Find an Affordable Health Insurance Plan in Edgecombe County
in North Carolina
Nationwide (BlueCard®)
Blue Advantage® is a PPO health plan from Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offering the company's largest nationwide network of doctors, specialists, and hospitals. More than 95% of North Carolina doctors and 98% of North Carolina hospitals are in-network, and coverage travels with you nationwide through the BlueCard® program, which is accepted in nearly 200 countries and territories worldwide.
Because it's a PPO, Blue Advantage gives you the fewest restrictions on which doctors you can see: no referrals to see a specialist, and out-of-network care is still covered (at a lower benefit level). It typically carries a higher premium than Blue Cross NC's in-state-only plans, so it's the plan we recommend when provider choice and nationwide access matter more than getting the lowest possible premium.
Blue Advantage is built for people who want the fewest restrictions on which doctors they can see. It's a strong fit if you travel frequently for work or split time between two states, have an established specialist relationship you don't want to disrupt, want emergency care covered at the in-network rate anywhere in the world, or simply value provider choice over the lowest possible monthly premium.
It's a weaker fit if you rarely leave North Carolina and don't need nationwide access. In that case, Blue Care offers nearly identical in-state provider access at a lower premium, and one of the regional Blue Home plans may lower your premium even further if your doctors belong to a single health system.
Nationwide network – Nationwide (BlueCard®)
Network: Anywhere in the U.S. and abroad2; 95%+ of NC doctors.1
Out-of-area care: Covered (lower benefit level).
Offered in Bronze, Silver, and Gold tiers.
Notes
Blue Cross NC Provider Internal Data; percentages indicated represent the Blue Cross NC PPO Network as of April 7, 2025.
Covered in nearly 200 countries and territories worldwide through the Blue Cross and Blue Shield Association BlueCard program. www.geo-blue.com/ (Accessed March 2025). BlueCard coverage varies for each Blue Cross and Blue Shield plan. For more complete details, including benefits, limitations, and exclusions, please refer to your certificate of coverage.
Blue Advantage is available on and off Marketplace in all North Carolina counties, except the following where it is available only off Marketplace: Alamance, Caswell, Chatham, Durham, Franklin, Johnston, Lee, Orange, Person, and Wake.
Blue Advantage is a PPO, which means you don't need a referral to see a specialist, and you're never limited to a single network — you're just paying more if you step outside it. If you see an in-network provider, you get the plan's full benefit level. If you see someone out-of-network, the plan still pays, just at a reduced benefit level, and you're responsible for the difference.
Because Blue Cross NC has more than 95% of North Carolina doctors and 98% of North Carolina hospitals in-network, most members rarely need to use that out-of-network benefit — but it's there if your situation calls for it.
Blue Advantage is the only Blue Cross NC individual plan built for people who leave the state. Through the BlueCard® program, your in-network benefits travel with you anywhere in the U.S. — so if you split time between two states, have kids away at college, or travel for work, you're not stuck finding a new plan or a new doctor.
Emergency care is covered at the in-network rate worldwide, including in nearly 200 countries and territories through BlueCard Worldwide®.
Blue Advantage typically carries a higher premium than Blue Cross NC's in-state-only plans like Blue Care® or the regional Blue Home℠ plans. That's the trade-off for the broadest network and out-of-network safety net Blue Cross NC offers. Like every Blue Cross NC ACA plan, it's available in Bronze, Silver, and Gold tiers, and most applicants qualify for a premium tax credit that lowers the monthly cost based on income and household size.
If nationwide access isn't something you need, it's worth comparing Blue Advantage against Blue Care or a Blue Home plan first — you may get nearly identical in-state coverage for meaningfully less.
You can enroll during the annual Open Enrollment Period (November 1 – January 15) or during a Special Enrollment Period if you've had a qualifying life event — a job change, a move, a new dependent, or losing other coverage.
A licensed Health Plans of NC agent can confirm your specific doctors are in-network, check what subsidy you qualify for, and compare Blue Advantage against the other six Blue Cross NC plans with you — at no cost. Call 800-797-0327.
