Primer: Understanding Private Health Insurance in North Carolina

Published December 30, 2025

Health insurance is a contract between an individual or group and a health insurance company. To obtain private health insurance coverage, an individual or group purchases a plan (also called a policy) from the insurer, paying a set amount of money each month in exchange for the insurer covering some, or all, of the individual’s or group’s health care costs.
 
The 3 broad categories of private health insurance are small group, large group, and non-group. Insurers provide small- and large-group coverage to groups, such as employers, unions, or other organizations. Individuals and families who do not receive coverage through a group or the government (e.g. through Medicaid or Medicare) can directly purchase non-group health insurance coverage from an insurance agent or through an insurance marketplace (also known as an exchange).

Abstract

Health insurance is a contract between an individual or group and a health insurance company. To obtain private health insurance coverage, an individual or group purchases a plan (also called a policy) from the insurer, paying a set amount of money each month in exchange for the insurer covering some, or all, of the individual’s or group’s health care costs.
 
The 3 broad categories of private health insurance are small group, large group, and non-group. Insurers provide small- and large-group coverage to groups, such as employers, unions, or other organizations. Individuals and families who do not receive coverage through a group or the government (e.g. through Medicaid or Medicare) can directly purchase non-group health insurance coverage from an insurance agent or through an insurance marketplace (also known as an exchange).