Durham, N.C. – Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will be reducing rates by an average of one percent statewide for 2021 Affordable Care Act (ACA) plans offered to individuals. This is the third straight year that Blue Cross NC has lowered rates – a three-year total reduction since 2018 of over $380 million.

“We’re pleased to make health insurance more affordable for North Carolinians who buy their own coverage from the individual market,” said Tunde Sotunde, President and CEO of Blue Cross NC. “Our customers can continue to count on us as they navigate challenges during this pandemic and beyond. We will again offer ACA plans in all 100 North Carolina counties, as we have since the beginning of the ACA in 2014.”

The decrease is a result of the company’s efforts to hold down costs while ensuring high-quality health care for members.

2021 rates take into account two unexpected and fluid circumstances—the ongoing COVID-19 pandemic and customers’ deferral of non-urgent care. After many customers deferred care in March through May, a large number have recently resumed elective procedures, which is reflected in a significant increase in customers’ medical claims for June and July.

Many experts, including the Centers for Disease Control and Prevention, are predicting a spike of COVID-19 cases in the fall. Experts also expect COVID-19 to contribute to an increase in customers’ medical costs in 2021. While Blue Cross NC did not include a significant adjustment in its individual 2021 rates due to COVID-19 costs, the long-term cost impacts of COVID-19 are still largely unknown.  

Regional Rates and Plans

While a majority of regions will see average rate decreases, customers’ premium amounts depend on federal premium subsidy levels, which will be available on November 1. Each year customers should shop for plans, to find the lowest-cost plan from Blue Cross NC that meets their needs in 2021.

Premium subsidies are available for customers with household incomes between 100 and 400 percent of the Federal Poverty Level. About 84 percent of Blue Cross NC’s current customers with individual ACA plans qualify for subsidies in 2020.

Individual premiums will be available in October. Open enrollment for ACA plans begins on November 1, 2020 and ends on December 15, 2020.

Product Offerings

Blue Cross NC is continuing to offer all current products for its individual under-65 customers in 2021 and will continue to offer additional narrow network plans in certain markets to help keep costs as low as possible. This includes a new plan that can reduce health care costs in the Charlotte region by $20 million in 2021, if customers move to this plan.

Blue Cross NC is also reintroducing Blue Advantage®, its broad network PPO, for individual customers into the Triangle, Charlotte and Gastonia regions. This product will be available Off-Exchange only in these areas.

Blue Cross NC will continue offering renewal of transitional plans in 2021. 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. These plans cannot be sold to new customers.

Factors Impacting Rates

  • As always, rates are largely determined by the cost of our members' medical claims and vary based on location, age, subsidy amount, and plan.
  • Marketplace Expertise: Blue Cross NC has gained substantial insights about its ACA customers over the seven years that it has participated in the Marketplace. The average rate reductions in most regions are supported by the company’s industry-leading move to value-based provider reimbursement.
  • Greater Stability and Certainty: Rates have stabilized, because of the state legislature’s and regulators’ willingness to avoid additional health insurance mandates and regulatory burdens that drive costs up for individuals and small businesses. The repeal of the federal health insurer tax for 2021 policies has also helped stabilize rates.

See here for more about Blue Cross NC’s current financial outlook during the COVID-19 pandemic, from Blue Cross NC’s chief financial officer, Mitch Perry.


About Blue Cross and Blue Shield of North Carolina:

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is committed to making health care better, simpler and more affordable. We have been driving better health in North Carolina since 1933, working to tackle our communities’ greatest health challenges. Blue Cross NC serves its customers and communities of more than 3.8 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.