Home › Blog › Same Person, Same North Carolina ZIP, Two Very Different Health Insurance Prices
Same Person, Same North Carolina ZIP, Two Very Different Health Insurance Prices
Here's a real pattern we see every week in North Carolina. Same person, same ZIP code, same month — and two quotes that are hundreds of dollars apart. Here's why.
The person
A 50-year-old self-employed consultant in Charlotte. Healthy, no medications, earns about $110,000. No subsidy.
Quote one: HealthCare.gov
Full-price Silver PPO-style plan from one of Blue Cross Blue Shield of North Carolina, Ambetter, Aetna CVS Health, and UnitedHealthcare: around $900 a month in 2026, $5,000 deductible, network concentrated around Charlotte. The price has nothing to do with his health — guaranteed-issue plans can't ask.
Quote two: private shared-network
A PPO on the Cigna, Aetna and PHCS PPO network: around $450 a month, $2,500 deductible, national network. The price has everything to do with his health — he answered a questionnaire and qualified.
Why both prices are "right"
They're answering different questions. The marketplace asks "what does it cost to insure everyone?" and spreads it evenly. The private plan asks "what does it cost to insure you?" For a healthy person, the second question has a lower answer. For someone with a serious condition, it wouldn't — and the marketplace would be the better deal.
What it means for you in North Carolina
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. If you're healthy and above the subsidy line, you should see both numbers before you renew. Check your options.