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North Carolina Health Insurance Consumer Guide
This guide was developed to help you understand the health coverage options and possible financial assistance available to you and your family in North Carolina. The options found in North Carolina’s ACA Marketplace may be a good choice for many consumers, and we will guide you through the options below.
North Carolina uses the federally run health insurance exchange Healthcare.gov for residents to purchase its ACA Marketplace plans. The Marketplace provides access to health insurance products from private insurers.
The federal government helps pay for insurance through an advance premium tax credit if you buy coverage from the exchange.
Explore our other comprehensive guides to coverage in North Carolina
Dental coverage in North Carolina
Need dental coverage? Learn about available options and find the right dental plan in North Carolina with our guide.
North Carolina’s Medicaid program
North Carolina has not yet expanded Medicaid eligibility under the Affordable Care Act (ACA), but that will change in the coming months. State lawmakers passed legislation which was signed into law in March 2023 that calls for Medicaid expansion in the state to take effect by the end of the year.1 There were 2,372,919 people enrolled in the North Carolina Medicaid program as of April 2023. 2
Medicare coverage and enrollment in North Carolina
As of February 2023, there were 2,142,905 residents with Medicare in North Carolina.3 Our guide will help you understand Medicare Parts A, B, C and D – as well as Medicare supplement (Medigap) plans available in North Carolina.
Short-term coverage in North Carolina
In North Carolina, consumers can buy short-term health insurance plans with initial policy terms of up to 364 days with the option to renew for a total duration up to 36 months. As of 2023, there were at least eight insurers selling short-term health insurance plans in North Carolina. 4
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:5
- 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.
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 15, your coverage will begin on February 1.7
Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage. 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, you can enroll three ways:
- Online through HealthCare.gov
- By phone at (800) 318-2596
In person, through agents, navigators, certified application counselors, or 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. More than nine out of ten eligible enrollees save money on premium payments amounting to an average savings of $583/month. After subsidies were applied, the average enrollee’s monthly cost was about $67/month.9
The Affordable Care Act provides income-based advance premium tax credits (subsidies) that offset your premium payments to help keep your expenses down. People with household incomes below 250% of the federal poverty level also qualify for cost-sharing reductions (CSR) that may reduce your deductibles and out-of-pocket expenses when you buy a Silver plan. In 2023, 96% of North Carolina Marketplace enrollees were receiving CSR benefits.10
Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.
Source: CMS.gov 11
How many insurers offer Marketplace coverage in North Carolina?
Five insurers offer exchange plans in North Carolina,12 including one that rejoined the exchange for 2023:
- Molina
- Ambetter/Magnolia
- Cigna
- Vantage Health Plan of North Carolina
- UnitedHealthcare (new for 2023, after previously leaving the market at the end of 2016)
All North Carolina residents have access to health plans from at least three insurers for 2023. 13
Are Marketplace health insurance premiums increasing in North Carolina?
There are nine insurers offering plans in North Carolina’s marketplace for 2024. They have requested the following rate changes for 2024:
North Carolina’s ACA Marketplace Plan 2024 Proposed Rate Increases by Insurance Company |
|
|---|---|
| Issuer | Percent Increase |
| Aetna Health Inc. (a PA corp.) | 2.44% |
| Ambetter/Centene | 0.96% |
| AmeriHealth Caritas | 0.00% |
| Blue Cross and Blue Shield of NC | -3.98% |
| Celtic/WellCare | 6.2% |
| Cigna | 7.23% |
| Oscar | 5.55% |
| UnitedHealthcare | -8.16% |
| CareSource | -4.2% |
Source: North Carolina Department of Insurance14
The overall average proposed rate change represents a 1.3% reduction in individual market premiums. 15
How many people are insured through North Carolina’s Marketplace?
In North Carolina, 800,850 people enrolled in private individual market plans through the exchange for 2023 coverage.16 This was by far a record high, and dwarfed the previous year’s record of a little more than 670,000 enrollees.
This increase in enrollment is thanks to the American Rescue Plan (ARP). Under the ARP, ACA’s premium subsidies are larger and more widely available. ARP has been extended through 2025 by the Inflation Reduction Act.17
Source: 2014,18 2015, 19 2016,20 2017,21 2018,22 2019,23 2020,24 2021,25 2022,26 202316 2023,16 202427
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
- “NC H76” BillTrack50, Accessed August 2023 ⤶
- “April 2023 Medicaid & CHIP Enrollment Data Highlights“ Medicaid.gov ⤶
- “Medicare Monthly Enrollment“ CMS.gov, Accessed August 2023 ⤶
- “Availability of short-term health insurance in North Carolina” healthinsurance.org, Sept. 23, 2022 ⤶
- ”A quick guide to the Health Insurance Marketplace” HealthCare.gov ⤶
- “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 ⤶
- “2023 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2023 ⤶
- “Effectuated Enrollment: Early 2023 Snapshot and Full Year 2022 Average” CMS.gov, March 15, 2023 ⤶
- “2024 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 2024 ⤶
- “North Carolina Rate Review” HealthCare.gov, 2023 ⤶
- “2023 Qualified Health Plans” CMS.gov, Oct. 26. 2022 ⤶
- “2024 Plan Year ACA Rate Filings” North Carolina Department of Insurance – Life & Health Division, ncdoi.gov, Accessed August 2023 ⤶
- “North Carolina: Preliminary Avg. Unsubsidized 2024 #ACA Rate Changes: -1.3%” ACASignups.net, August 2023 ⤶
- “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, 2023 ⤶ ⤶ ⤶
- “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, Accessed August 2023 ⤶
- “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 2024 OPEN ENROLLMENT REPORT” CMS.gov, 2024 ⤶
