North Carolina residents who need health insurance in 2026 have access to the ACA marketplace through Healthcare.gov. Six insurers are selling plans in the state this year, down from nine in 2025, and premiums have risen sharply. Average individual rates increased roughly 28.6% compared to 2025. The good news is that most NC marketplace enrollees still qualify for premium tax credits: 87% of those who enrolled during the most recent open enrollment period received subsidies averaging $660 per month, which brought the typical monthly cost down to about $97.
This guide covers the income thresholds that determine your subsidy, the metal plan tiers available, the insurers operating in NC, and how to enroll or see if you qualify right now at CoveredUSA.
What Changed in North Carolina for 2026
The biggest shift for 2026 is the expiration of the enhanced premium tax credits that were originally created by the American Rescue Plan in 2021 and extended through 2025. Those enhanced credits allowed households above 400% of the federal poverty level (FPL) to get subsidies. Starting January 1, 2026, the subsidy cliff returned: if your income exceeds 400% FPL, you receive no premium tax credit.
Three insurers (Aetna, CareSource, and Celtic/WellCare) exited the North Carolina individual market for 2026. Six carriers remain:
- Ambetter of North Carolina
- AmeriHealth Caritas North Carolina
- Cigna HealthCare of North Carolina
- Oscar Health Plan of North Carolina
- UnitedHealthcare of North Carolina
- Blue Cross and Blue Shield of North Carolina
The specific plans and carriers available to you depend on your county. Some counties have fewer choices than others.
North Carolina ACA Income Limits for 2026
ACA subsidies for 2026 coverage are calculated using the 2025 federal poverty guidelines. To qualify for a premium tax credit, your household income must fall between 100% and 400% of FPL. To qualify for cost-sharing reductions (which lower your deductible and out-of-pocket costs on Silver plans), your income must be at or below 250% FPL.
North Carolina expanded Medicaid in December 2023. Adults earning up to 138% FPL now qualify for NC Medicaid rather than marketplace coverage. Check CoveredUSA's screener if you are unsure which program applies to your household.
2026 ACA Subsidy Income Limits for North Carolina (48 Contiguous States)
| Household Size | 100% FPL (Medicaid floor) | 138% FPL (Medicaid limit) | 250% FPL (CSR cutoff) | 400% FPL (Subsidy cutoff) |
|---|
| 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 |
| 6 | $43,150 | $59,547 | $107,875 | $172,600 |
| 7 | $48,650 | $67,137 | $121,625 | $194,600 |
| 8 | $54,150 | $74,727 | $135,375 | $216,600 |
| Each additional person | +$5,500 | +$7,590 | +$13,750 | +$22,000 |
Income figures above are annual. FPL amounts are based on 2025 federal poverty guidelines used for 2026 ACA coverage calculations.
If your income falls below 100% FPL and you are not eligible for Medicaid for another reason (e.g., immigration status), you may still qualify for marketplace coverage with subsidies in some circumstances. Use the CoveredUSA screener to confirm which programs match your situation.
Plan Metal Tiers Explained
North Carolina marketplace plans come in four standard metal tiers plus catastrophic plans for people under 30 or those with hardship exemptions.
| Metal Tier | What You Pay Monthly | What Insurance Pays | Best For |
|---|
| Bronze | Lowest premiums | 60% of costs on average | Healthy people who rarely use care |
| Silver | Mid-range premiums | 70% of costs on average | Most subsidy-eligible enrollees (CSRs apply here) |
| Gold | Higher premiums | 80% of costs on average | People with regular medical needs |
| Platinum | Highest premiums | 90% of costs on average | High healthcare users who want low deductibles |
Important: Cost-sharing reductions (CSRs) that reduce your deductible and out-of-pocket maximum are only available on Silver plans. If your income is between 100% and 250% FPL, enrolling in a Silver plan may save you significantly more over the year than the premium difference suggests.
How Premium Tax Credits Work in 2026
A premium tax credit reduces your monthly insurance bill. The credit is calculated as the difference between the cost of the benchmark Silver plan in your area and what the government determines you should pay based on your income and household size.
For 2026, the percentage of income you are expected to contribute toward the benchmark Silver plan ranges from roughly 2% at the low end (for households near 100% FPL) to 8.5% at the upper end. Because the enhanced subsidies that kept the cap at 8.5% for all income levels expired, households above 400% FPL now owe the full unsubsidized premium.
The average NC enrollee who received a subsidy in 2026 got $660 per month in tax credit and paid around $97 per month out of pocket.
You can apply your credit in advance (reducing your monthly bill immediately) or claim it when you file your federal tax return. Most people choose the advance credit.
Cost-Sharing Reductions
Cost-sharing reductions are a second form of help available only to households between 100% and 250% FPL. CSRs reduce:
- Your annual deductible
- Your out-of-pocket maximum
- Copays for doctor visits and prescriptions
To get CSRs, you must enroll in a Silver plan. If you pick a Bronze plan at the same income level, you still get your premium tax credit but you lose the CSR benefit, meaning your actual medical costs during the year could be much higher even if your monthly premium is lower.
Step-by-Step: How to Enroll in North Carolina ACA Coverage
Step 1: Check Your Eligibility
Before picking a plan, confirm you understand which program fits your household. NC residents under 138% FPL typically qualify for NC Medicaid. Households between 138% and 400% FPL qualify for marketplace coverage with subsidies. Use the free CoveredUSA screener to get a clear answer based on your specific income, household size, and county. It takes about two minutes.
