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North Carolina Health Insurance Consumer Guide
This guide, including the FAQs below, was developed to help you understand the health coverage options and possible financial assistance available to you and your family in North Carolina.
The health plan options found in North Carolina’s ACA Marketplace/exchange are designed to cover people who don’t have access to Medicare, Medicaid, or an employer’s health plan. North Carolina uses the federally run health insurance exchange platform — Healthcare.gov — for residents to purchase its ACA Marketplace plans.
North Carolina’s Marketplace provides access to health insurance products from nine private insurers, all of which plan to continue to offer Marketplace coverage in 2025.1
The federal government helps pay for insurance through an advance premium tax credit if you buy coverage from the exchange and are eligible for the tax credit based on your income. Some enrollees are also eligible for cost-sharing reductions, which reduce out-of-pocket costs on Silver-level plans for eligible enrollees.
North Carolina Medicaid expansion took effect on December 1, 2023, making hundreds of thousands of North Carolina residents newly eligible for Medicaid. Some were previously in the coverage gap, while others were previously eligible for subsidies to offset the cost of Marketplace coverage.2
Explore our other comprehensive guides to coverage in North Carolina
Dental coverage in North Carolina
Hoping to improve your smile? Dental insurance may be a smart addition to your health coverage. Our guide explores dental coverage options in North Carolina.
North Carolina’s Medicaid program
Learn about North Carolina's Medicaid expansion, the state’s Medicaid enrollment and Medicaid eligibility.
Medicare coverage and enrollment in North Carolina
Use our guide to learn about Medicare, Medicare Advantage, and Medigap coverage available in North Carolina as well as the state’s Medicare supplement (Medigap) regulations.
Short-term coverage in North Carolina
Short-term health plans provide temporary health insurance for consumers who may find themselves without comprehensive coverage. Learn more about short-term plan availability in North Carolina.
Frequently asked questions about health insurance in North Carolina
Who can buy Marketplace health insurance?
To qualify for health coverage through the North Carolina Marketplace, you must:3
- 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.4
- If married, file a joint tax return.5
- Not be able to be claimed by someone else as a tax dependent.5
When can I enroll in an ACA-compliant plan in North Carolina?
In North Carolina, the open enrollment period for individual/family health coverage runs from November 1 to January 15.6
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 1.7
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.
How do I enroll in a North Carolina Marketplace plan?
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.8
How can I find affordable health insurance in North Carolina?
North Carolina uses the federally run exchange for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov.
As of early 2024, 96% of the people with effectuated Marketplace coverage in North Carolina were saving money on their premiums due to premium tax credits (subsidies) that averaged $558/month. After subsidies were applied, the average enrollee’s monthly cost was about $70/month (including those who paid full price).9
(The numbers above are based on effectuated enrollment. They differ from the numbers in the chart below as it includes some different metrics and is based on all enrollments completed during the open enrollment period for 2024 coverage.)
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.10 As of early 2024, half of North Carolina’s Marketplace enrollees were receiving CSR benefits.9
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 11
How many insurers offer Marketplace coverage in North Carolina?
Nine insurers offer exchange plans in North Carolina, with coverage areas that vary from one insurer to another.12 All nine plan to continue to offer Marketplace coverage in 2025.1
The federal Marketplace insurer participation map shows North Carolina having one fewer Marketplace insurer in 2024 than they had in 2023.13 However, based on an analysis of the Marketplace landscape files, that’s because Friday Health Plans participated in the Marketplace in 2023 and will not in 2024.14
However, all Friday Health Plans policies in North Carolina terminated at the end of August 2023, so people no longer had coverage under those plans when open enrollment began for 2024 coverage. All of the other insurers continued to offer coverage in the North Carolina Marketplace for 2024, and plan to do so in 2025 as well.
Are Marketplace health insurance premiums increasing in North Carolina?
The insurers that offer plans in North Carolina’s health insurance Marketplace have proposed the following average rate changes (calculated before subsidies are applied) for 2025. The rates are under review by state regulators and will be finalized before open enrollment begins in November 2024:
North Carolina’s ACA Marketplace Plan 2025 PROPOSED Rate Increases by Insurance Company |
|
---|---|
Issuer | Percent Increase |
Aetna Health Inc. | 14.77% |
Ambetter/Centene | 0.37% |
AmeriHealth Caritas | 0.69% |
Blue Cross and Blue Shield of NC | 2.98% |
CareSource | 13.54% |
Celtic/WellCare | 5.03% |
Cigna | 4.12% |
Oscar | 4.65% |
UnitedHealthcare | 4.72% |
Source: North Carolina Department of Insurance1
Based on the enrollment numbers provided by the North Carolina Department of Insurance, the overall weighted average proposed rate increase is about 7%.1 But there is quite a bit of variation from one plan to another.
And since most North Carolina Marketplace enrollees receive premium subsidies, the net premium change also depends on how a person’s subsidy amount changes from one year to the next (which depends on how the cost of the second-lowest-cost Silver plan changes).