Blue Advantage is a PPO (Preferred Provider Organization) plan. That means you can see out-of-network providers — you’ll just pay more — and you generally don’t need a referral to see a specialist. It’s the most flexible network Blue Cross NC offers.
Yes. Blue Advantage includes nationwide in-network access through the BlueCard® program, and emergency care is always covered at the in-network benefit level no matter where you are — including in nearly 200 countries and territories worldwide.
Yes, Blue Advantage is available in all 100 North Carolina counties. In 25 of them it’s available off-Marketplace only, meaning you’d enroll directly (through an agent or Blue Cross NC) rather than through HealthCare.gov. A Health Plans of NC agent can handle either path for you.
Both give you nearly the same broad in-state network (about 95% of NC doctors), but Blue Advantage is a PPO that adds nationwide out-of-network coverage, while Blue Care is an HMO limited to North Carolina with no out-of-network benefit except emergencies. Blue Advantage costs a bit more for that added flexibility.
Our recommendation: choose Blue Advantage if you travel, split time between states, or want maximum provider choice; choose Blue Care if you stay in NC and want to save on premium.
Statewide NC network
Blue Care® is an HMO health plan from Blue Cross NC that offers the company's largest in-state network — more than 95% of North Carolina doctors and 98% of NC hospitals in-network — at a lower monthly premium than the nationwide Blue Advantage PPO.
The trade-off for that lower premium is that Blue Care keeps your care inside North Carolina: outside of urgent and emergency situations, only in-network NC providers are covered, and there's no out-of-network benefit. For NC residents who rarely travel, Blue Care delivers almost the same broad provider choice as Blue Advantage for less money — which is why we often recommend it as the best-value option for people who stay in-state.
Blue Care fits residents who live and receive their care entirely within North Carolina, want broad in-state provider choice without paying for nationwide coverage they won't use, and are comfortable with no out-of-network benefit outside of emergencies.
It's a poor fit if you split time between states, have kids at out-of-state college, or travel frequently for work — non-emergency care outside North Carolina isn't covered. If that's you, Blue Advantage is the better choice.
Statewide network – Statewide NC network
Network: North Carolina only. A large network, with more than 95% of North Carolina doctors and 98% of North Carolina hospitals in-network.
Out-of-area care: Emergency / urgent only.
Offered in Bronze, Silver, and Gold tiers.
Blue Care is available in all North Carolina counties, except: Alamance, Caswell, Chatham, Durham, Franklin, Johnston, Lee, Orange, Person, and Wake.
Blue Care is an HMO built on Blue Cross NC's largest in-state network — more than 95% of North Carolina doctors and 98% of NC hospitals in-network. It's priced lower than the nationwide Blue Advantage PPO because it trades nationwide access for coverage that stays inside North Carolina.
Outside of emergency and urgent care, only in-network NC providers are covered — there's no out-of-network benefit to fall back on, so it's worth confirming your specific doctors participate before you enroll.
Blue Care is sold in every NC county except Alamance, Caswell, Chatham, Durham, Franklin, Johnston, Lee, Orange, Person, and Wake — those counties fall inside the Triangle-area service area for the Blue Home℠ with UNC Health Alliance plan instead. If you live in one of the excluded counties, Blue Care isn't available to you regardless of which providers you use.
Because the in-state network is nearly as broad as Blue Advantage's, most Blue Care members never notice a difference in provider choice day to day — the difference only shows up if you need care outside North Carolina.
Blue Care's premium runs lower than Blue Advantage's specifically because it removes the nationwide and out-of-network safety net. It's offered in Bronze, Silver, and Gold tiers, and most applicants qualify for a premium tax credit that lowers the monthly cost based on income and household size.
You can enroll during the annual Open Enrollment Period (November 1 – January 15) or during a Special Enrollment Period if you've had a qualifying life event — a job change, a move, a new dependent, or losing other coverage.
A licensed Health Plans of NC agent can confirm your doctors are in-network, check your subsidy, and compare Blue Care against Blue Advantage and the regional plans — at no cost. Call 800-797-0327.
Yes. Blue Care is structured as an HMO with a statewide North Carolina network. Outside of urgent and emergency situations, care is only covered when you use in-network NC providers.
