Blue Cross Blue Shield of North Carolina (BCBSNC) Claims Data
Average Member Months
|| 1: Insured & Multiple Employer Welfare Arrangements (INS)
||2: Administrative Services Only (ASO)||3: Individual Market and Affordable Care Act Plans (after 1/1/14) (IND)|
|GENDER – 2014 (number of members)
|GENDER||1: INS||2: ASO||3:IND|
|Female||397,498 (48.05)||414,862 (50.60)||367,198 (52.46)|
|Male||425,101 (51.38)||400,362 (48.83)||329,903 (47.13)|
|Unknown||4,709 (0.57)||4,724 (0.58)||2,813 (0.40)|
| Age Group 2014 (number of members)
|<2||13,339 (1.61)||17,870 (2.18)||12,300 (1.76)|
|2-17||126,258 (15.26)||167,719 (20.45)||109,296 (15.62)|
|18-44||425,465 (51.43)||357,205 (43.56)||278,164 (39.74)|
|45-64||245,469 (29.67)||257,555 (31.41)||279,700 (39.96)|
|65-84||16,644 (2.01)||19,166 (2.34)||19,933 (2.85)|
|85+||133 (0.02)||433 (0.05)||521 (0.07)|
|Distribution by CPT Category in Professional Claims BCBSNC, 2014 (Number of Procedure codes per Unique Member ID, Service Date and Rendering Provider).|
|CPT Procedure Categories
NC Medicaid Data
|Medicaid Eligibility Category||Average member months, 2016|
|Aged, Blind, and Disabled||447,666|
|Children and Families||1,375,017|
|Medicare Savings Program||78,529|
|NC Health Choice||96,567|
Aged, blind, and disabled. This category includes Medicaid recipients who are older adults (age 65 or older), blind, or those considered disabled (under the Social Security disability standards). This category includes some dual eligibles (those who receive both Medicare and Medicaid), as well as individuals who are aged, blind or disabled who only receive Medicaid. These individuals are entitled to full Medicaid benefits.
Children and Families. This category includes Medicaid recipients who are children under age 19, young adults ages 20-21, and the parents or other caretaker relatives of children who are taking care of the children under age 19. It also includes pregnant women who qualify on the basis of their pregnancy.
Medicare Savings Programs (sometimes referred to as Medicaid for Medicare Qualified Beneficiaries (MQB)). This category includes aged (65 or older), blind, or disabled adults who receive Medicare. There are different types of Medicare Savings programs. Individuals enrolled in the different Medicare Savings programs have incomes too high to qualify for full Medicaid services. These individuals get help paying some of the Medicare cost sharing (such as the Part B premium, or deductible, depending on the type of Medicare Savings program). They do not get full Medicaid coverage. Thus, unlike the regular aged, blind, and disabled category, the Medicare Savings individuals are not eligible for coverage of Medicaid-covered services that Medicare does not cover (such as dental services or hearing aids).
Other Medicaid. This includes other groups, not included in the other categories. For example, this includes people enrolled in Medicaid through the Family Planning program, Breast and Cervical Cancer program, or emergency Medicaid.
NC Health Choice. This program covers children who are enrolled in North Carolina’s Child Health Insurance Program (CHIP). This includes children ages 6-18 whose income is too high to qualify for Medicaid, but no more than 210% of the federal poverty guidelines.