Find an Affordable Health Insurance Plan in Madison 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 |
| Ambetter of North Carolina | 15 |
| Cigna Healthcare | 10 |
| AmeriHealth Caritas Next | 8 |
| Oscar Health Plan of North Carolina | 8 |
| Total | 59 |
Source: CMS QHP Landscape PY2026, Individual Market Medical, updated August 26, 2026 (data.healthcare.gov). Counts distinct Plan IDs offered on the Marketplace in Madison County, once per carrier.
in North Carolina
Find affordable health insurance in Madison County, NC with Health Plans of NC. Health Plans of NC helps residents of Madison County, North Carolina find and enroll in the right health insurance plan for 2026, with local expertise connecting families to coverage that works alongside Mission Hospital and area employers like Mars Hill University and Madison County Schools.
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 |
Madison County, home to 21,640 residents with a 2.1 percent population growth since 2020, offers a wide range of health coverage options through the ACA Marketplace, Medicaid, employer-sponsored plans, and other programs suited to the county's diverse workforce. Major local employers such as Madison County Schools, Ingles Markets, Mars Hill University, and Asheville Kombucha Mamas provide employer-sponsored coverage to many working residents, while Mission Hospital and HCA Healthcare anchor the regional health system that most plans connect to. With 1.4 percent of Madison County residents being foreign-born, Health Plans of NC offers multilingual assistance to ensure every community member can navigate available coverage options with confidence.
ACA Marketplace plans are available to Madison County individuals and families who do not receive coverage through a qualifying employer, with Blue Cross NC offering plans that connect members to Mission Hospital and nearby facilities.
Medicaid coverage is available to qualifying low-income Madison County adults following North Carolina's Medicaid expansion, providing access to Mission Hospital and HCA Healthcare facilities at little or no cost.
Employer-sponsored insurance is offered by major Madison County employers including Madison County Schools, Ingles Markets, Mars Hill University, and Asheville Kombucha Mamas to eligible full-time employees and their dependents.
Short-term health plans may serve Madison County residents who are between jobs or waiting for open enrollment, though these plans do not meet ACA minimum essential coverage standards and have limited benefits.
COBRA continuation coverage allows Madison County residents who recently left employment at local organizations such as Ingles Markets or Mars Hill University to temporarily maintain their prior employer-sponsored plan.
Small business SHOP Marketplace plans are available to Madison County small business owners, including independent operators and entrepreneurs, who want to offer group health coverage to their employees through Blue Cross NC.
For 2026, Madison County residents can choose from plans offered under two Blue Cross NC networks, Blue Advantage and Blue Care, spanning plan structures that provide broad access to providers across the region. Blue Advantage is a PPO network covering more than 95 percent of North Carolina doctors and connects Madison County members to Mission Hospital in Asheville, Blue Ridge Regional Hospital in Spruce Pine, and the Mars Hill Medical Center. Blue Care is an HMO network covering more than 95 percent of North Carolina doctors and provides Madison County residents with strong statewide access including Mission Health facilities, CarePartners Rehabilitation Hospital, and multiple Mission Health clinics serving the greater Madison County area.
Blue Advantage, a PPO network, includes more than 95 percent of NC doctors in-network and connects Madison County members to Mission Hospital, Blue Ridge Regional Hospital, and Mission Health clinics throughout the region.
Blue Care, an HMO network, covers more than 95 percent of NC doctors in-network and gives Madison County residents access to Mission Hospital, CarePartners Rehabilitation Hospital, and area Mission Health outpatient facilities.
Both the Blue Advantage and Blue Care networks allow Madison County members to access specialty care at facilities such as Mars Hill Medical Center and Mission Children's Hospital without requiring a primary care referral.
Blue Advantage PPO plans give Madison County residents the flexibility to see out-of-network providers at higher cost, which is especially useful near the Asheville metro corridor, while Blue Care covers out-of-network care only for emergencies and urgent care.
Plan tier options within both Blue Advantage and Blue Care networks range from Bronze to Gold coverage levels, allowing Madison County residents to choose the balance of monthly cost and out-of-pocket exposure that fits their medical needs.
Catastrophic plans are available to eligible Madison County residents under age 30 or those qualifying for a hardship exemption, providing a low-cost safety net option within the Blue Cross NC network.
Bronze plans in Madison County start at approximately $403.47/month before subsidies. With a median household income of $58,628, many residents qualify for premium tax credits. Subsidies may reduce your monthly premium significantly based on income.
Bronze plans in Madison County start at $403.47 per month for a 35-year-old before subsidies, offering the lowest monthly premium with higher out-of-pocket costs when care is needed.
Silver plans in Madison County start at $518.72 per month for a 35-year-old before subsidies and are the only tier eligible for cost-sharing reductions, which lower deductibles and copays for qualifying residents.
