Part A, which pays most hospital costs. The vast majority of 65-year-olds also choose to pay a premium (currently $104.90 per month for most people) for Part B. Getting the “Medicare card,” which documents coverage in Parts A and B, is a prerequisite for choosing the rest of the retirement health care safety net including Part C (Medicare Advantage), Part D (Prescription Drug coverage), and Medigap supplemental insurance.

There can be a significant disadvantage to not paying the Part B premium starting at age 65 – namely, the premium can automatically increase by 10% for each year of delay.

However, before advising all clients to begin Medicare at age 65, you should be aware of an important exception. If the client continues to work and has employer-provided health care coverage at age 65, there is no need to enroll in Medicare and pay the Part B premium. If there is overlapping coverage (employer health insurance and Medicare) and if the employer has more than 20 employees, the employer-provided plan generally pays claims first, ahead of Medicare. So, Medicare coverage becomes redundant.

Recognizing this, the federal government allows a person who continues working after age 65 to sign up for Part B at any time that there is employer-provided health insurance, without being subject to the 10% annual Part B premium increase.

Some companies offer their retired workers retiree health insurance coverage or COBRA coverage. It’s important to note that these do not qualify for the exception to the Part B delay. The coverage must be in the employer’s regular health insurance plan for active workers.

If Part B is declined at age 65, there is no need to notify Medicare. However, there also is a procedure that people who keep working after age 65 should follow, at the time they either stop work or choose to start Part B coverage, to prove to Medicare that they’ve had valid employer-provided health insurance.

Within eight months after ending employment, the worker must file with Medicare twoforms, an Application for Enrollment in Part B and a Request for Employment Information, which verifies that employment continued beyond age 65.

To avoid the 10% annual increase, which can be retroactive back to age 65, these forms must be filed within eight months after employment ends, even if the retiring worker chooses to extend employer coverage under COBRA. Medicare has summarized the procedure.

When your clients are approaching age 65 and still working, it’s a good idea to evaluate healthcare options several months before the 65th birthday. In some cases clients may want to stop paying out-of-pocket premiums for employer coverage and choose Medicare instead. In other cases they can avoid premiums for Parts B, C, D and Medigap by continuing employer coverage as long as they keep working – and then proving to Medicare that work and employer coverage continued after age 65.

Additionally, if you are on highly subsidized health insurance plans, your costs may go up significantly! Always best to talk to an independent health insurance agent first to review all your option

Reprint courtesy of :

Benefits Pro (             Aug 31, 2016 | By Rich White

A Well Written Perspective on the ACA Obamacare..

I could not have written this better so I am reprinting Patrick Tomlinson’s post in it’s entirety…. Thank you Patrick.

A well written perspective on the ACA Obamacare…. by By Patrick Tomlinson, contributor; published in The Hill  on 8/23/2016

Since 2002, I’ve been a licensed Life and Health agent. For the majority of that time, my focus has been on health insurance for the senior market, Medicare supplements, prescription drug plans. I’ve spent more than a decade doing my best to match plans to my client’s needs and budget. I’ve worked for years learning all the ins and outs of our private, for-profit healthcare system, dealing with bottlenecks on both the insurance and provider side of the coin as I tried to be an effective advocate for my clients’ health.

I have been in the business long enough to see the creation of George W Bush’s Medicare Modernization Act and the implementation of Medicare Part D and Medicare Advantage plans. And now I’ve seen the transition from the Affordable Care Act’s rocky early days to the surprisingly popular and robust system that is today. It’s from this foundation of professional knowledge and experience which I’d like to address the obstructionist Republicans in Congress and in statehouses across the country, as well as “C” level executives in boardrooms at companies like Aetna, all of which seem to be involved in a coordinated attempt to sabotage the ACA and drag us back to the broken free-for-all which preceded it.

You just don’t get it.

The ACA is, at its core, a 30-year-old conservative proposal. Its roots date all the way back to Richard Nixon’s administration, who was the first to propose an employer mandate. It was expanded in the early 90’s by the conservative Heritage Foundation, which proposed the individual mandate as well as a penalty for nonparticipation and a low-income subsidy. It was embraced by Speaker of the House Newt Gingrich as an alternative to First Lady Hillary Clinton’s healthcare reform plan. And finally, a near carbon copy of it was signed into law in Massachusetts by Governor and future GOP Presidential candidate, Mitt Romney. This is the plan which in one form or another, conservatives had been clamoring after for more than three decades.

