Health Insurance in North Carolina

Medicaid expansion changed the landscape

North Carolina's Medicaid expansion covers adults aged 19-64 with household income up to 138% FPL (about $21,597 for a single person in 2026). There are no work requirements, no asset tests, and enrollment is open year-round.

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. Six carriers offer plans for 2026, down from nine in 2025.

An important change coming: starting in fall 2026, the Open Enrollment window will be shorter. Instead of November 1 through January 15, it will run November 1 through December 15, matching a new federal rule. This matters for 2027 enrollment planning.

Carriers in North Carolina (2026)

• Blue Cross Blue Shield of North Carolina is the largest carrier in the state with the most extensive provider network. Available in every county.
• Ambetter (Centene) offers lower premiums in many counties, particularly in urban areas. Networks are narrower.
• UnitedHealthcare is available in select regions, mostly in the Charlotte and Triangle areas.
• Cigna operates in certain counties, focused on the Charlotte metro and surrounding areas.
• Oscar Health is available in the Charlotte and Triangle markets.
• Aetna CVS Health availability varies. Check your county.

The drop from nine to six carriers means some counties, especially rural ones, lost options. In the most rural parts of western and eastern NC, BCBS may be the only carrier, which limits competition and can mean higher prices.

Key regions

Charlotte (Mecklenburg County)

The most competitive market in the state. Five or more carriers operate here. Premiums tend to be lower because of competition. Atrium Health and Novant Health are the major hospital systems, and coverage of both varies by carrier.

Triangle (Raleigh-Durham-Chapel Hill)

Strong carrier competition with BCBS, Oscar, Ambetter, and United. 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)

Moderate competition. BCBS is the anchor with one or two additional carriers depending on the county.

Western NC (Asheville and mountains)

Limited carrier options, often just BCBS. Mission Health (now HCA) is the dominant hospital system in the Asheville area. Premiums are typically higher in this region.

Estimate your subsidy

Resources

• HealthCare.gov for marketplace enrollment
• NC ePASS for Medicaid and other benefit applications
• NC Navigator Consortium for free local enrollment help