Blue Cross NC Announces ACA Rate Increases Below National Average

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is taking steps to keep health care more affordable for North Carolinians with a modest rate increase for 2025 Affordable Care Act (ACA) plans. The North Carolina Department of Insurance (NCDOI) has approved a 3% average rate increase for individual customers and families enrolled in ACA plans through Blue Cross NC. This increase is less than half of the estimated national average rate increase of 7% for ACA Marketplace plans.

“The average rate increase of 3% on our ACA plans is less than half the national average. We have worked hard to keep our ACA plans as affordable as possible, but we know any increase is too much for many families,” said Dr. Tunde Sotunde, President and CEO of Blue Cross NC. “The cost of health care – including prescription drugs – is still too high. It will take all of us, including health systems and pharmaceutical companies, to make health care more affordable.”

2025 Plan Offerings

In 2025, Blue Cross NC will continue to offer a variety of plans tailored to meet the diverse needs of North Carolinians. Among these options, the broad network preferred provider organization (PPO) plan, Blue Advantage®, will be available in all 100 counties. Blue Cross NC is the only insurer that has consistently offered ACA plans across every county in North Carolina since the marketplace first opened in 2014. 

In addition to Blue Advantage®, Blue Cross NC is collaborating with local health systems to provide plans featuring smaller, curated networks of high-quality providers at a lower cost. 

Triad, Triangle, and Charlotte regions**: Blue LocalSM and Blue HomeSM plans will continue to be available. These plans offer average monthly rates that are $100 to $200 lower than similar PPO plans.

Wilmington, Hickory, and Gastonia areas**: Blue ValueSM plans will be available, with average monthly rates that are $80 to $100 lower than similar PPO plans.

New for 2025, Blue Cross NC will introduce Blue Care®, a broad network health maintenance organization (HMO) plan, in all counties where Blue LocalSM or Blue HomeSM plans are not available. Blue Care® provides statewide coverage, with exceptions for out-of-network or out-of-state urgent care and emergency services, which will be covered at the in-network benefit level.

Understanding Rate Determination

The rates for Blue Cross NC plans are primarily influenced by members’ collective medical and pharmacy costs. Factors such as location, age, and plan type also play a significant role. For individual ACA customers, premium amounts will depend on federal premium subsidy levels, which will be set by the Centers for Medicare and Medicaid Services in October. 

While the statewide average rate increase for Blue Cross NC ACA plans is 3%, there is some regional variability, with changes ranging from an average of -0.5% to 6.8%. Individual premium rates for 2025 will be released in October, ahead of the open enrollment period for under-65 ACA plans, which runs from November 1, 2024, to January 15, 2025.

Supporting Affordability Through Subsidies

Approximately 86% of Blue Cross NC’s current ACA plan customers qualify for subsidies in 2025. These subsidies, expanded under the American Rescue Plan Act (ARPA) and extended by the Inflation Reduction Act (IRA), help limit premiums to no more than 8.5% of household income. Blue Cross NC is also continuing the renewal of "transitional plans" for individuals and small groups in 2025. These plans, which do not meet ACA requirements, were purchased between March 2010 and October 2013 and are allowed under federal law, although they cannot be sold to new customers.

Blue Cross NC remains committed to working with health systems, communities, and policymakers to find solutions that make health care more affordable for all North Carolinians.