- Blue Cross NC’s average rate for an individual ACA plan offered in 2024 is 4% lower than in 2023.
- Blue Cross NC’s rate savings have significantly lowered total premium costs in the ACA market—by an estimated $1.35 billion1 from 2018 through 2024.
- Blue Cross NC is the only insurer that has offered ACA plans in all 100 counties of North Carolina since the ACA market first opened in 2014—and the only insurer that offered individual and family plans in all 100 counties prior to 2014.
DURHAM, N.C. – Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced today that the North Carolina Department of Insurance (NCDOI) has approved a 4% average rate decrease for individual customers and families who enroll in Affordable Care Act (ACA) plans in 2024.
This average rate decrease will lower total premiums by an estimated $130 million and reflects Blue Cross NC’s commitment to creating sustainable health plans that are more affordable for all.
“Our rates for an individual ACA health plan are actually 5% lower than they were in 2018, despite the rising costs of health care and overall inflation in the U.S.,” said Dr. Tunde Sotunde, CEO and president of Blue Cross NC. “As the only not-for-profit insurer in all 100 counties of the state, we are bringing savings directly to our members to make their health care more affordable.”
How Rates are Determined
Rates are largely determined by the cost of members’ collective medical and pharmacy claims. Rates vary based on location, age and plan. For individual ACA customers, customers’ premium amounts depend on federal premium subsidy levels, which will be determined by the Centers for Medicare and Medicaid Services in October. Factors with a significant impact on 2024 rates include:
- Blue Cross NC’s industry-leading Blue Premier initiative reduces costs by paying hospitals and doctors based on improving patient care rather than only the number of procedures or tests performed. The program has lowered health care costs by approximately $650 million since it began in 2019. More than 1.4 million members are now under the care of Blue Premier providers.
- To address the skyrocketing cost of specialty drugs, Blue Cross NC has worked to negotiate lower costs with drug manufacturers and ensure Blue Cross NC plans cover the most effective drugs at the lowest cost. While pharmaceutical costs in the U.S. grew 9.4% in 20222, Blue Cross NC successfully held down the overall pharmacy trend for its individual ACA market to 0.7%3 in 2022 and to 2.9%, so far in 20234.
Blue Cross NC is lowering ACA rates in every rating region of North Carolina: regional rate changes range from an average of -0.2% to -6.6%. Individual premiums will be available in October. Open enrollment for individual under-65 ACA plans begins on November 1, 2023, and ends on January 15, 2024.
In 2024, Blue Cross NC will continue to offer its broad network preferred provider organization (PPO) plan, Blue Advantage®, in every county of the state5. And in many areas, Blue Cross NC is collaborating with local health systems to offer plans that feature a smaller, curated network of high-quality providers, at a lower cost than a similar broad network PPO plan.
- In the Triad, Triangle and Charlotte regions, Blue Cross NC will continue to offer Blue LocalSM and Blue HomeSM plans. These plans’ average monthly rates are $100 to $2006 lower than a similar PPO plan.
- In the Wilmington, Hickory and Gastonia areas of the state, Blue Cross NC will continue to offer Blue ValueSM plans. These plans’ average monthly rates are $70 to $907 lower than a similar PPO plan.
About 85% of Blue Cross NC’s current customers with individual ACA plans qualify for subsidies for their 2024 plans. Subsidies vary by plan and household income. The federal American Rescue Plan Act (ARPA) expanded these subsidies to more individuals, lowering premiums to no more than 8.5% of customers’ household incomes. In 2022, these expanded subsidies were extended for three years, through the federal Inflation Reduction Act.
Blue Cross NC will continue offering renewal of what are considered “transitional plans” in 2024, for both individuals and small groups. These are plans purchased between March 2010, when the ACA was signed, and October 2013 when regulations went into effect. Transitional plans do not meet ACA requirements but are allowed by federal law. The plans cannot be sold to new customers.
About Blue Cross and Blue Shield of North Carolina:
Blue Cross and Blue Shield of North Carolina (Blue Cross NC), the leading not-for-profit health plan in North Carolina, is committed to making health care more affordable, easier to navigate and accessible for all. Since 1933, the health insurer has created programs and initiatives to provide North Carolinians the opportunity to be healthy. Blue Cross NC serves its customers and communities of more than 4.2 million members, including approximately 1.1 million on behalf of other Blue Plans. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association. Visit Blue Cross NC online at www.bluecrossnc.com. All other marks are the property of their respective owners.
1 Estimated total premium savings across all individual ACA plans sold by Blue Cross NC for effective dates of Jan 1, 2018, through Dec 31, 2023
2 National trends in prescription drug expenditures and projections for 2023 - PubMed (nih.gov)
3 This Blue Cross NC pharmacy trend does not include pharmacy rebates, which are discounts given by pharmaceutical manufacturers off the list price of the drug and often paid through pharmacy benefit managers to health plans, to lower overall costs. As a not-for-profit, Blue Cross NC passes the value of these rebate dollars through to our membership, bringing down premiums.
4 Blue Cross NC internal data - June 2023
5 In some counties, these are only available as Off-Marketplace plans
6 Based on rates for a 40-year-old non-tobacco user on the lowest cost Silver plan design
7 Based on rates for a 40-year-old non-tobacco user on the lowest cost Silver plan design