Find an Affordable Health Insurance Plan in Wilson 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 Wilson County, once per carrier.
in North Carolina
Find affordable health insurance in Wilson County, NC with Health Plans of NC. Health Plans of NC helps Wilson County residents find and compare affordable health insurance plans for 2026, with local expertise covering everything from individual coverage to family plans. Whether you work for Bridgestone Americas, Wilson County Schools, or another local employer, Health Plans of NC makes it easy to explore every available 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 |
Wilson County, home to 78,648 residents and experiencing a population change of -0.2 percent since 2020, offers a range of health coverage pathways suited to diverse household situations. Major local employers including Bridgestone Americas, Wilson County Schools, S.T. Wooten Corporation, Truist Bank, and the County of Wilson provide employer-sponsored insurance to a significant share of working residents, while UNC Health Wilson and ECU Health anchor the local provider network for those seeking ACA marketplace or Medicaid coverage. With 6.0 percent of residents being foreign-born, multilingual plan support and accessibility to culturally competent providers through these health systems are important factors for many Wilson County families.
ACA Marketplace coverage through Blue Cross NC gives Wilson County individuals and families access to plans that include UNC Health Wilson and ECU Health facilities in-network.
Medicaid coverage is available to eligible low-income Wilson County residents, with expanded access following North Carolina's Medicaid expansion, providing comprehensive benefits at little or no cost.
Employer-sponsored insurance from major Wilson County employers such as Bridgestone Americas and Wilson County Schools covers a large share of working residents and their dependents.
Short-term health plans may serve Wilson County residents who are between jobs or waiting for open enrollment, though these plans offer more limited benefits than ACA-compliant coverage.
COBRA continuation coverage allows Wilson County employees who lose job-based insurance, such as those previously covered through S.T. Wooten Corporation or Truist Bank, to maintain their existing plan temporarily.
Small business SHOP marketplace plans allow Wilson County employers, including smaller local businesses, to offer ACA-compliant group health insurance to their employees and qualify for potential tax credits.
For 2026, Wilson County residents can choose from plans offered under two Blue Cross NC networks: Blue Advantage and Blue Care, both structured as plans that allow access to a broad range of local and statewide providers. Blue Advantage connects enrollees to the largest nationwide PPO network, with over 95 percent of North Carolina doctors participating in-network, while Blue Care provides broad statewide HMO coverage with over 95 percent of NC doctors in-network, both including key Wilson County facilities such as Wilson Medical Center at 1705 Tarboro St SW. Health Plans of NC agents help Wilson County residents compare both network options side-by-side to ensure that preferred providers like ECU Health Family Medicine on Glendale Dr SW or Eastpointe mental health services are accessible before enrollment.
Blue Advantage, a PPO network, includes Wilson Medical Center and connects Wilson County residents to the largest nationwide provider network, with 95 percent or more of NC doctors participating in-network.
Blue Care, an HMO network, covers Wilson County residents with broad statewide access, including over 95 percent of NC doctors in-network and key local facilities such as Wilson Medical Center.
Both Blue Advantage and Blue Care plans allow Wilson County enrollees to see specialists at Nash General Hospital in Rocky Mount and UNC Health Johnston in Smithfield without a referral requirement.
Wilson County residents managing chronic conditions, such as those relying on cardiology or oncology services at Wilson Medical Center, should verify specialist availability within their chosen Blue Advantage or Blue Care network.
Mental health and behavioral health services, including Eastpointe, are accessible through both Blue Advantage and Blue Care plans, supporting Wilson County residents seeking behavioral health coverage.
Health Plans of NC compares every Blue Advantage and Blue Care plan option available in Wilson County for 2026, helping residents identify the network and coverage tier that best fits their provider preferences.
Bronze plans in Wilson County start at approximately $443.10/month before subsidies. With a median household income of $51,381, many residents qualify for premium tax credits. Subsidies may reduce your monthly premium significantly based on income.
Bronze plans in Wilson County start at $443.10 per month for a 35-year-old before subsidies, offering the lowest monthly premiums with higher deductibles for those who want financial protection against major medical events.
Silver plans start at $569.49 per month before subsidies and are the only tier eligible for cost-sharing reductions, which lower deductibles and copays for qualifying Wilson County residents.
Gold plans start at $588.91 per month before subsidies and feature lower out-of-pocket costs, making them a strong choice for Wilson County residents who expect frequent medical care throughout the year.
Wilson County residents earning between 100 and 400 percent of the federal poverty level qualify for ACA premium tax credits that can reduce monthly plan costs well below the published starting prices.
