North Carolina residents shopping for 2026 Marketplace coverage face average rate increases of nearly 28.6%, and the enhanced premium tax credits that lowered costs since 2021 expired at the end of 2025. That means most people still qualify for some help paying premiums through Healthcare.gov, but the subsidy cliff at 400% of the federal poverty level (FPL) is back, and anyone above that income line now pays full price with no cap on how much of their income goes toward premiums. This guide covers current income limits, what changed with subsidies, and how to apply.
North Carolina Uses the Federal Marketplace
North Carolina does not run its own health insurance exchange. Residents enroll through Healthcare.gov, the federally facilitated marketplace (FFM), the same system used by most states that haven't built a state-based exchange. There is no separate "NC exchange" website. If a site claims to be North Carolina's official marketplace and isn't Healthcare.gov, be cautious.
Open enrollment for 2026 coverage runs November 1, 2025 through January 15, 2026. Enrolling by December 15 typically means coverage starts January 1. Outside that window, coverage is only available through a Special Enrollment Period triggered by events like losing a job, having a baby, getting married, or moving.
What Changed for 2026: Enhanced Subsidies Are Gone
From 2021 through 2025, the American Rescue Plan and later the Inflation Reduction Act boosted ACA premium tax credits, capping premium contributions at a lower share of income and eliminating the 400% FPL cutoff entirely. Congress did not extend those enhancements, and they expired January 1, 2026.
For plan year 2026, the marketplace reverts to the original ACA subsidy structure:
- Premium tax credits are still available to households between 100% and 400% of FPL (or as low as 138% FPL for adults in expansion states like North Carolina, since Medicaid covers that lower range).
- Households above 400% FPL get no premium tax credit at all, regardless of how high their premium is relative to income. This is the "subsidy cliff."
- The percentage of income lower-earning households are expected to contribute toward the benchmark plan rose compared to the 2021-2025 enhanced formula, so even subsidized enrollees are generally paying more out of pocket in 2026 than in 2025.
Combined with base premium increases from insurers, this is why many North Carolinians are seeing sharply higher costs this year even if they still qualify for a subsidy.
Why NC Premiums Rose Nearly 29%
The North Carolina Department of Insurance approved individual market rate increases averaging 28.6% for 2026, with specific plans ranging from about 17% to over 36% depending on the carrier and metal tier. Insurers cited two factors: rising medical costs and the expiration of the enhanced federal subsidies, which they expect will push healthier enrollees out of the market, leaving a sicker, costlier risk pool behind.
Six carriers are selling 2026 marketplace plans in North Carolina:
- Blue Cross and Blue Shield of North Carolina
- Ambetter (Centene)
- AmeriHealth Caritas
- Cigna
- Oscar Health
- UnitedHealthcare
Three carriers that sold 2025 plans (Aetna, Celtic/WellCare, and CareSource) exited the North Carolina market for 2026, so returning customers on those plans had to actively pick a new one during open enrollment or risk being auto-enrolled somewhere that may not fit their needs.
2026 Income Limits for Marketplace Subsidies
Premium tax credit eligibility for 2026 coverage is based on 2025 federal poverty guidelines. Cost-sharing reductions, which lower deductibles and copays on Silver plans, are available up to 250% of FPL.
| Household Size | 100% FPL (annual) | 138% FPL (Medicaid cutoff) | 250% FPL (CSR cutoff) | 400% FPL (subsidy cliff) |
|---|
| 1 | $15,650 | $21,597 | $39,125 | $62,600 |
| 2 | $21,150 | $29,187 | $52,875 | $84,600 |
| 3 | $26,650 | $36,777 | $66,625 | $106,600 |
| 4 | $32,150 | $44,367 | $80,375 | $128,600 |
| 5 | $37,650 | $51,957 | $94,125 | $150,600 |
Because North Carolina expanded Medicaid, most adults below 138% FPL are not eligible for marketplace subsidies at all. Instead they qualify for NC Medicaid, which has no monthly premium and copays never exceed $4. The marketplace subsidy range effectively starts just above the Medicaid cutoff and runs through 400% FPL.
Average Costs on the North Carolina Marketplace
For the 2026 plan year, healthcare.gov data show:
- About 87% of North Carolina enrollees qualified for premium tax credits, averaging roughly $660/month in subsidy value.
- The average net monthly premium for subsidy-eligible enrollees after tax credits is approximately $97/month.
- Including enrollees who pay full price with no subsidy, the average net premium across all NC marketplace enrollees is closer to $180/month.
- The lowest-cost plan available to a subsidy-eligible enrollee is projected at around $50/month after tax credits, though this varies significantly by county, age, and household income.
These are averages. A 27-year-old earning 150% of FPL in a low-cost rating area will pay far less than a family of four just under the 400% FPL cliff, since the tax credit shrinks as income rises and disappears entirely above the cliff.
