Medicaid expansion changed the landscape
North Carolina's Medicaid expansion covers adults aged 19-64 with household income up to 138% FPL (about $22,025 for a single person, or $45,540 for a family of four, for 2027 coverage). There are no asset tests, and enrollment is open year-round.
New federal work requirements apply to expansion adults. States must start them by January 1, 2027 (a state making a good-faith effort can get extra time). Most expansion enrollees ages 19 to 64 will need to show 80 hours a month of work, school, job training, or community service. Parents of children under 14, pregnant people, people who are disabled or medically frail, and some others are exempt. Watch for notices from NC Medicaid or your county DSS.
Over 450,000 North Carolinians enrolled in the first year. Before expansion, childless adults didn't qualify for Medicaid at any income level, and parents had to earn under about 43% FPL (roughly $6,900/year for a family of three). The change was substantial.
If you earn under 138% FPL, check Medicaid eligibility first. Apply through ePASS or your local county Department of Social Services. Medicaid is free or very low-cost.
The marketplace for everyone else
If your income is above 138% FPL, the ACA marketplace is your path to subsidized coverage. North Carolina uses HealthCare.gov. Five insurers offer plans for 2027, down from six in 2026 after Cigna left. About 761,000 North Carolinians picked a marketplace plan during 2026 open enrollment, according to CMS.
Open enrollment runs November 1, 2026 through January 15, 2027. A federal rule would have ended it on December 15, but a federal court struck that change down, and CMS confirmed the regular dates. Enroll by December 15 for coverage that starts January 1. If you enroll between December 16 and January 15, coverage starts February 1.
The enhanced premium tax credits expired after 2025 and were not renewed. For 2027 there is no tax credit above 400% FPL ($63,840 for a single person, $132,000 for a family of four), and people below that line pay a larger share of their income than they did in 2025.
What plans cost in 2027
Price changes for 2027 vary a lot by county. Here is the benchmark (second-lowest cost Silver) premium for a 40-year-old before subsidies, from HealthCare.gov plan data:
- Mecklenburg County (Charlotte): about $626 per month, up from $583 in 2026
- Wake County (Raleigh): about $566, down from $591
- Durham County: about $583, down from $610
- Guilford County (Greensboro): about $557, up from $542
- Buncombe County (Asheville): about $696, down from $702
- Pitt County (Greenville): about $995, up from $828
Carriers in North Carolina (2027)
- Blue Cross Blue Shield of North Carolina is the largest carrier in the state with the most extensive provider network. Available in all 100 counties.
- Ambetter of North Carolina (Centene) sells plans in 63 counties for 2027 and often has lower premiums. Networks are narrower.
- AmeriHealth Caritas Next sells plans in 46 counties for 2027, including much of western NC and the Triad.
- UnitedHealthcare sells plans in 37 counties, including Charlotte, Raleigh, and the Triad.
- Oscar Health sells plans in 27 counties, including Charlotte, the Triad, and Asheville.
Cigna left the North Carolina marketplace after 2026, so Cigna enrollees need to pick a new plan. Some rural counties, especially in eastern NC, have only Blue Cross for 2027. Pitt and Hyde counties are examples, and both have benchmark premiums near $1,000 a month for a 40-year-old.
Key regions
Charlotte (Mecklenburg County)
Mecklenburg County has four marketplace insurers for 2027: Blue Cross, Ambetter, Oscar, and UnitedHealthcare. Atrium Health and Novant Health are the major hospital systems, and coverage of both varies by carrier.
Triangle (Raleigh-Durham-Chapel Hill)
Fewer choices than you might expect for 2027. Wake County has three insurers (Blue Cross, Ambetter, and UnitedHealthcare), and Durham County has two (Blue Cross and Ambetter). Benchmark premiums dipped slightly in both. Duke Health and UNC Health are the dominant systems. Make sure your preferred system is in-network before picking a plan.
Triad (Greensboro, Winston-Salem)
The most competitive area of the state for 2027. Guilford and Forsyth counties each have all five marketplace insurers.
Western NC (Asheville and mountains)
Buncombe County has four insurers for 2027 (Blue Cross, Ambetter, AmeriHealth Caritas Next, and Oscar), but options thin out further into the mountains. Cherokee County, in the far west, has two. Mission Health (now HCA) is the dominant hospital system in the Asheville area. Premiums are typically higher in this region.
Estimate your subsidy
Subsidy Estimator
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Resources
- HealthCare.gov for marketplace enrollment
- NC ePASS for Medicaid and other benefit applications
- NC Navigator Consortium for free local enrollment help