Business

Insurer pulls out of NC online health exchange

Posted September 13, 2013

— FirstCarolinaCare Insurance Co. announced Thursday that it has abandoned its plan to offer health insurance coverage through North Carolina's online marketplace, which opens in three weeks.

The Pinehurst-based insurance company had proposed 16 plans to sell in the marketplace, also known as a health exchange, under the Affordable Care Act. The plans would have been limited to residents of Moore, Richmond, Montgomery, Hoke, Scotland and Lee counties.

The Affordable Care Act requires everyone nationwide to obtain health coverage, starting in 2014, or face a tax penalty. Each state has its own exchange, where people can compare prices and coverage options, and open enrollment starts Oct. 1.

"This was not a step taken lightly,” Kenneth Lewis, president of FirstCarolinaCare Insurance, said in a statement. “When we originally proposed participation in the exchange, we recognized that there were many unknowns for all of us. However, after months of review, there continue to be uncertainties in the exchange implementation and processes for insurers."

The company's withdrawal leaves Blue Cross Blue Shield of North Carolina and Coventry Health Care of the Carolinas as the only insurers offering plans through the exchange.

Lewis said he expects residents in FirstCarolinaCare's service area will still have "viable options for individual insurance coverage" through the exchange.

“Our goal for 2014 is to continue to focus our efforts on improving the health of our community and provide coverage options where we can be competitive and add the most value to the market,” he said. “The individual marketplace landscape will undoubtedly change in the coming months, and we will re-evaluate our decision next year to determine if it will be a more competitive environment in which to participate.”

152 Comments

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  • kidsrn Sep 13, 7:26 p.m.

    You only get care through the ER for an actual EMERGENCY. The ER is not going to treat your cancer, or your chronic back pain, or your arthritis, or a cold.

    I wish people would stop spreading the lie that makes it sound like the ER would be your PCP. If you have cancer and don't know it, and they diagnose it in the ER because you were in pain or bleeding, they'll patch you up and send you home to die, because cancer is not an emergency. ---smcallah

    And I wish you would work with me to see what I see. People who go to the ED for EVERYTHING --- chronic constipation, ear infection, sore throat, you name it, it comes through the ER doors. Sometimes for the same problem multiple days in a row. I have seen this over and over. I don't know why these people (who for the most part are uninsured) don't go to the Health Department providing it is not a true EMERGENCY. Emergency rooms are like this all over. Go ahead---ask any ER staff. It is sad and it is true.

  • BGJ Sep 13, 7:12 p.m.

    BGJ: Even $695. in 2016 is nothing compared to the annual cost of individual health insurance - josephlawrence43

    Average individual policies currently sit between 250 and 350. With ACA rating, it will be closer to 350. So, in fact, yes it will be much higher than the individual policies currently on the market.

  • BGJ Sep 13, 7:08 p.m.

    And, kidrn, "everyone" means with generally few exceptions...

  • BGJ Sep 13, 7:07 p.m.

    and will continue to use the ER as their PCP - just to clarify, when I say "PCP", I am saying this to mean that their only care is emergency care.

  • BGJ Sep 13, 7:02 p.m.

    Yes, smcallah, but that was not my original point.

    I was making a point to kidrn who indicated that everyone was forced to purchase insurance but she now says not everyone is forced to purchase insurance.

    I agree that not everyone will have to pay, but everyone will have to have it - unlike the current system. Except, NC didn't expand Medicaid nor will subsidies be provided to those between 100 and 133 FPL which means they are kind of out of luck - and will continue to use the ER as their PCP. Not only that, they will only be able to afford the $95 fine which will be taken out in their tax,josephlawrence43.

  • smcallah Sep 13, 6:50 p.m.

    "I think you're confused. The law requires everyone to purchase it or pay a fine. The current system allowed people to not pay into the system and still receive care through the emergency room." --- BGJ

    You only get care through the ER for an actual EMERGENCY. The ER is not going to treat your cancer, or your chronic back pain, or your arthritis, or a cold.

    I wish people would stop spreading the lie that makes it sound like the ER would be your PCP. If you have cancer and don't know it, and they diagnose it in the ER because you were in pain or bleeding, they'll patch you up and send you home to die, because cancer is not an emergency.

  • josephlawrence43 Sep 13, 6:49 p.m.

    BGJ: Even $695. in 2016 is nothing compared to the annual cost of individual health insurance. What comes next after the fine? Jail? Fine, let the taxpayers pay for the prisoners medical care like we do now.

  • kidsrn Sep 13, 6:33 p.m.

    "I think you're confused. The law requires everyone to purchase it or pay a fine. The current system allowed people to not pay into the system and still receive care through the emergency room." --- BGJ

    I agree and disagree. You are correct when you say that the current system allows people to not pay into the system and still receive care through the emergency room. However, NOT EVERYONE will be paying into this system as you state. A person will not have to have medical insurance coverage if they satisfy a few requirements: 1. income level (won't have to pay if they do not make enough to meet the minimum income requirement) 2. religious exemption (no idea what the gov't means by that) 3. are an undocumented immigrant 4. are in jail 5. are a member of an Indian tribe. The only exclusion I think that will be a sticking point is #3. I work in a large hospital and there are A LOT of illegal immigrants that use the ED as their doctor's office. I don't see that changing, sadly.

  • BGJ Sep 13, 6:11 p.m.

    The fine will be quite substantial in 2015 - $325 and $695 in 2016

  • josephlawrence43 Sep 13, 6:05 p.m.

    I do believe that were I "younger", given the alternative of paying a $97.00 "fine" or shelling out a couple of thousand dollars per year for insurance I don't really think I need, well guess which I am going to choose?"?

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