North Carolina Medicaid Expansion Changed the Coverage Gap
North Carolina expanded Medicaid effective December 1, 2023, becoming the 40th state to do so. This matters directly for marketplace shoppers because it eliminated the historic "coverage gap" for most adults.
Before expansion, adults without dependent children who earned too little to qualify for marketplace subsidies (below 100% FPL) but too much for the old, narrow Medicaid rules had no affordable option. That gap is now closed for most people. Adults age 19 to 64 earning up to 138% of FPL (about $1,800/month for a single person, monthly limits scale up with household size) qualify for NC Medicaid instead of a marketplace plan.
Practically, this means:
- If your income is below 138% FPL, you likely qualify for NC Medicaid, not marketplace subsidies. Apply through ePASS or Healthcare.gov, either portal routes Medicaid-eligible applicants correctly.
- If your income is between 138% and 400% FPL, you're in marketplace subsidy territory.
- If your income is above 400% FPL, you pay full price on the marketplace with no premium tax credit for 2026.
Read our full guide to North Carolina benefits programs for details on Medicaid income limits by household size and other assistance programs.
Who Should Watch the Subsidy Cliff Closely
The 400% FPL cliff hits hardest for older enrollees and families in higher cost-of-living areas, because premiums for older applicants are legally allowed to be up to three times higher than for young adults, and the subsidy that used to cushion that gap is gone above the cliff. A 60-year-old couple earning just above 400% FPL could see a jump from a few hundred dollars a month to well over a thousand, with no phase-out cushion.
If your income fluctuates near the 400% line, consider:
- Reporting income changes to Healthcare.gov promptly during the year, since a dip below 400% FPL can restore subsidy eligibility for the following month.
- Reviewing whether pre-tax retirement contributions or HSA contributions can lower your Modified Adjusted Gross Income (MAGI) enough to stay under the cliff.
- Comparing off-marketplace plans, since some insurers sell similar plans directly that aren't ACA-compliant in the same way, though these typically lack the same consumer protections.
How to Apply for North Carolina Marketplace Coverage
- Gather documents. Social Security numbers for everyone applying, income information (pay stubs, tax returns), and details on any current job-based coverage offers.
- Go to Healthcare.gov. Create an account or log into an existing one. North Carolina does not have a separate state portal for this step.
- Complete the application. Enter household size, income, and coverage needs. The system will tell you if you qualify for NC Medicaid instead of a marketplace plan, and route you accordingly.
- Compare plans. Review premiums, deductibles, and provider networks across the six carriers offering NC plans. Pay attention to whether your doctors are in-network, since networks changed as carriers entered and exited the state.
- Enroll by the deadline. Select a plan by January 15, 2026 for 2026 coverage. Enrolling by December 15, 2025 ensures coverage starts January 1.
- Get free help if needed. The NC Navigator Consortium (1-855-733-3711, ncnavigator.org) provides free, unbiased enrollment assistance across the state. Certified application counselors and licensed agents can also help at no direct cost to you.
Frequently Asked Questions
Does North Carolina have its own health insurance marketplace?
No. North Carolina uses Healthcare.gov, the federal marketplace. There is no state-run NC exchange.
Are premium tax credits still available in North Carolina for 2026?
Yes, but only for households between roughly 138% and 400% of the federal poverty level. The enhanced subsidies that removed the 400% cap expired January 1, 2026, so households above that income level no longer receive a premium tax credit.
What is the 400% FPL subsidy cliff?
It's the income threshold above which marketplace enrollees receive no premium tax credit at all. For 2026, that's $62,600 for a single person and $128,600 for a family of four. Above this line, you pay the full, unsubsidized premium.
Did North Carolina expand Medicaid?
Yes, effective December 1, 2023. Adults ages 19 to 64 earning up to 138% of FPL qualify for NC Medicaid rather than marketplace coverage.
How much did North Carolina marketplace premiums increase for 2026?
The NC Department of Insurance approved an average increase of about 28.6% for individual market plans, with a range of roughly 17% to over 36% depending on the insurer and plan.
Which insurers sell marketplace plans in North Carolina for 2026?
Blue Cross and Blue Shield of North Carolina, Ambetter, AmeriHealth Caritas, Cigna, Oscar Health, and UnitedHealthcare. Aetna, Celtic/WellCare, and CareSource exited the state's individual market after 2025.
What happens if I don't pick a new plan and my old insurer left the market?
Healthcare.gov typically auto-enrolls returning customers into a similar plan from a remaining carrier, but the assigned plan may have a different network or cost-sharing structure. It's worth actively logging in and comparing options rather than relying on auto-enrollment.
When is open enrollment for North Carolina in 2026?
November 1, 2025 through January 15, 2026. Enroll by December 15, 2025 for coverage starting January 1, 2026. Outside this window, you need a qualifying life event to enroll through a Special Enrollment Period.
Where can I get free help enrolling in North Carolina?
The NC Navigator Consortium (1-855-733-3711 or ncnavigator.org) offers free, unbiased application help. Certified application counselors and licensed insurance agents are also available at no direct cost.