It is based on the free market, for-profit healthcare system of both insurance companies and healthcare providers. Indeed, it has empowered them both, swelling enrollment by millions and sending their profits soaring. Even as Aetna pledged last week to drop out of the healthcare exchanges in eleven of fifteen states, citing anticipated losses, their Q2 earnings topped $780 million.

There is nothing anti-capitalist about the ACA. It works in conjunction with the free-market healthcare system which has existed here since the beginning. It is also the very last chance that system has to prove it can work.

Last November, citizens of Colorado delivered over one hundred and fifty thousand signatures to place a referendum on the ballot to create a first-of-its-kind single-payer healthcare system which would encompass all citizens of the state. If passed, it would effectively end the private, for-profit model of healthcare in an entire U.S. state. And while it may seem radical now, so too did marijuana legalization, or same sex marriage a few short years ago (both of which have my full support). In the digital age, ideas like these don’t stay contained for long, and when they catch fire, very little can be done to slow their momentum.

I am a conservative. Which is why I support the ACA and want to see it succeed. Because I believe it is a reasonable compromise which curtails the worst abuses of the for-profit system, such as pre-existing condition exclusions and lifetime maximums, while encouraging people to take responsibility for addressing their own healthcare costs and stop passing costs off to everyone else through medical bankruptcy.

I worry about the expansion of government power into the private sector a single-payer system would represent. I worry about what would be an actual government takeover of some 20 percent of the economy. And I worry about the impact it may have on competition, and therefore medical and pharmaceutical innovation in our country.

Which is why I have for so many years put my full weight behind what has always been the conservative alternative. The ACA is the alternative. And if you keep encouraging the arsonists within the ranks of the GOP to burn it down, you are the ones ushering in single-payer.

The longer you oppose it, the longer GOP statehouses try to deliberately sabotage it by refusing

to set up state health insurance exchanges and refuse federal money for Medicaid expansion, and the more the corporate giants find ways not to insure the most vulnerable among us, the faster they put themselves out of business. If the ACA isn’t allowed to work, the day is fast approaching when average, everyday Americans band together and demand what nearly every other industrialized, first-world nation on Earth already provides for their citizens; universal, single-payer healthcare.

Because make no mistake, the alternative the American people will accept a few years down the road will not be a return to the cruel, broken, corrupt system which existed before the ACA’s protections took effect. It will be something much more like what Colorado has proposed. It will be the adoption of healthcare not as a luxury, but as a public utility just as essential as roads, schools, or police. And there won’t be an opportunity any longer to put profit above the health of the nation’s people.

Stop kidding yourselves. You’re trying to win this race by sawing off your own foot.

Tomlinson is an author and comedian. Follow him@stealthygeek.

The views expressed by Contributors are their own and are not the views of The Hill.

Turning 65 – Oh My!

Turning 65 for many means the beginning of your Golden Years. The first step is usually applying for Medicare. That is relatively easy. You contact Medicare directly and apply by phone or even online. Usually done same day. This may be complicated if you are still working and have group medical insurance. You will want to check with your employer first to see what your next steps should be.

Now that you have applied for Medicare Part A and B the confusion sets in! Medicare only pays for 80% on average of your medical bills and has no prescription drug coverage. This means you definitely want to add some additional coverage to reduce your financial risks. There are two different types of plans. Medigap or supplement plans or Medicare Advantage plans. They are very different options with pros and cons to each. We are lucky in NC to have so many wonderful choices. Understanding these plans will take some time. Once you have an idea what type of plan you want, then it is evaluating all the different company choices. Not an easy task even for us.

An independent insurance agent can be a great resource. We are free to use. The price is the price on these plans no matter how you buy them Why not make life easy and use an experienced agent to help you make this important decision. We will review your individual situation and advise you on the best type of plan for you as well as the best company for you in your area. We are also there down the rod when you have questions or problems.

You have seven months to make this important decision. Three months before your birthday month, the month of your birthday and three months after your birthday. After that you can only enroll or change plans during open enrollment season which is usually October 15th through December 7th.

Don’t be overwhelmed. Call an independent agent to help.


