Figuring out whether you qualify for affordable health insurance in North Carolina can feel overwhelming. Between Medicaid expansion, the ACA Marketplace, premium subsidies, and recent changes to federal tax credits, there is a lot to sort through. This guide breaks down everything you need to know about ACA eligibility in North Carolina for 2026, including income limits, how to apply, and what options are available right now.
If you want a quick answer, use our free eligibility screener to check what programs you may qualify for in just a few minutes.
How ACA Eligibility Works in North Carolina
North Carolina uses the federally run Health Insurance Marketplace at Healthcare.gov for individual and family health insurance plans. The state does not operate its own exchange.
To be eligible for an ACA Marketplace plan in North Carolina, you must:
- Live in North Carolina
- Be lawfully present in the United States
- Not currently be incarcerated
- Not be enrolled in Medicare
Anyone meeting these basic requirements can purchase a Marketplace plan. However, qualifying for premium subsidies (also called premium tax credits) to lower your monthly costs depends on your household income.
What Changed for 2026: Enhanced Subsidies Expired
One of the biggest changes affecting North Carolina residents in 2026 is the expiration of enhanced premium tax credits. These expanded subsidies, first introduced in 2021 under the American Rescue Plan and extended through 2025 by the Inflation Reduction Act, expired on December 31, 2025.
Here is what that means for you:
- The "subsidy cliff" is back. If your household income exceeds 400% of the Federal Poverty Level (FPL), you no longer qualify for any premium subsidy. Previously, subsidies were available at all income levels.
- Higher out-of-pocket premiums. According to KFF, Marketplace premium payments are estimated to more than double on average for many enrollees in 2026.
- Fewer people qualify for help. People with incomes above 400% FPL who previously received subsidies now pay full price.
- Average rate increases in NC. Insurers in North Carolina approved an average rate increase of approximately 28% for 2026, partly driven by the subsidy expiration.
If you already have a Marketplace plan, it is important to check whether your subsidy amount changed for 2026 and whether your current plan is still the most affordable option.
North Carolina ACA Income Limits for 2026
Your eligibility for Marketplace subsidies in North Carolina depends on where your household income falls relative to the Federal Poverty Level. Because North Carolina expanded Medicaid in December 2023, the income ranges work like this:
- Below 138% FPL: You likely qualify for NC Medicaid instead of Marketplace coverage
- 138% to 400% FPL: You may qualify for ACA Marketplace premium subsidies
- Above 400% FPL: You can purchase a Marketplace plan but will not receive subsidies in 2026
2026 Federal Poverty Level Guidelines (2025 FPL Used for 2026 Coverage)
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 250% FPL (CSR Eligible) | 400% FPL (Subsidy Limit) |
|---|---|---|---|---|
| 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 |
For households with more than 6 people, add $5,500 per additional person to the 100% FPL amount and calculate the percentages from there.
Example: A family of four earning $50,000 per year falls between 138% and 400% FPL. They would qualify for premium tax credits to lower their monthly Marketplace insurance costs. A single person earning $70,000 per year exceeds 400% FPL and would not receive subsidies in 2026.
Cost-Sharing Reductions
If your income is between 138% and 250% FPL and you choose a Silver-level plan, you may also qualify for cost-sharing reductions (CSRs). These lower your deductibles, copays, and out-of-pocket maximums without raising your premium. About 45% of North Carolina Marketplace enrollees were receiving CSR benefits as of early 2025.
NC Medicaid Eligibility (Expansion)
North Carolina expanded Medicaid on December 1, 2023, making it the 40th state to do so. This means adults aged 19 to 64 with household income up to 138% FPL now qualify for NC Medicaid.
NC Medicaid Income Limits (Monthly)
| Household Size | Adults 19 to 64 | Children 0 to 18 | Pregnant Women |
|---|---|---|---|
| 1 | $1,800/mo | $2,752/mo | $3,455/mo |
| 2 | $2,433/mo | $3,719/mo | $4,353/mo |
| 3 | $3,065/mo | $4,686/mo | $5,252/mo |
| 4 | $3,698/mo | $5,645/mo | $6,150/mo |
| 5 | $4,340/mo | $6,621/mo | $7,048/mo |
NC Medicaid has no monthly premium and copays never exceed $4. Children qualify at higher income levels (approximately 211% FPL), and pregnant women qualify at approximately 196% FPL.
If your income falls below the Medicaid threshold, you should apply for Medicaid rather than a Marketplace plan. You can apply year-round since Medicaid does not have an open enrollment period.
To learn more, visit our North Carolina Benefits Overview.
Insurance Companies Offering NC Marketplace Plans in 2026
Six insurers offer ACA Marketplace plans in North Carolina for 2026:
- Ambetter (Centene)
- AmeriHealth Caritas
- Blue Cross and Blue Shield of NC
- Cigna
- Oscar
- UnitedHealthcare
Three insurers left the North Carolina market after 2025: Aetna, Celtic/WellCare, and CareSource. If you were previously enrolled with one of these companies, you needed to select a new plan during open enrollment.
Coverage availability varies by county, so not all six carriers may be available in your area. Check Healthcare.gov to see which plans are offered where you live.
How to Apply for ACA Coverage in North Carolina
Step 1: Check Your Eligibility
Before applying, estimate your household income for 2026 and compare it to the FPL table above. You can also use our free screener to get a quick estimate of programs you may qualify for.
