North Carolina Health Insurance Guide

Health Insurance Overview in North Carolina

North Carolina expanded Medicaid in 2023 — one of the most recent states to do so — after years of legislative resistance. The expansion coverage began for eligible residents in December 2023. North Carolina uses the federal HealthCare.gov marketplace and has seen improvements in insurer competition in recent years, particularly in metro areas.

Average Health Insurance Costs in North Carolina

Marketplace Enrollment in North Carolina

North Carolina residents can enroll in individual and family health insurance plans through HealthCare.gov (Federal). Open enrollment runs November 1 – January 15 (federal marketplace).

Average Premiums by City in North Carolina

Medicaid in North Carolina

North Carolina Medicaid expanded in December 2023, covering adults with incomes up to 138% of the federal poverty level. Previously uninsured adults who qualify should apply immediately.

Children's Health Insurance (CHIP) in North Carolina

Health Choice covers children under 19 in families with incomes up to 211% of the federal poverty level.

What Makes North Carolina Unique

North Carolina's Medicaid expansion in 2023 was tied to a broader hospital and Medicaid reform package that provided incentives for hospitals to support expansion. The expansion is expected to cover approximately 600,000 previously uninsured North Carolinians and represents a significant policy shift after years of legislative opposition.

ACA Subsidies: What North Carolina Residents Should Know

The enhanced subsidies first enacted in the American Rescue Plan expired at the end of 2025. For 2026, premium tax credits follow the original ACA rules: there is no credit above 400% (the “subsidy cliff”), and enrollees are expected to pay up to 9.96% of income toward the benchmark Silver plan. House in January 2026 but has not become law, so 2027 plans are being priced and subsidized under the same rules unless Congress acts.

North Carolina’s Marketplace for 2027: Insurers, Rates, and Dates

North Carolina residents enroll through HealthCare.gov. Full-price premiums rose about 28% on average for 2026, before subsidies. 6 insurers sold plans for 2026.

About 761,000 people enrolled for 2026. About 87% received premium tax credits, and the average net premium after credits was about $180 a month.

Open enrollment for 2027: November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

What’s Different About Health Coverage in North Carolina

North Carolina had the largest marketplace enrollment drop in the country for 2026 — down about 22% to roughly 761,000 — after expanding Medicaid in December 2023 moved many low-income adults to Medicaid and the enhanced credits expired. Enrollment in Silver plans with cost-sharing reductions fell sharply as people switched to Bronze; if your income is under 250% FPL, compare the total cost, not just the premium.

Tips for Choosing Health Insurance in North Carolina

North Carolina residents who were previously uninsured should immediately check eligibility for the newly expanded Medicaid program. HealthCare.gov subsidies are available for incomes 100-400% of the federal poverty level. Health Choice provides children's coverage. The 2023 expansion is expected to significantly improve coverage rates statewide.

• Enroll during open enrollment (November 1 – January 15 (federal marketplace)) — missing the deadline means waiting until the next open enrollment unless you have a qualifying life event.

Frequently Asked Questions

How many insurers sell marketplace plans in North Carolina?

Six insurers sold North Carolina marketplace plans for 2026.

When is open enrollment in North Carolina for 2027?

November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

How much do North Carolina marketplace enrollees pay after subsidies?

In 2026 about 87% of North Carolina enrollees received premium tax credits, and the average net premium was about $180 a month. There is no credit above 400% of the federal poverty level.

The information on this page is provided for general informational purposes only and reflects estimated industry averages and program eligibility rules as of 2026. Health insurance premiums, Medicaid eligibility thresholds, marketplace options, and program rules change annually. Always verify current eligibility and enrollment options at the official HealthCare.gov (Federal) or by contacting a certified navigator or broker. Premium figures shown are approximations before subsidies — actual net premiums depend on individual income, household size, and plan selection.