Individual Health Insurance for 2017

The outlook for 2017 is one that is very uncertain for individuals in NC who purchase their own insurance. United Health Care announced in November of 2015 that they would not be back selling under 65 individual health insurance on the ACA Marketplace for 2017. Aetna is announcing they will be back in 2017 with some expanded counties. BCBSNC has filed rates for the 2017 plan year, but also announced they are still unsure if they are going to be returning. They have until September 23, 2016 to make a final decision.

What does that mean to me? If you are in a BCBSNC only county and they do not return, you will have no insurance options for 2017! This will affect over 50 counties in NC. It is still very unclear how this is finally going to play out in NC. Stay tuned for more news as we get closer to the 9/23 deadline.


Marketplace is Closed for 2016 and Agents Are Fired

Sunday marked the end of the third Federal Open Enrollment and also an end to agents in the individual health market. As of April 2016, Blue Cross and Blue Shield of North Carolina (BCBSNC) announced that they will eliminate paying commissions for individual under-65 plans. Blue Cross is following the path taken by United Healthcare which announced that they would not pay brokers as of 1/1/2016. Aetna also ended commissions to brokers two weeks ago.

 Brokers have provided a valuable service to our clients in offering objective but thorough advice in choosing an individual health insurance plan in this complicated and ever changing market of health insurance options. I have become very close to many of my clients over the last three years. I am sad to see this career path come to such an abrupt end. We know this will make it very difficult for consumers going forward to have all the information they need to really make informed decisions. Unfortunately this is the path these companies have chosen. I am happy I was able to provide the help I could over these last three years.

As many of you know, I have an existing business Chicks Building Nest Eggs which I will now move into full time. I am excited about the incredible opportunities to teach my clients how to greatly increase their retirement income using tax free strategies. As the stock market enters a period of serious unrest, insurance offers a way to save safely for retirement without government control, and offers huge savings in taxes during retirement.


*UHC has stated that they will NOT be an option in 2017.

In 2016 You Better Shop Around!

This year finds three companies on the Health Insurance Marketplace in NC. BCBS of NC, Aetna/Coventry and United Healthcare. These are three major companies along with pretty equivalent plans.

BCBS of NC has discontinued open choice plans for doctors in the Triangle and in Charlotte. In their place are very focused limited network plans based around hospital networks. Blue Local in the Triangle is based on Wake Med/Duke.  Blue Value in the Triangle is based around UNC/Rex/Wake Med. They have also further limited doctors included in these two networks. BCBSNC no longer offers out of area coverage in NC in these new network plans except in a case of an emergency which is also true of the Aetna/Coventry product. United is in 100 counties. United is the lowest price generally with Aetna/Coventry closely competitive. BCBS is generally much higher especially in the Triangle.

There are many other differences especially involving prescription drug coverage as well. You need to work with  a qualified agent who works with all three companies to insure you truly pick the most affordable plan for your individual needs. Quotes can be done very quickly. Enrollment is easy because we take care of it. We are free to use because the price is the price no matter how you buy, so why not get the best advise you can find.

Remember coverage starts 1/1/2016. You need to enroll by December 15th to get this first start time. December 16th to Jan 15th, gets you a start date of Feb. 1st.  Jan 16th to the 31st gets you a March 1,2016 start date. The marketplace closes for 2016 on January 31st, 2016.



Higher Premiums- Less Networks -the New 2016 BCBS in the Triangle

BCBS NC is about to announce that all BCBS NC subscribers who buy their own insurance through the ACA Marketplace are going to be moved in to one of only two (2) LIMITED access networks for 2016.

There will now be only two (2) choices for BCBS members in the Triangle. Blue Local (Duke/Wake Med) or Blue Value (UNC/Rex/Wake Med) with Blue Value being more expensive. There are limited doctors in each of these plans. Many independent doctors will no longer be in either network.  If you choose to go to a non network doctor, you will pay out of network prices. Additionally with this big network change is also coming a big premium increase.

There are two other options in the Triangle. United Healthcare and Aetna/Coventry. We are anticipating both to be at lower premiums. Definitely a year to rethink all your options!

There is also no longer across NC “in network coverage” except in an “emergency” . What that is, is not yet defined clearly. United is in 100 counties and Coventry is also restricted but they have an equivalent network to Blue Local at anticipated lower premiums.

This is the year, you want to work with an Independent local agent to really understand all the new changes and make the best possible choice for you and your family.