Only urgent and emergency care is covered outside your Blue Care network. Routine or non-emergency care while traveling out of state is not covered, so Blue Care is best for people who receive their care in North Carolina.
Blue Care isn’t offered in Alamance, Caswell, Chatham, Durham, Franklin, Johnston, Lee, Orange, Person, or Wake counties. In several of those counties, Blue Home℠ with UNC Health Alliance is offered instead.
Every Blue Cross NC individual plan comes in three “metal” tiers that describe how you and the plan split covered costs. Bronze plans have the lowest monthly premium but pay about 60% of covered costs, so you pay roughly 40% when you use care. Silver plans pay about 70% (you pay ~30%), and Gold plans pay about 80% (you pay ~20%) in exchange for a higher premium.
As a rule of thumb: Bronze suits people who rarely use care and want the lowest premium, Gold suits people who use regular or ongoing care, and Silver is the middle ground. Silver is also the only tier that unlocks Cost-Sharing Reductions (CSRs) — extra savings on deductibles and copays if your income qualifies — so many subsidy-eligible shoppers get the best overall value from a Silver plan. A licensed Health Plans of NC agent can run the numbers for your situation at no cost.
The most important step before choosing any plan is confirming your doctors, specialists, and preferred hospitals are in that plan’s network. Networks differ a lot between Blue Cross NC plans — a doctor who is in-network on one plan may be out-of-network, and far more expensive, on another.
You can check each plan’s provider directory on bcbsnc.com, or — the easier route — call a Health Plans of NC agent at 800-797-0327 and we’ll verify your specific providers before you enroll, at no charge.
Most North Carolinians who buy their own coverage qualify for a premium tax credit — a subsidy based on your income and household size that lowers what you pay each month. Subsidy amounts and eligibility rules can change from year to year, so the only way to know your real price is to run a personalized quote.
Health Plans of NC can check your subsidy eligibility and show you the after-subsidy premium for any of these plans for free. Call 800-797-0327 or request a quote online.
You can enroll during the annual Open Enrollment Period, which runs each fall (generally starting November 1) for coverage that begins the following year. Outside that window, you can still enroll if you have a qualifying life event — such as losing other coverage, moving, marriage, or having a baby — which opens a 60-day Special Enrollment Period.
Because enrollment dates and rules can change, it’s worth confirming the current deadline. A Health Plans of NC agent can tell you whether you’re eligible to enroll right now — call 800-797-0327.
Nothing. Health Plans of North Carolina is an independent, authorized agency licensed to sell Blue Cross NC plans, and our help — comparing plans, checking your doctors, estimating subsidies, and enrolling — is completely free to you. Agents are paid by the insurance company, and the plan price is the same whether you enroll with us or on your own.
Call 800-797-0327 to talk with a licensed local agent.
| Carrier | Distinct plans |
|---|---|
| Blue Cross and Blue Shield of NC | 18 |
| Cigna Healthcare | 10 |
| Total | 28 |
Source: CMS QHP Landscape PY2026, Individual Market Medical, updated August 26, 2026 (data.healthcare.gov). Counts distinct Plan IDs offered on the Marketplace in Edgecombe County, once per carrier.
in North Carolina
Find affordable health insurance in Edgecombe County, NC with Health Plans of NC. Health Plans of NC helps residents of Edgecombe County, NC find and enroll in affordable health coverage, working with families, individuals, and employees of major local employers like Sara Lee Frozen Bakery and ABB. Whether you are looking for marketplace coverage, Medicaid, or employer-sponsored insurance, Health Plans of NC agents guide you through every option at no cost.
Plan Network | Type | Network Coverage |
|---|---|---|
Blue Advantage® | PPO | Largest nationwide network, 95%+ of NC doctors in-network |
Blue Care® | HMO | Broad statewide network, 95%+ of NC doctors in-network |
Edgecombe County is home to approximately 48,777 residents, with population growth of -0.3% since 2020 and 3.1% of residents identifying as foreign-born, reflecting a diverse community with varying coverage needs across Rocky Mount, Tarboro, and Pinetops. Major employers including Edgecombe-Tarboro Schools, the City of Rocky Mount, Sara Lee Frozen Bakery, ABB, and Edgecombe County government provide a base of employer-sponsored coverage, while health systems including UNC Health Nash and Vidant Edgecombe Hospital anchor the local care network. Health Plans of NC helps county residents explore every available coverage pathway to find the option that best fits their household situation.
