What Is the Average Cost of Health Insurance in NC?

Health insurance costs in North Carolina are highly individualized, influenced by numerous factors. Understanding these elements is important for anyone navigating the health insurance market. This article clarifies the components that shape health insurance expenses, helping consumers understand potential costs.

Average Health Insurance Costs in North Carolina

The average cost of health insurance in North Carolina varies by plan type and coverage (individual or family). In 2024, the average monthly premium for a benchmark plan on the Affordable Care Act (ACA) Marketplace was approximately $495, slightly higher than the national average of $477. Lowest-cost options included Bronze plans at $369 per month, Silver plans at $493, and Gold plans at $513.

For 2025, the average cost for a 40-year-old purchasing a Silver plan is projected to be $664 per month. This indicates an overall increase in premiums. However, average rates for individual ACA plans from certain major insurers in North Carolina were approved for a 4% decrease in 2024. For 2025, a 3% average rate increase was approved for ACA plans from a prominent insurer.

Family health insurance expenses increase with the number of covered individuals. For a family of four, the average monthly cost for a Silver plan in North Carolina was approximately $2,123. Adding a child to a Silver health insurance plan typically adds about $397 per month.

Actual premiums can be substantially impacted by eligibility for financial assistance. Many North Carolina residents qualify for premium tax credits, which can significantly reduce their monthly premium payments. About half of shoppers in North Carolina pay less than $10 per month for health insurance after subsidies. This financial aid is available to individuals earning less than $60,240 or a family of four earning less than $124,800.

Factors Influencing Health Insurance Premiums

Factors influencing health insurance premiums include age, as premiums generally increase with advancing age. For example, a 60-year-old typically pays a higher premium than a 30-year-old for the same plan. This reflects the statistical increase in healthcare utilization and costs associated with older populations.

Geographic location within North Carolina also influences premium costs. Costs can vary by county or region due to differences in healthcare service costs, the number of competing insurers, and regional healthcare utilization patterns. Urban areas might have different cost structures compared to rural areas, affecting local premium rates.

The number of individuals covered under a plan directly impacts the total premium. A single individual plan is less expensive than a family plan, as each additional person increases the risk pool for the insurer. While children are generally cheaper to insure than adults, their inclusion still adds to the overall cost. For example, a Silver plan for an individual averaged $664 per month, but for a family of four, the average jumped to $2,123 per month.

Tobacco use can lead to higher premiums. Insurers are permitted to charge tobacco users up to 50% more than non-tobacco users, reflecting increased health risks. Disclosing tobacco use during the application process is important.

Understanding Health Plan Structures and Their Costs

The structure of a health plan determines both the monthly premium and out-of-pocket costs. Plans available on the ACA Marketplace are categorized into metallic tiers: Bronze, Silver, Gold, and Platinum. These tiers indicate how costs are shared between the insurance company and the enrollee. Higher-tier plans generally have higher monthly premiums but lower out-of-pocket expenses, while lower-tier plans feature lower premiums but higher cost-sharing responsibilities.

Bronze plans typically have the lowest monthly premiums but the highest out-of-pocket costs, with the insurer paying approximately 60% of medical expenses. These plans are designed for individuals who anticipate minimal medical needs. Platinum plans have the highest premiums but the lowest out-of-pocket costs, with the insurer covering around 90% of expenses. Gold plans fall in between, with the insurer paying about 80% of costs.

Silver plans represent a balance between premiums and out-of-pocket costs, with the insurer typically paying about 70% of medical expenses. They offer more coverage than Bronze plans while having lower monthly rates than Gold plans. Silver plans are also the only tier eligible for cost-sharing reductions, which lower deductibles, copayments, and coinsurance for eligible individuals with lower incomes.

Beyond the metallic tiers, plan network types like Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) influence costs. HMOs generally have lower premiums because they require individuals to select a primary care physician (PCP) within their network who coordinates all care, including referrals to specialists. PPOs often have higher premiums but offer more flexibility, allowing individuals to see any provider without a referral, though using in-network providers results in lower costs.

Navigating Health Insurance Enrollment Options

Individuals in North Carolina have several avenues to secure health insurance coverage, each with distinct cost implications. The Affordable Care Act (ACA) Marketplace, accessible through HealthCare.gov, is a pathway for those without employer or government coverage. A key feature is financial assistance, such as premium tax credits and cost-sharing reductions, which can substantially lower the cost of coverage for eligible individuals and families. These subsidies are based on income and household size.

Employer-sponsored health plans are a common source of coverage, where employers typically contribute a portion of the premium, reducing the financial burden on the employee. In North Carolina, employers offering Preferred Provider Organization (PPO) plans generally cover about 78% of single premiums and 42% of family premiums. The specific cost to the employee varies based on the employer’s contribution strategy and the plan selected.

Medicaid offers a no-cost or very low-cost health insurance option for individuals and families with limited income and resources. Eligibility for Medicaid in North Carolina is determined by federal poverty level guidelines, with specific criteria for different groups such as pregnant women, children, and adults. Medicaid provides comprehensive health benefits with minimal or no out-of-pocket costs.

Medicare serves as the primary health insurance program for individuals aged 65 or older, as well as for younger people with certain disabilities or end-stage renal disease. Medicare consists of different parts, including Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). While Part A is generally premium-free for most individuals, Parts B and D typically involve monthly premiums, deductibles, and copayments.