Step 2: Gather the Documents You Need
You will need:
- Social Security numbers for all household members applying for coverage
- Proof of income (pay stubs, W-2s, or a tax return)
- Current health insurance information if you have any
- Immigration documents if applicable
Step 3: Create or Log In to Your Healthcare.gov Account
North Carolina uses the federally facilitated marketplace at Healthcare.gov. Create an account or log in if you have one from a previous year. If you enrolled before, your account should auto-populate some of your information.
Step 4: Complete Your Application
Enter your household income, household size, and other required details. The system will calculate your estimated subsidy and show you which plans and prices are available in your zip code.
Step 5: Compare Plans and Enroll
Review the available Bronze, Silver, Gold, and Platinum options. Compare:
- Monthly premium after your tax credit
- Deductible (how much you pay before insurance kicks in)
- Out-of-pocket maximum
- Whether your current doctors and prescriptions are covered
Enroll in the plan you choose. Coverage typically starts the first of the following month.
Step 6: Reconcile Your Credits at Tax Time
At the end of the year, when you file your federal tax return, you will complete Form 8962 to reconcile the advance premium tax credits you received against your actual income for the year. If your income was higher than estimated, you may owe some credits back. If lower, you may receive a refund.
Special Enrollment Periods
Open enrollment for 2026 coverage ran from November 1 to January 15, 2026. That window is closed. However, you can still enroll outside of open enrollment if you experience a qualifying life event, including:
- Losing job-based health coverage (including COBRA expiration)
- Getting married or divorced
- Having a baby or adopting a child
- Moving to a new county or state
- Losing Medicaid or CHIP eligibility
- Gaining citizenship or lawful immigration status
A special enrollment period (SEP) typically gives you 60 days from the qualifying event to enroll. Log in to Healthcare.gov and select "Report a life change" to apply.
North Carolina-Specific Resources
North Carolina has a free Medicare and Seniors' Health Insurance Information Program called SHIIP (the NC version of SHIP) for Medicare questions. For ACA marketplace questions, you can contact the NC marketplace line at 1-800-318-2596 or visit Healthcare.gov directly.
For Medicaid questions or to apply for NC Medicaid, visit epass.nc.gov or call 1-888-245-0179.
NC-based navigators and certified application counselors can help you enroll at no cost. Search for local help at localhelp.healthcare.gov.
What Happens If You Miss the Income Cutoff
If your income is just over 400% FPL, your full unsubsidized premium applies. In that situation, it is worth checking whether a short-term health plan, a health sharing arrangement, or an employer plan (if available) might be more affordable, though those alternatives have significant coverage limitations compared to ACA marketplace plans.
If your income drops below 138% FPL during the year, you can switch to NC Medicaid through a special enrollment period at any time. Medicaid has no open enrollment window.
Frequently Asked Questions
How many ACA plans are available in North Carolina for 2026?
Six insurers are selling marketplace plans in North Carolina for 2026: Ambetter of North Carolina, AmeriHealth Caritas North Carolina, Cigna HealthCare of North Carolina, Oscar Health Plan of North Carolina, UnitedHealthcare of North Carolina, and Blue Cross Blue Shield of North Carolina. The exact plans available to you depend on your county and zip code.
What is the income limit to get subsidies on NC ACA plans in 2026?
For 2026, subsidies are available to households earning between 100% and 400% of the 2025 federal poverty level. For a single person that is between $15,650 and $62,600 per year. For a family of four, the range is $32,150 to $128,600. Households under 138% FPL typically qualify for NC Medicaid instead.
Did ACA subsidies get cut in North Carolina for 2026?
The enhanced premium tax credits that were in place from 2021 through 2025 expired on December 31, 2025. Those credits allowed households over 400% FPL to receive subsidies and reduced premiums for everyone. Starting in 2026, subsidies again phase out entirely at 400% FPL, and the income cap is back in effect.
How do I apply for an ACA plan in North Carolina?
North Carolina uses Healthcare.gov as its marketplace. Go to healthcare.gov, create an account or log in, complete the application with your household income and size, and compare the available plans. Enrollment for 2026 coverage closed January 15, 2026, but you can still enroll if you have a qualifying life event that triggers a special enrollment period.
Can I get a $0 premium plan in North Carolina?
Depending on your income, yes. At lower income levels (roughly 100% to 150% FPL), the premium tax credit can cover the entire cost of certain Bronze or Silver plans, leaving you with no monthly premium. These $0 premium plans do not mean $0 in cost if you need care; deductibles and copays still apply.
What is the difference between a premium tax credit and cost-sharing reduction?
A premium tax credit lowers your monthly insurance premium and is available to households between 100% and 400% FPL. A cost-sharing reduction lowers your deductible, out-of-pocket maximum, and copays when you use care, and is only available to households between 100% and 250% FPL who enroll in a Silver plan. Both forms of help can apply at the same time if you qualify.
Is North Carolina Medicaid or the ACA marketplace better?
If you qualify for NC Medicaid (income under 138% FPL), Medicaid typically has lower out-of-pocket costs than marketplace plans. It has no premium, low or no copays, and no deductible in most cases. If your income is between 138% and 400% FPL, the marketplace with subsidies is the option available to you. Use CoveredUSA to see which program you qualify for before choosing.
How do I find in-network doctors on NC ACA plans?
Each insurer has its own provider directory. After comparing plans on Healthcare.gov, use each plan's directory lookup to confirm your current doctors and any specialists you need are in-network before enrolling. Provider networks change year to year, so even if your doctor was in-network in 2025, verify for 2026.
Check your eligibility now at CoveredUSA. It takes 2 minutes.
See which NC health insurance programs you qualify for
