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How North Carolina Realtors Should Compare Health Insurance Plans
Agents compare premiums and stop. Here's the order that actually protects you.
1. Out-of-pocket maximum
The most you can spend in a year on covered care. This is the number that matters in a bad year. Marketplace plans in North Carolina cap around $9,200 individual; private PPOs commonly $6,000–$9,000.
2. Network — and where it works
Is your doctor in it? Is the hospital you'd actually go to in Mecklenburg County in it? Does it work in another state? HMO vs. PPO decides this. Cigna, Aetna and PHCS PPO PPOs are national.
3. Deductible
How much you pay before the plan pays. Healthy agents usually do best with a mid-range deductible and lower premium, plus an HSA.
4. Premium
Only now. And compare net of subsidy if you qualify, net of the self-employed deduction either way. North Carolina has a flat state income tax, so the self-employed premium deduction helps at both the federal and state level.
5. Enrollment flexibility
Marketplace: once a year. Private: any month. If your income is volatile, flexibility has value.
Medicaid expansion in late 2023 moved hundreds of thousands of lower-income North Carolinians onto Medicaid — which means the people still shopping are mostly above the subsidy range.
Our quoting tool shows every private plan in North Carolina with deductible and out-of-pocket max side by side. Or check your options and we'll compare both markets for you.