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%15
- 2016: Average increase of 28.1%16
- 2017: Average increase of 24.3%17
- 2018: Average increase of 14.8%18
- 2019: Average decrease of 3.9%19
- 2020: Average decrease of 5.6%20
- 2021: Average preliminary increase of 4%21
- 2022: Average increase of 3.2%22
- 2023: Average increase of 7.93%23
- 2024: Average decrease of 1.3%24
How many people are insured through North Carolina’s Marketplace?
1,027,930 people enrolled in private plans through the North Carolina Marketplace during the open enrollment period for 2025 coverage.25
This was by far a record high (see chart below for enrollment in prior years), 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 to a significant new record high for 2024.
The increase in enrollment (which has 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.26
The increase is 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.27
Source: 2014,28 2015,29 2016,30 2017,31 2018,32 2019,33 2020,34 2021,35 2022,36 202337 2023,38 202439
What health insurance resources are available to North Carolina residents?
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)
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
Footnotes
- ”2025 Plan Year ACA Rate Filings” North Carolina Department of Insurance. Accessed Aug. 15, 2024. ⤶ ⤶ ⤶ ⤶
- Questions and Answers about Medicaid Expansion. North Carolina Medicaid Division of Health Benefits. Accessed November 2023. ⤶
- ”A quick guide to the Health Insurance Marketplace” HealthCare.gov ⤶
- Medicare and the Marketplace, Master FAQ. Centers for Medicare and Medicaid Services. Accessed November 2023. ⤶
- Premium Tax Credit — The Basics. Internal Revenue Service. Accessed May 10, 2024 ⤶ ⤶
- “When can you get health insurance?” HealthCare.gov, 2023 ⤶
- “When can you get health insurance?” HealthCare.gov, 2023 ⤶
- “Entities Approved to Use Enhanced Direct Enrollment” CMS.gov, April 28, 2023 ⤶
- ”Effectuated Enrollment: Early 2024 Snapshot and Full Year 2023 Average” CMS.gov, July 2, 2024 ⤶ ⤶
- ”APTC and CSR Basics” Centers for Medicare & Medicaid Services. June 2024. ⤶
- “2024 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 2024 ⤶
- North Carolina Department of Insurance – Life & Health Division Health Insurance Rate Change Requests for 2024 for Individual Policies (Approved) North Carolina Department of Insurance. Accessed November 2023. ⤶
- Plan Year 2024 Qualified Health Plan Choice and Premiums in HealthCare.gov Marketplaces. Centers for Medicare and Medicaid Services. October 25, 2023 ⤶
- FFM QHP landscape files: Health and dental datasets for researchers and issuers; 2024 plan data. HealthCare.gov. Accessed November 2023. ⤶
- Analysis Finds No Nationwide Increase in Health Insurance Marketplace Premiums. The Commonwealth Fund. December 2014. ⤶
- FINAL PROJECTION: 2016 Weighted Avg. Rate Increases: 12-13% Nationally* ACA Signups. October 2015. ⤶
- Avg. UNSUBSIDIZED Indy Mkt Rate Hikes: 25% (49 States + DC). ACA Signups. August 2016. ⤶
- 2018 Rate Hikes. ACA Signups. October 2017 ⤶
- 2019 Rate Hikes. ACA Signups. October 2018. ⤶
- 2020 Rate Changes. ACA Signups. October 2019. ⤶
- 2021 Rate Changes. ACA Signups. October 2020. ⤶
- 2022 Rate Changes. ACA Signups. October 2021. ⤶
- UPDATED: FINAL Unsubsidized 2023 Premiums: +6.2% Across All 50 States +DC. ACA Signups. Accessed November 2023. ⤶
- North Carolina: *Final* Avg. Unsubsidized 2024 #ACA Rate Changes: -1.3% (Updated). ACASignups.net, October 2023 ⤶
- ”Health Insurance Marketplaces 2024 Open Enrollment Period Report” CMS.gov. March 22, 2024 ⤶
- “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, Accessed August 2023 ⤶
- HealthCare.gov Marketplace Medicaid Unwinding Report. Medicaid.gov. Data through April 2024; Accessed Aug. 15, 2024 ⤶
- “ASPE Issue Brief (2014)” ASPE, 2015 ⤶
- “Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report”, HHS.gov, 2015 ⤶
- “HEALTH INSURANCE MARKETPLACES 2016 OPEN ENROLLMENT PERIOD: FINAL ENROLLMENT REPORT” HHS.gov, 2016 ⤶
- “2017 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2017 ⤶
- “2018 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2018 ⤶
- “2019 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2019 ⤶
- “2020 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2020 ⤶
- “2021 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2021 ⤶
- “2022 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2022 ⤶
- “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, 2023 ⤶
- “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, 2023 ⤶
- ”HEALTH INSURANCE MARKETPLACES 2024 OPEN ENROLLMENT REPORT” CMS.gov, 2024 ⤶