North Carolina Health Insurance Consumer Guide

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

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.

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

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

Nine insurance companies offer individual/family health plans through North Carolina’s Marketplace for 2025 (all of which also offered coverage for 2024).¹

Coverage areas vary by insurer, but most counties in North Carolina have at least four or five insurers offering coverage through the Marketplace for 2025.¹²

The following average rate changes were approved for 2025 for the insurers that offer individual/family plans in North Carolina’s health insurance Marketplace (calculated before subsidies are applied).

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 was about 7%,¹³ and the approved rates are almost identical to the proposed rates.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%¹⁴
• 2016: Average increase of 28.1%¹⁵
• 2017: Average increase of 24.3%¹⁶
• 2018: Average increase of 14.8%¹⁷
• 2019: Average decrease of 3.9%¹⁸
• 2020: Average decrease of 5.6%¹⁹
• 2021: Average preliminary increase of 4%²⁰
• 2022: Average increase of 3.2%²¹
• 2023: Average increase of 7.93%²²
• 2024: Average decrease of 1.3%²³

1,027,930 people enrolled in private plans through the North Carolina Marketplace during the open enrollment period for 2025 coverage.²⁴

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.²⁵

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.²⁶

Source: 2014,²⁷ 2015,²⁸ 2016,²⁹ 2017,³⁰ 2018,³¹ 2019,³² 2020,³³ 2021,³⁴ 2022,³⁵ 2023³⁶ 2023,³⁷ 2024³⁸

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)