People who buy individual federal health-insurance plans through Blue Cross and Blue Shield of North Carolina will see different rates and discounts for 2019, depending on where they live in the state.

Overall, rates will drop by an average of 4.1 percent for the plans in the state, but the rate changes will vary from a drop of more than 20 percent in Raleigh to an increase of more than 9 percent in parts of the Triad, Blue Cross said Wednesday.

Rates for people in the Winston-Salem metropolitan statistical area will decrease by an average of 2.9 percent. The region is comprised of Davidson, Davie, Forsyth, Stokes and Yadkin, with Surry included.

Meanwhile, Alleghany, Ashe, Watauga and Wilkes counties will have a 4.8 percent increase, while the Greensboro-High Point MSA counties of Guilford, Randolph and Rockingham will have a 9.3 percent increase — tied for the highest among the state’s regions.

The individual plans are offered under the federal Affordable Care Act, commonly known as “Obamacare.”

In North Carolina’s other major metro areas, the Charlotte MSA gets a 17 percent discount, the Raleigh-Cary a 20.3 percent discount and the Durham-Chapel Hill MSA (including Alamance County) a 22 percent discount.

On Wednesday, the N.C. Department of Insurance approved the rates for all 100 counties.

Open enrollment will begin Nov. 1 and end Dec. 15. Blue Cross projects that its plans will cover more than 475,000 North Carolinians in 2019.

Blue Cross spokesman Austin Vevurka said the main premium pricing difference is “Winston-Salem is almost entirely Blue Value. This is a narrow network product that, on average this year, saw a larger decrease.”

“Greensboro and the Northwest part of the state is almost entirely Blue Advantage/Blue Select. These are broad network products that didn’t see that decrease,” Vevurka said.

“As always, rates vary based on location, age, subsidy amount and plan. Individual premiums will be available in October.”

Blue Cross said the Charlotte and Triangle reductions were caused in part by provider agreements with health-care systems in the respective markets, including Novant Health Inc. and Atrium Health in Charlotte and UNC Health Alliance in the Triangle, which is its main in-network provider.

The Triangle, Charlotte and Gastonia regions account for about 40 percent of Blue Cross’ individual ACA members under age 65.

The statewide reduction is the first by Blue Cross since entering the current individual market in 1993. By comparison, state insurance officials approved a 14.1 percent premium increase for 2018. The insurer initially asked for a 22.9 percent increase.

Blue Cross said the new provider arrangements will reduce medical costs by $120 million in 2019.

“Our new provider arrangements (reduce costs) by making both parties responsible for the quality and total cost of care,” said Dr. Patrick Conway, the insurer’s president and chief executive.

“An average decrease is good news for many families, but we can’t lose sight of the fact that premiums are still too high — particularly for those who don’t get a subsidy,” Conway said.

“To keep driving premiums down, we need more market stability and more certainty from Washington.”

Blue Cross stressed on Aug. 1 that the statewide reduction could have been up to 15 percent if not for the uncertainty about the future of the ACA.

For example, the Trump administration drastically cut federal funding for publicizing the six-week ACA enrollment period.

Federal tax credits, known as premium subsidies, are available for customers with household incomes between 100 percent and 400 percent of the federal poverty level.

About 90 percent of Blue Cross current customers with ACA plans qualified in 2018. Subsidies vary by plan and household income.

The insurer’s three main individual product categories are available at

The Blue Advantage plan has an 8.1 percent rate increase, while the Blue Value plan has a 15.8 percent decline and the Blue Select plan has a 10.3 percent increase.

Blue Cross projects the overall 4.1 percent rate decrease will represent $120 million in reduced individual health-care costs statewide.

By comparison, during the first three years of the ACA, from 2014 to 2016, Blue Cross lost more than $450 million on the individual plans.

Blue Cross said it will offer transition plans again in 2019. Those plans were purchased between March 2010 and October 2013. Transitional plans do not meet ACA requirements but are allowed by federal law. They cannot be sold to new customers. Blue Cross NC has 41,500 members with transitional plans.

The federal Centers for Medicare and Medicaid Services announced in July that it is providing only $10 million nationwide for the navigator service that funds nonprofit groups assisting individuals with obtaining ACA insurance.

That includes a drop in North Carolina from $3.4 million for the 2018 sign-up period to $500,000 for 2019. That’s even though the state had the fourth-highest overall enrollment, as well as third-highest among the 34 states in the federal-based marketplace.

Overall funding is down from the $63 million allotted by the Obama administration in 2016 and the $36 million in 2017, the first year of the Trump administration.

North Carolina experienced another drop in the number of individuals without health insurance, reaching a record low of 10.4 percent in 2016, according to data released in September by the U.S. Census Bureau.

However, that number could be significantly lower if the Republican-controlled General Assembly approved expanding Medicaid coverage to more than 500,000 of the 1.04 million North Carolinians who still lack health insurance. There are 33 states with some form of Medicaid expansion, including Virginia, who did so in June.

Zagros Madjd-Sadjadi, an economics professor at Winston-Salem State University, said that “any move to lower costs will cause an increase in demand for this to some extent.”

“But, at the same time, a lack of willingness to advertise the federal marketplace, along with a decision not to penalize individuals for not carrying insurance, will likely override this rather positive development,” Madjd-Sadjadi said. 336-727-7376 @rcraverWSJ

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