Healthy Living

Having health insurance is a good way to help manage your health care costs. There are numerous options to gaining health insurance including individual or family insurance, employer sponsored insurance, or public options (Medicare, Medicaid). Because there are differences across plans, it is helpful to think about whether you want to choose your primary doctor (or one is assigned to you), where you receive your care, whether certain doctors/clinics are in your network paid for by your insurer, and whether vision, dental, and prescription care are covered. It’s also helpful to look at each plan to consider the costs, deductibles, benefits, and copayments required.
 
For individual (or family) insurance, North Carolina uses the federally run health insurance exchange through the HealthCare.gov website. The exchange is the only place where you may be able to get subsidies that can help with your monthly premiums and help reduce out-of-pocket expenses. When you can enroll in new programs, renew, or make changes in current programs typically occurs in October.
 
The different types of health insurance plans include:

Health maintenance organizations (HMOs)
An HMO is a medical insurance group that provides health services for an annual fee. It serves as a link between the patient and health care providers (hospitals, doctors, etc.) and provides or arranges services. The fee for an HMO is likely less than a PPO and you will be assigned a provider who manages your care.

Preferred provider organizations (PPOs)
A PPO is a medical insurance group that provides health services for an annual fee. The fees may be higher than for an HMO, but you can choose your physician and location of care.

Exclusive provider organizations (EPOs)
An EPO allows more freedom than an HMO in deciding your health care providers and no referral for a specialist is needed. Typically, a lower premium than an HMO is available, but if you see a provider out of network, you will have to pay the costs.

Point-of-service (POS) plans
POS plans blend aspects of PPOs and HMOs.

High-deductible health plans (HDHPs), which may be linked to health savings accounts.

Medicare. For people 65+ or those who qualify due to a disability or special situation.

Medicaid. This is a federal and state program that helps with healthcare costs for some people with limited income and resources and those with eligible disabilities.

You can see if you qualify for Medicaid by visiting the Medicaid website or by filling out an application in the Health Insurance Marketplace. 
https://www.hhs.gov/answers/medicare-and-medicaid/who-is-eligible-for-medicaid/index.html

There are Medicaid programs that specifically assist children: 
Children’s Health Insurance Program (CHIP) – The Children’s Health Insurance Program (CHIP) provides health coverage (i.e., routine checkups, immunizations, dental care) to eligible children 18 years and under, through both Medicaid and separate CHIP programs.  https://www.insurekidsnow.gov/coverage/nc/index.html

Early Periodic Screening Diagnostic and Treatment Medicaid Services for Children (EPSDT) – This is the child health component of Medicaid that states that children under age 21 who are enrolled in Medicaid are entitled to certain benefits and that States must cover a broad array of preventive and treatment services. Even if a service is not covered under the NC Medicaid State Plan, it can be covered for recipients under 21 years of age if the service is listed at 1905(a) of the Social Security Act and if all EPSDT criteria are met.  https://www.ncdhhs.gov/providers/provider-info/mental-health/early-periodic-screening-diagnostic-and-treatment-medicaid-services-for-children

Short term insurance. Budget-friendly monthly payments but it is time limited. This type of insurance can be helpful while you search for a long-term option. However, this type of insurance usually does not cover preexisting conditions and it may not cover all Essential Health Benefits in your state.

Vision Benefits (may be included in some types of individual/family plans).

Dental (may be included in some types of individual/family plans).

Drug Benefits (may be included in some types of individual/family plans).