Households earning up to 250 percent of the federal poverty level may qualify for cost-sharing reduction plans on the Silver tier, lowering deductibles and copays beyond what the base premium reduction provides.
Some Wilson County residents with incomes just above the Medicaid threshold may qualify for a zero-dollar or near-zero-dollar premium Silver plan after applying all available premium tax credits.
Blue Cross NC is one of two ACA marketplace carriers offering plans in Wilson County for 2026, with 18 total plans available to eligible residents across multiple coverage tiers. These 18 plans are built on two network options, Blue Advantage and Blue Care, giving Wilson County shoppers meaningful choice in terms of network breadth and provider access. Blue Advantage connects enrollees to the largest nationwide PPO network with 95 percent or more of NC doctors in-network, while Blue Care provides broad statewide HMO coverage including over 95 percent of NC doctors, both anchored locally by Wilson Medical Center and supported by regional facilities such as Nash General Hospital and UNC Health Johnston. The network a Wilson County resident selects directly determines which local providers, specialists, and hospitals are accessible at in-network cost-sharing levels, making network comparison a critical step before enrolling. Health Plans of NC agents compare every available Blue Cross NC plan side-by-side at no cost, helping Wilson County residents identify the carrier plan and network combination that best matches their healthcare needs and preferred local providers.
Blue Cross NC: one of two ACA marketplace carriers in Wilson County for 2026, offering 18 plans across Bronze, Silver, Gold, and Catastrophic tiers on both Blue Advantage PPO and Blue Care networks.
North Carolina expanded Medicaid in December 2023, extending eligibility to adults earning up to 138 percent of the federal poverty level and opening comprehensive, low-cost or no-cost coverage to thousands of Wilson County residents who were previously uninsured. Wilson County currently has an uninsured rate of 12.8 percent, representing approximately 10,000 residents without coverage, many of whom may now qualify for Medicaid or subsidized marketplace plans. Children in families earning up to 210 percent of the federal poverty level may qualify for NC Health Choice, the state's CHIP program, providing low-cost comprehensive coverage for eligible minors in Wilson County. Health Plans of NC offers free eligibility checks to help Wilson County residents determine whether they qualify for Medicaid, CHIP, or an ACA marketplace plan, with licensed agents available to guide families through the enrollment process at no cost.
Working adults in Wilson County who earn at or below 138 percent of the federal poverty level may now qualify for full Medicaid coverage following North Carolina's December 2023 expansion.
Children in Wilson County families earning up to 210 percent of the federal poverty level may be eligible for NC Health Choice, the state CHIP program, which provides comprehensive low-cost health coverage.
Pregnant women in Wilson County are eligible for Medicaid at higher income thresholds than standard adult eligibility, ensuring prenatal and delivery care is covered for many low-income expectant mothers.
Wilson County seniors with limited income may qualify for dual Medicare and Medicaid coverage, helping to offset costs for premiums, deductibles, and long-term care services.
With a poverty rate of 21.0 percent in Wilson County, a substantial share of residents may qualify for Medicaid or CHIP, and Health Plans of NC can confirm eligibility and assist with enrollment at no cost.
Health Plans of NC licensed agents serve Wilson County residents at no cost, comparing every available plan side-by-side and helping with enrollment from start to finish. Call 800-797-0327 today to speak with a local agent who can identify the right coverage for your household and help you maximize any available savings.
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 Wilson 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 |
|---|---|---|
Wilson Medical Center | 1705 S Tarboro St, Wilson, NC 27893 |
Clinic | Address | Phone |
|---|---|---|
Fast Pace Health | 2209 Nash St. NW, Wilson, NC 27896 | |
Wilson Community Health Center | 303 Green St E, Wilson, NC 27893 | |
Wilson Family Care | 1700 Tarboro St W Ste 100, Wilson, NC 27893 | |
Wilson New Hope Primary Care | 2508 Ward Blvd, Wilson, NC 27893 | |
Wilson Primary Care | 1700 Tarboro St W Ste 200, Wilson, NC 27893 | |
Brentwood Clinic | 110 Brentwood Center Ln N, Wilson, NC 27896 | |
Eastern Internal Medicine | 2635 Tilghman Rd N, Wilson, NC 27896 | |
Eastern North Carolina Medical Group | 1812 Glendale Dr SW Suite B, Wilson, NC 27893 | |
Ebk Healthcare Services | 2305 Wellington Dr SW Ste E, Wilson, NC 27893 | |
Family Medicine | 2546 Ward Blvd, Wilson, NC 27893 |
Wilson County ZIP Codes include: 27813, 27822, 27851, 27873, 27880, 27883, 27893, 27894, 27895, and 27896