Gold plans in Madison County start at $536.24 per month for a 35-year-old before subsidies and feature lower out-of-pocket maximums, making them a strong value for residents with frequent medical needs.
Madison County residents with household incomes between 100 percent and 400 percent of the federal poverty level qualify for Advance Premium Tax Credits that can substantially reduce monthly premiums across all metal tiers.
Some Madison County households with incomes just above 100 percent of the federal poverty level may qualify for a $0 premium Silver plan after tax credits are applied, making comprehensive coverage available at no monthly cost.
Out-of-pocket maximums for 2026 ACA plans vary by network and tier, and Health Plans of NC agents help Madison County residents compare total annual cost exposure across all available Blue Cross NC plan options.
Blue Cross NC is one of five carriers offering individual and family ACA Marketplace plans in Madison County for 2026, with 18 total plans available across multiple coverage tiers. These plans are offered through two networks, Blue Advantage and Blue Care, each providing Madison County residents with broad access to physicians and hospitals across North Carolina. The Blue Advantage network connects Madison County members to more than 95 percent of NC doctors, including providers at Mission Hospital and Blue Ridge Regional Hospital, while the Blue Care network covers more than 95 percent of NC doctors with access to Mission Health facilities and CarePartners Rehabilitation Hospital. Choosing between Blue Advantage and Blue Care directly affects which local specialists, clinics, and hospital systems are covered at in-network rates for Madison County residents throughout the plan year. Health Plans of NC licensed agents compare all 18 available Blue Cross NC plans side by side at no cost, helping residents in Marshall, Mars Hill, Hot Springs, and surrounding communities select the most appropriate network and coverage level for their needs.
Blue Cross NC, offering 18 individual and family ACA Marketplace plans in Madison County for 2026, including plan options across the Blue Advantage and Blue Care networks at Bronze, Silver, Gold, and Catastrophic coverage tiers.
North Carolina expanded Medicaid in December 2023, and Madison County residents whose household income falls at or below 138 percent of the federal poverty level may now qualify for comprehensive Medicaid coverage at little or no monthly cost. Currently, 8.7 percent of Madison County residents, approximately 2,000 people, remain uninsured, and many of these individuals may be eligible for Medicaid or low-cost ACA plans but have not yet enrolled. Children in Madison County families earning up to 210 percent of the federal poverty level may qualify for NC Health Choice, also known as CHIP, which provides affordable pediatric coverage including doctor visits, dental, and preventive care. Health Plans of NC offers free eligibility checks for Madison County residents who want to find out whether they qualify for Medicaid, CHIP, or a subsidized Marketplace plan.
Working adults in Madison County who are self-employed, part-time, or employed without employer coverage may qualify for Medicaid if their income falls at or below 138 percent of the federal poverty level.
Children in Madison County whose families earn too much for traditional Medicaid but too little for full-price coverage may qualify for NC Health Choice, the state's CHIP program, at very low or no cost.
Pregnant women in Madison County are eligible for expanded Medicaid coverage that includes prenatal visits, labor and delivery services, and postpartum care through nearby Mission Hospital and Mission Health clinics.
Madison County's poverty rate of 11.4 percent means a meaningful portion of residents may qualify for full Medicaid benefits covering hospital stays, prescriptions, and specialist visits at no monthly premium.
Madison County residents with disabilities or seniors with low income who do not yet have Medicare or who need supplemental assistance may also qualify for Medicaid programs and should contact Health Plans of NC for a free eligibility review.
Health Plans of NC licensed agents serve Madison County residents at no cost, comparing every available plan side by side to find the right coverage for your health needs and budget. Call 800-797-0327 today to speak with a local agent who can walk you through enrollment and make sure you are not leaving any available benefits on the table.
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 Madison 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.
Madison County does not have a hospital within its borders. The hospitals below are located in neighboring counties and serve Madison County residents.
Hospital | Address | Phone |
|---|---|---|
Mission Hospital | 509 Biltmore Ave, Asheville, NC 28801 | |
Haywood Regional Medical Center | 262 Leroy George Dr, Clyde, NC 28721 |
Clinic | Address | Phone |
|---|---|---|
Hot Springs Medical Center | 66 NW US 25 70 Hwy, Hot Springs, NC 28743 | |
Laurel Medical Center | 80 Guntertown Rd, Marshall, NC 28753 | |
Mars Hill Medical Center | 119 Mountain View Rd, Mars Hill, NC 28754 | |
Mashburn Medical Center | 590 Medical Park Dr, Marshall, NC 28753 | |
Madison County Health Department - Mass Immunizations | 493 Medical Park Dr, Marshall, NC 28753 | |
Collaborative Health Partnership | 281 Laurel Valley Rd, Mars Hill, NC 28754 | |
Wnc Healing Collaborative | 32 N Main St Unit 1, Marshall, NC 28753 |
Madison County ZIP Codes include: 28743, 28753, and 28754
