North Carolina health insurance Marketplace guide

To qualify for health coverage through the North Carolina Marketplace, you must:⁵

• Live in North Carolina
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁶
• If married, file a joint tax return.⁷
• Not be able to be claimed by someone else as a tax dependent.⁷

In North Carolina, the open enrollment period for individual/family health coverage runs from November 1 to January 15.⁸ 

Your coverage will start on January 1 if you enroll before December 15. But if you apply between December 16 and January 16, your coverage will begin on February 1.⁹ 

Starting in the fall of 2026, the open enrollment period will be shorter. In states like North Carolina that use HealthCare.gov as their Marketplace, the enrollment window will run from November 1 through December 15, and all policies selected during open enrollment will take effect January 1. This is due to a federal rule change that was finalized in 2025.

Outside of open enrollment, a qualifying event is generally necessary to enroll or make changes to your coverage, although some people can qualify for a special enrollment period without a specific qualifying life event.

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

If you’re eligible for an ACA Marketplace plan, there are several ways you can enroll: 

• Online through HealthCare.gov
• By phone at (800) 318-2596
• With local help in your community from an agent/broker, Navigator, or certified application counselors (these individuals are available to help you over the phone, online, and sometimes in-person, depending on your preference)
• Through an approved enhanced direct enrollment entity.¹⁰

North Carolina uses the federally facilitated exchange for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov.

During the open enrollment period for 2025 coverage, 94% of the people who enrolled in Marketplace coverage in North Carolina were eligible for premium tax credits (subsidies) that averaged $573/month. After subsidies were applied, the average enrollee’s monthly cost was about $97/month, including those who paid full price (if we only consider the 94% of enrollees who qualified for subsidies, their average net premium was just $69/month).¹¹

In addition to premium tax credits, the ACA also provides cost-sharing reductions (CSR) to enrollees with household income up to 250% of the federal poverty level, as long as they purchase a Silver-level plan.¹² Forty-five percent of North Carolina Marketplace enrollees were receiving CSR benefits as of early 2025.¹³

Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the most affordable and robust health insurance option for you.

Source: CMS.gov ¹⁴

Seven insurers will offer Marketplace plans in North Carolina for 2026, with coverage areas that vary from one insurer to another.¹⁵

Nine insurance companies offer individual/family health plans through North Carolina’s Marketplace for 2025,³ but two of them are leaving North Carolina’s individual market at the end of 2025.

Aetna and Celtic/WellCare are both exiting the state’s market. According to their market withdrawal filings in SERFF, Aetna has about 130,000 enrollees in North Carolina who will need to select new coverage for 2026. Celtic/WellCare has only 25 individual market enrollees in North Carolina, but they too will need to select new plans during open enrollment.¹⁶

The following average rate changes have been proposed for 2026 by the insurers that offer individual/family plans in North Carolina’s health insurance Marketplace (calculated before subsidies are applied).

Source: North Carolina Department of Insurance¹⁵ Market exits based on SERFF Filings¹⁶

The weighted average proposed rate increase for 2026 is almost 29% in North Carolina.¹⁷ These significant rate increases are driven in part by the impending expiration of the federal subsidy enhancements that have been in place since 2021, and by the Marketplace rules that were finalized by HHS in 2025. Both will have the effect of reducing enrollment, which tends to drive premiums higher (the people who cancel their coverage will tend to be healthy, so the overall risk pool will become less healthy).

For perspective, here’s a summary of how average unsubsidized premiums have changed each year in North Carolina’s individual/family market:

• 2015: Average increase of 12%¹⁸
• 2016: Average increase of 28.1%¹⁹
• 2017: Average increase of 24.3%²⁰
• 2018: Average increase of 14.8%²¹
• 2019: Average decrease of 3.9%²²
• 2020: Average decrease of 5.6%²³
• 2021: Average preliminary increase of 4%²⁴
• 2022: Average increase of 3.2%²⁵
• 2023: Average increase of 7.93%²⁶
• 2024: Average decrease of 1.3%²⁷
• 2025: Average increase of 7%[efm_note]”North Carolina: *Final* avg. unsubsidized 2025 #ACA rate changes: +7.0% (updated)” ACA Signups. Oct. 29, 2024[/efn_note]

975,110 people enrolled in private plans through the North Carolina Marketplace during the open enrollment period for 2025 coverage.²⁸ Although most areas of the country reached record-high enrollment in 2025, that was not the case in North Carolina (see chart below).

The record enrollment level in North Carolina came the year before, when 1,027,930 people enrolled during the open enrollment period for 2024 coverage.²⁹

The record high enrollment for 2024 happened even though Medicaid expansion took effect in North Carolina in December 2023.

Before Medicaid expansion, people with income between 100% and 138% of the poverty level were eligible for Marketplace subsidies, whereas they’re now eligible for Medicaid instead. So states tend to see a dip in their Marketplace enrollment after expanding Medicaid. But North Carolina’s enrollment reached a significant new record high for 2024.

The increase in enrollment (which had been ongoing in North Carolina since 2021) is driven in part by the American Rescue Plan (ARP). Under the ARP, ACA’s premium subsidies are larger and more widely available. The ARP’s subsidy enhancements have been extended through 2025 by the Inflation Reduction Act.³⁰ But as noted above, these subsidy enhancements will expire at the end of 2025, unless Congress acts to extend them again. If they expire, enrollment is expected to drop sharply in 2026, as coverage will be less affordable.

The enrollment increase in 2024 was also due to the “unwinding” of the pandemic-era Medicaid continuous coverage rule. Between June 2023 and April 2024, more than 272,000 people in North Carolina were disenrolled from Medicaid and transitioned to a Marketplace plan.³¹

Source: 2014,³² 2015,³³ 2016,³⁴ 2017,³⁵ 2018,³⁶ 2019,³⁷ 2020,³⁸ 2021,³⁹ 2022,⁴⁰ 2023⁴¹ 2023,⁴² 2024,⁴³ 2025²⁸

HealthCare.gov
800-318-2596

State Exchange Profile: North Carolina
The Henry J. Kaiser Family Foundation overview of North Carolina’s progress toward creating a state health insurance exchange.

North Carolina Institute of Medicine (NCIOM)

Health Insurance Smart NC
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
Toll free: 1-877-885-0231

Managed Care Patient Assistance Program
Serves consumers who are members of managed health benefit plans.
(919) 733-6272 / Toll-Free: 1-866-867-6272 (in North Carolina only)
[email protected]

Community Care of North Carolina

Legal Aid of North Carolina (855-733-3711)