Step 2: Gather Your Documents
You will need:
- Social Security numbers for everyone in your household
- Immigration documents (if applicable)
- Employer and income information (pay stubs, W-2s, or tax returns)
- Information about any employer-sponsored insurance available to you
- Policy numbers for any current health coverage
Step 3: Create an Account or Log In
Visit Healthcare.gov and create an account if you do not already have one. You will need an email address and a username/password.
Step 4: Complete Your Application
Fill out the Marketplace application with your household and income details. The system will determine whether you qualify for:
- Premium tax credits (subsidies)
- Cost-sharing reductions
- Medicaid or CHIP (for children)
Step 5: Compare Plans and Enroll
Once you see your results, compare available plans by:
- Monthly premium (after subsidies)
- Deductible and out-of-pocket maximum
- Provider network (make sure your doctors are covered)
- Prescription drug coverage
- Plan metal level (Bronze, Silver, Gold, Platinum)
Select a plan and complete enrollment.
Step 6: Pay Your First Premium
Your coverage does not start until you pay your first monthly premium. Set up automatic payments to avoid a lapse in coverage.
Enrollment Periods for 2026
Open Enrollment (Closed)
The open enrollment period for 2026 coverage ran from November 1, 2025 through January 15, 2026. This window has passed.
Special Enrollment Periods
You can still enroll or change plans outside of open enrollment if you experience a qualifying life event, such as:
- Losing other health coverage (job loss, aging off a parent's plan, losing Medicaid)
- Getting married or divorced
- Having or adopting a child
- Moving to a new area with different plan options
- Changes in household income that affect Medicaid eligibility
You typically have 60 days from the qualifying event to enroll. Visit Healthcare.gov or call 1-800-318-2596 to start a special enrollment application.
Medicaid: Apply Anytime
NC Medicaid does not have an enrollment period. You can apply at any time through:
- Online: epass.nc.gov
- Phone: 1-888-245-0179
- In person: Your local Department of Social Services office (find yours here)
Getting Free Help With Your Application
You do not have to navigate the application process alone. Free help is available:
- NC Navigator Consortium: Call 1-855-733-3711 or visit ncnavigator.org for free appointments with trained enrollment assistants
- NC Medicaid Ambassadors: Visit medicaid.ncdhhs.gov to find an ambassador near you
- Healthcare.gov Help Center: Call 1-800-318-2596 (TTY: 1-855-889-4325), available 24/7
- Local brokers and agents: Licensed insurance agents can help you enroll at no cost to you
Frequently Asked Questions
Can I still sign up for ACA coverage in North Carolina in 2026?
Open enrollment for 2026 ended on January 15, 2026. However, you can enroll during a Special Enrollment Period if you have a qualifying life event such as losing coverage, moving, getting married, or having a baby. If you qualify for Medicaid, you can apply at any time.
What income do I need to qualify for subsidies in North Carolina?
For 2026, your household income must be between 138% and 400% of the Federal Poverty Level. For a single person, that means roughly $21,597 to $62,600 per year. For a family of four, the range is approximately $44,367 to $128,600.
I earn less than $21,597 as a single person. What are my options?
Since North Carolina expanded Medicaid, adults aged 19 to 64 earning below 138% FPL qualify for NC Medicaid. This provides comprehensive health coverage with no monthly premium and minimal copays. Apply through epass.nc.gov or your local DSS office.
Why did my Marketplace premium go up so much for 2026?
The enhanced premium tax credits that were in place from 2021 through 2025 expired at the end of 2025. This means subsidies are smaller for many people, and those earning above 400% FPL no longer receive any subsidy at all. Additionally, North Carolina insurers raised rates by an average of approximately 28% for 2026.
What is the difference between Medicaid and ACA Marketplace insurance?
NC Medicaid is a government health program with no monthly premium and very low copays (no more than $4). It covers adults up to 138% FPL. ACA Marketplace plans are private insurance plans that you purchase through Healthcare.gov, often with premium subsidies to make them more affordable. Marketplace plans have monthly premiums, deductibles, and copays that vary by plan.
Do I have to file taxes to get ACA subsidies?
Yes. To receive premium tax credits, you must file a federal income tax return. If you are married, you must file jointly. You also cannot be claimed as a dependent on someone else's tax return.
Can undocumented immigrants get ACA coverage in North Carolina?
No. You must be lawfully present in the United States to purchase a Marketplace plan or receive subsidies. However, lawfully present immigrants below 138% FPL may qualify for Medicaid depending on their immigration status and how long they have been in the country.
How do I know if my employer's insurance is considered "affordable"?
For 2026, employer-sponsored coverage is considered affordable if your share of the premium for self-only coverage does not exceed 9.96% of your household income. If your employer's plan exceeds this threshold, you may qualify for Marketplace subsidies instead.
Key Contacts for North Carolina Health Coverage
| Resource | Phone | Website |
|---|---|---|
| Healthcare.gov | 1-800-318-2596 | healthcare.gov |
| NC Medicaid | 1-888-245-0179 | medicaid.ncdhhs.gov |
| NC Navigator Consortium | 1-855-733-3711 | ncnavigator.org |
| ePASS (Apply for Medicaid) | N/A | epass.nc.gov |
| Local DSS Offices | Varies | ncdhhs.gov/localDSS |
Next Steps
Not sure which program is right for you? Try our free eligibility screener to find out what benefits you may qualify for based on your income, household size, and situation. It takes just a few minutes and covers ACA subsidies, Medicaid, SNAP, and more.
For a complete look at all assistance programs available in the state, visit our North Carolina Benefits Overview.
