North Carolina Health Insurance Consumer Guide

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.

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.

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

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

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

There are nine insurers offering plans in North Carolina’s marketplace for 2024. They have requested the following rate changes for 2024:

Source: North Carolina Department of Insurance¹⁴

The overall average proposed rate change represents a 1.3% reduction in individual market premiums. ¹⁵

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

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)