North Carolina’s Exchange in 2019

Louise Norris is doing her usual excellent work and updates us on the insurers participating in North Carolina for 2019’s ACA market:

Insurers that wish to offer individual market coverage in North Carolina in 2019 had to file rates and forms by May 21, 2018. The two insurers that offer 2018 coverage in the North Carolina exchange — Cigna and Blue Cross Blue Shield of North Carolina — have both filed rate for 2019….

In addition, Ambetter (Centene) has filings in SERFF for North Carolina’s 2019 individual market. Ambetter does not yet offer coverage in North Carolina, and will be new to the market, assuming their plan filings are approved.

In 2018, BCBS-NC offered plans in all one hundred counties in the state. Cigna offered plans in five greater Raleigh area counties. BCBS-NC was not able to get their Gold premiums below the benchmark Silver but they kept the Gold premiums close to the CSR inflated Silver premiums. There was not significant Silver gapping in the state.

Centene’s entry into the state will be a significant shake-up. Centene’s strategy is to consistently offer very low cost, narrow networks. Centene does not Silver Gap. It instead aggressively compresses the Silver spread between its plans while trying to have a large gap between the benchmark and the least expensive plans of its broader network competitors. This leads to large risk adjustment outflows as Centene covers a dis-proportionally healthy population. This works well for healthy unsubsidized individuals as the premium is low. It will increase post-subsidy premiums for anyone who needs broad networks.

North Carolina’s market is ripe for new competitors on the insurer side as it is a large market with high premiums. The entry of Centene will be good for the federal government, it will be good for non-subsidized buyers, and it will be indifferent for reasonably healthy people who are buying subsidized Silver plans. It will most likely lead to higher premiums net of subsidy for people buying Bronze plans as well as people who have significant medical needs the require broad networks.

2 replies
  1. 1
    J R in WV says:

    Hi Dave,

    I couldn’t stand to see the goose egg number of comments on another excellent health care post, so here’s a big Thank You for keeping up this flow in important information about our health care funding mechanisms.

    We’re not in NC, and we’re old enough to be on Medicare now, but we have so many friends and family who aren’t. Plus the health care markets for younger people appear to be closely related to costs within the Medicare system as well, so it matters to everyone.

    Keep up the good work!

  2. 2
    StringOnAStick says:


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