ACA Marketplace plans through Blue Cross NC are available to Edgecombe County residents who do not have access to employer coverage at workplaces like Sara Lee Frozen Bakery or ABB.
Medicaid coverage is available to qualifying low-income Edgecombe County adults and families, with eligibility determinations supported by Health Plans of NC at no cost.
Employer-sponsored insurance through large local employers such as Edgecombe-Tarboro Schools and the City of Rocky Mount often provides group health benefits to full-time employees and their dependents.
Short-term health plans may serve as a temporary bridge for Edgecombe County residents between jobs or waiting for open enrollment, though they do not meet ACA minimum coverage standards.
COBRA continuation coverage allows Edgecombe County residents who leave employment at local organizations to temporarily maintain their existing group health plan after a qualifying separation.
Small business SHOP plans are available to small employers in Edgecombe County who want to offer group health benefits to their workforce and may qualify for small business tax credits.
For 2026, Edgecombe County residents can choose from plans offered under two Blue Cross NC networks, Blue Advantage and Blue Care, both of which connect enrollees to providers across eastern North Carolina including facilities in the Vidant Edgecombe and UNC Health Nash systems. Blue Advantage is a PPO network with the largest nationwide reach, while Blue Care is an HMO structure offering broad statewide access, and both networks allow enrollees to see specialists without a referral requirement. Health Plans of NC agents help Edgecombe County residents compare these network options side-by-side to determine which plan structure best matches their preferred doctors and facilities.
Blue Advantage, a PPO network, provides Edgecombe County enrollees access to the largest nationwide provider network, with over 95% of NC doctors participating in-network, including providers at Vidant Edgecombe Hospital in Tarboro.
Blue Care, an HMO network, offers broad statewide coverage with over 95% of NC doctors in-network, giving Edgecombe County residents access to specialists throughout the eastern North Carolina region.
Both Blue Advantage and Blue Care plans allow Edgecombe County residents to self-refer to specialists without needing prior approval from a primary care provider.
Blue Advantage and Blue Care plans are available across multiple coverage tiers, giving Edgecombe County families the flexibility to choose between lower premiums or lower out-of-pocket costs depending on their healthcare use.
Edgecombe County residents who receive care at UNC Health Nash facilities can confirm in-network status under both Blue Advantage and Blue Care plans before enrolling to avoid unexpected costs.
Health Plans of NC agents review which specific doctors, clinics, and hospitals are included under Blue Advantage and Blue Care for each Edgecombe County zip code, including 27801, 27804, and 27886.
Bronze plans in Edgecombe County start at approximately $403.47/month before subsidies. With a median household income of $48,480, many residents qualify for premium tax credits. Subsidies may reduce your monthly premium significantly based on income.
Bronze plans in Edgecombe County start at $403.47 per month for a 35-year-old before subsidies, offering the lowest monthly premiums with higher deductibles for those who want basic protection.
Silver plans start at $518.72 per month before subsidies and are the only tier eligible for cost-sharing reductions, which lower deductibles and copays for qualifying Edgecombe County households.
Gold plans start at $536.24 per month before subsidies and provide lower out-of-pocket costs throughout the year, making them well-suited for residents who use healthcare services frequently.
Edgecombe County households with incomes between 100% and 400% of the federal poverty level qualify for ACA premium tax credits that can significantly reduce monthly costs below the starting prices listed above.
Residents with incomes between 100% and 150% of the federal poverty level may qualify for enhanced subsidies that bring Silver plan premiums down to $0 per month under current ACA rules.
Health Plans of NC provides free personalized quotes with exact subsidy calculations for every Edgecombe County household, using actual income and family size to determine the true net monthly cost.
