This page offers a detailed breakdown of the 2027 Healthcare.gov options available to residents of Durham, North Carolina during this year’s Open Enrollment window. The goal is to provide a starting point for our patients to learn about their options, compare basic plan features, and make an informed decision when choosing their coverage for the next year. I hope this helps!
WHAT PLANS ARE AVAILABLE?
To see what plans are offered in your zip code, click here to visit Healthcare.gov and enter your information.
If you believe that you might qualify for subsidies, answer the “Tell us about you & your household” section to show dependents and income. This won’t change the plans available to you, but it will show you the “true price” that you’ll end up paying for your monthly premiums.
If you don’t believe you qualify for subsidies, want to skip those annoying questions, or just want to see the full price of the plans available, you can click the “See Full Price Plans” bar at the bottom. You’ll have to provide this information if you proceed and actually want to sign up for the plan, but you don’t need to do that to browse options.
For Durham, North Carolina, individual plans are generally between $400-$700 per month. Bronze tiers generally offer lower premiums and higher deductibles, so you’ll save each month, but pay more when you seek care. Gold tiers offer higher premiums and lower out-of-pocket expenses, so it may be worth it to consider paying higher premiums for better coverage. For a comprehensive breakdown on how to balance this decision for your own personal needs, check out this article I wrote 10 years ago.
DO I QUALIFY FOR SUBSIDIES?
Subsidies are provided based on income and household size. If you earn below a certain amount, you qualify for prorated discounts on your healthcare insurance through Healthcare.gov. The discount is equivalent to the write-off you would receive for healthcare expenses in your annual tax filing at your expected income level, but the difference is that you receive that write-off up front every month through a reduction in your premiums, rather than a lump sum at the end of the year.
For North Carolina, here are the 2027 Income Levels to qualify for subsidies:
- 1 Person: $22,024 to $63,840
- 2 People: $29,863 to $86,560
- 3 or More People: $37,701 to $109,280
The sliding scale means that you’ll receive the greatest discounts at the lower end of the threshold. eg. If you are a single person making $23,000, you will pay a much lower premium than a single person making $62,000. The $23k person will receive ~95% off their premium, while the $62k person will only receive ~5% off their premium.
If you fall below these thresholds, you are no longer eligible for a Healthcare.gov plan and will be directed to enroll with a (free) Medicaid plan, instead.
If you earn above these thresholds, you may still sign up for a Healthcare.gov plan, but you will not qualify for a subsidy and will pay full price for your premiums. These are still almost certainly cheaper and better plans than you’ll find by going directly to an insurer, even if you have to pay the full cost.
AM I IN-NETWORK AT FAMILY CARE?
For 2027, Family Care is only in-network with the Blue Home / UNC Health Alliance plans offered on Healthcare.gov.
There are 15 options through Ambetter, 9 options through BCBS, and 7 options through Cigna.
- We are in-network with all BCBS / UNC Health Alliance plans available on the marketplace.
- We are out-of-network with Ambetter and Cigna Connect.
We are in-network with Cigna’s normal commercial policies, but Cigna Connect is the Healthcare.gov exclusive HMO option through Cigna. Ambetter is out-of-network, entirely.
To receive coverage for services at Family Care, you will need to select a BCBS Blue Home / UNC Health Alliance option.
BCBS BLUE HOME WITH UNC HEALTH ALLIANCE OPTIONS
There are 9 separate BCBS Blue Home with UNC Health Alliance choices that you can select, each with similar features, just different numbers. All plans have the same coverage for Preventive Services, so things like vaccines, mammograms, colonoscopies, and annual wellness exams are covered, regardless of the tier you choose. This is a breakdown of the lowest premium, most expensive premium, and the differences to compare among all of the choices in-between.
Blue Home Bronze Basic | 3 Free PCP | $25 Tier 1 Rx | Integrated | with UNC Health Alliance
- GOOD: This plan has the lowest monthly premium and covers the first 3 primary care appointments for free.
- BAD: Other than 3 PCP visits, everything else will be very expensive. Even the copays for primary care and urgent care visits are likely going to be equivalent to 100% of the service, and you’re most likely going to save money on prescriptions by just using a discount program like GoodRx.
- YEARLY PREMIUM: $439 x 12 = $5,268
- WHO SHOULD CHOOSE THIS? Someone who only expects to be seen 3 or fewer times by their PCP each year and does not plan to visit an urgent care or hospital for any reason. You’re saving $172 on your premiums each month compared to the highest premium plan, but you’ll also owe a minimum of $175 every time you visit an urgent care or emergency room. Even if you only expect to need these more urgent services 2-3 times per year, you’re probably better going with a mid-tier plan that has better urgent care benefits.
Blue Home Gold Standard A | with UNC Health Alliance
- GOOD: $30 copays for PCP, combined medical/pharmacy deductible, and lowest total out-of-pocket maximum.
- BAD: Highest premiums, but still doesn’t offer lowest out-of-pocket expenses before reaching the deductible. If you are not going to exceed the maximum, you would need to visit the doctor very often to make up the difference in out-of-pocket expenses relative to the premiums. Even just one level down, you’re saving $7/month on the premium and getting much better coverage on the initial end of your yearly benefits.
- YEARLY PREMIUM: $611 x 12 = $7,332
- WHO BENEFITS FROM THIS? Someone who received very expensive care. The only person who saves money on this plan is someone who’s total cost of care will exceed $8,200 per year. Effectively, you are guaranteed to pay ~$2,100 extra per year, to potentially save ~$2,400 per year on total OOP maximum costs. If you are not >88% certain that your healthcare will be at least this expensive next year, there are better options in the tiers just below this one.
Other important features to consider:
- Combined deductible? Some plans have a shared deductible, where all expenses go into the same pot. Some plans have multiple deductibles, where your medical and pharmacy benefits are both considered separate columns. If you know that the majority of your expenses come from one side or the other (eg. you take a high cost medication, like a GLP), you’ll want to know which threshold you’ll need to meet.
- Free PCP visits. Some plans have a limit on the number of PCP visits you’ll receive for free, but those are still valuable benefits. For plans that only cost ~$5 more per month, you could save $30+ at each visit, making the equation worth paying a higher premium if you know that you’ll use those PCP visits during the year.
Ultimately, all of these plans have value and you’re guaranteed to receive a real health insurance that has to provide a minimum standard of coverage. Even the worst plan on this list is better than plans offered through most employers, so you should be happy with any choice.
If you have any questions, please contact ask!