North Carolina Health Insurance 2026

North Carolina has a moderately competitive ACA marketplace with 75–115 plans statewide, anchored by BCBS NC, Cigna, and Ambetter. Silver premiums average $445–$465/month for a 40-year-old before subsidies. The Charlotte, Research Triangle, and Triad metros have the most carrier competition, while rural Appalachian and eastern NC counties have fewer options and persistent network gaps. North Carolina uses Healthcare.gov for marketplace enrollment. Strong enrollment assistance programs have contributed to growing marketplace participation.

North Carolina expanded Medicaid in December 2023, becoming the last state in the Southeast to do so. The expansion was passed with bipartisan support after a compromise tied hospital certificate-of-need reform to expansion passage. An estimated 600,000 North Carolinians became eligible. The expansion was a major political milestone in a state that had resisted expansion for nearly a decade. North Carolina's Medicaid program is transitioning to managed care (NC Medicaid Managed Care). The state has no state-based exchange or reinsurance program.