For 2026, Blue Cross NC is one of two ACA Marketplace carriers offering plans in Edgecombe County, with 18 total plans available to residents across the county. These 18 plans are distributed across two networks, Blue Advantage and Blue Care, giving residents a choice between the broadest nationwide access and broad statewide coverage. Blue Advantage connects Edgecombe County enrollees to the largest national provider footprint, while Blue Care offers strong statewide access to hospitals and specialists across eastern North Carolina, including those affiliated with Vidant Edgecombe Hospital and UNC Health Nash. The network a resident selects directly affects which doctors, clinics, and hospitals are available in-network, making network comparison an important step before enrollment. Health Plans of NC agents compare all 18 Blue Cross NC plans side-by-side for Edgecombe County residents at no cost, ensuring each household selects the right network and tier for their needs.
Blue Cross NC, offering plan structures under the Blue Advantage and Blue Care networks, with 18 total ACA Marketplace plans available to Edgecombe County residents for 2026.
North Carolina expanded Medicaid in December 2023, extending free or low-cost coverage to adults earning up to 138% of the federal poverty level, a significant development for Edgecombe County where 10.8% of residents, approximately 5,000 people, remain uninsured. The county's 21.9% poverty rate means a substantial share of Edgecombe County households may qualify for Medicaid or heavily subsidized coverage and may not yet be enrolled. Children in families earning up to 210% of the federal poverty level may qualify for NC Health Choice, the state's CHIP program, providing low-cost comprehensive coverage for minors. Health Plans of NC offers free eligibility checks for Edgecombe County residents to determine whether they qualify for Medicaid, CHIP, or a subsidized marketplace plan.
Working adults in Edgecombe County who earn low wages at area employers and do not have access to affordable job-based coverage may qualify for Medicaid under NC's expansion.
Children in Edgecombe County families with moderate incomes may qualify for NC Health Choice, which provides comprehensive low-cost coverage including dental and vision benefits.
Pregnant women in Edgecombe County are eligible for Medicaid coverage during pregnancy and for a postpartum period, with eligibility thresholds higher than the standard adult limit.
Edgecombe County seniors with low income may qualify for dual eligibility under both Medicare and Medicaid, reducing out-of-pocket costs for prescription drugs, hospital stays, and long-term care.
With a county poverty rate of 21.9%, a significant portion of Edgecombe County residents with disabilities who have limited income and resources may qualify for full Medicaid benefits covering medical, behavioral, and long-term services.
Health Plans of NC licensed agents serve Edgecombe County residents at no cost, comparing all available plans side-by-side and walking you through the full enrollment process from start to finish. Call 800-797-0327 today to speak with an agent who knows the Edgecombe County market and can find the right plan for your household.
Call 800-797-0327 (toll free) or 704-303-8256 to speak with a licensed agent and schedule a free appointment
Email [email protected] with questions about plans available in Edgecombe County
Find a licensed agent and book directly at healthplansofnc.com/agents
No cost, no pressure. Health Plans of NC agents work for you, not the carrier.
Hospital | Address | Phone |
|---|---|---|
ECU Health Edgecombe Hospital | 111 Hospital Dr, Tarboro, NC 27886 |
Clinic | Address | Phone |
|---|---|---|
Freedom Hill Community Health Center | 162 NC Highway 33 E, Tarboro, NC 27886 | |
Mainstreet Family Care - Tarboro | 110 Western Blvd, Tarboro, NC 27886 | |
OIC Family Medical Center | 111 S Fairview Rd, Rocky Mount, NC 27801 | |
OIC Specialty Care Center | 260 Albemarle Ave, Rocky Mount, NC 27801 | |
Rural Health Group at Whitakers | 105 SE Railroad St, Whitakers, NC 27891 | |
Vidant Family Medicine- Pinetops | 1473 NC 42 43 W, Pinetops, NC 27864 | |
Edgecombe County Health Department | 122 E Saint James St, Tarboro, NC 27886 | |
Tarboro Clinic | 101 Clinic Dr, Tarboro, NC 27886 | |
Better Days Ahead of Rocky Mount | 1107 N Fairview Rd, Rocky Mount, NC 27801 | |
Safe Haven Center | 340 Calbrad Rd, Rocky Mount, NC 27801 |
Edgecombe County ZIP Codes include: 27801, 27819, 27852, 27864, 27881, and 27886
