North Carolina premiums rose about 28% this year — but unlike most of the South, NC expanded Medicaid, giving lower-income households a safety valve most states don't have. Here's what North Carolinians actually pay in 2026, and every lever for paying less.
Based on 2026 rate filings, the lowest silver premiums in North Carolina come from Ambetter, Oscar, and Blue Cross NC, with silver plans starting around $540 a month before subsidies. Blue Cross NC's cheapest silver runs about $584 — and it's the only carrier available in every one of the state's 100 counties.
Six insurers sell marketplace plans in NC for 2026: Ambetter, AmeriHealth Caritas, Blue Cross NC, Cigna, Oscar, and UnitedHealthcare. In an analysis of every 2026 silver HMO available to a 40-year-old, the spread between the cheapest and most expensive was about $275 a month — $3,300 a year — for the same metal tier.
The only carrier statewide, and the only one selling more than HMOs — EPO, POS, and PPO plans included. The default pick when network flexibility matters or when it's the only option in your county.
Files some of the state's lowest silver rates in the metros. HMO-only — coverage stays in-network, so confirm your doctors participate before enrolling.
A digital-first insurer with competitive metro pricing and the gentlest rate increase in the state this year. Strong app-based care navigation; HMO networks.
Figures are approximate, from 2026 rate-filing analyses for a 40-year-old on silver plans. AmeriHealth Caritas, Cigna, and UnitedHealthcare also compete in parts of the state. Your rate varies by county, age, household size, tobacco use, and income.
With a $275-a-month spread on the same tier, guessing is expensive. A licensed agent can pull every carrier's 2026 price for your ZIP code, age, and income — free, in about 10 minutes.
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Before subsidies, silver plans for a 40-year-old North Carolinian generally run from about $540 to over $800 a month in 2026 depending on carrier and county. The NC Department of Insurance approved average increases of roughly 28% for 2026 — the largest in years — with roughly one million North Carolinians enrolled in marketplace coverage.
| Carrier | 2026 position | Approved rate increase |
|---|---|---|
| Ambetter | Cheapest silvers from ~$540 | mid-range |
| Oscar | Low metro pricing | +16.9% (lowest) |
| Blue Cross NC | Cheapest silver ~$584; all 100 counties | mid-range |
| Cigna / UnitedHealthcare | Mid-to-higher priced | double-digit |
| AmeriHealth Caritas | Higher priced for 2026 | +36.4% (highest) |
Approximate 2026 figures from NC Department of Insurance approvals and public rate-filing analyses, before premium tax credits. Availability and pricing vary by county.
ACA rates follow the federal age curve — a 64-year-old can be charged up to three times a 21-year-old's rate. Using a ~$700 statewide silver average at age 40:
| Age | Approx. monthly premium (silver) | vs. age 21 |
|---|---|---|
| 21 | ~$550 | 1.0× |
| 30 | ~$620 | 1.1× |
| 40 | ~$700 | 1.3× |
| 50 | ~$980 | 1.8× |
| 60 | ~$1,485 | 2.7× |
Illustrative — applies the federal default age factors to an approximate 2026 NC silver average. Subsidies are age-aware, so older enrollees with moderate incomes often receive much larger credits.
NC's roughly one million marketplace enrollees got hit from two directions this year:
The enhanced premium tax credits that capped marketplace premiums from 2021–2025 ended December 31, 2025. That's the main reason enrollment dipped and why renewal notices stung. The original ACA credits are still in place for households between 100% and 400% of the federal poverty level (roughly up to $62,600 single, $128,600 family of four).
Unlike Florida, Texas, or Georgia, North Carolina expanded Medicaid (December 2023). If the new marketplace math priced you out and your income is under roughly 138% of the poverty level, you may simply belong in NC Medicaid — free or nearly free, enrollable year-round. Hundreds of thousands of North Carolinians have qualified since expansion.
Aetna left the individual marketplace nationwide for 2026, and Cigna has announced it won't offer marketplace plans anywhere for 2027 — including North Carolina. If you're on either, actively pick your next plan this fall rather than letting the marketplace map you to one.
Sources: NC Department of Insurance, healthinsurance.org NC marketplace guide, Peterson-KFF Health System Tracker.
From the mountains to the Outer Banks, your carrier lineup — and your price — changes with your county:
Because Blue Cross NC is the only carrier in all 100 counties, rural shoppers often assume it's their only option — sometimes true, sometimes not. It costs nothing to check.
Tell me your ZIP code, ages, and household income — I'll compare every carrier filed in your county (and check your Medicaid eligibility while we're at it), then show you what you'd actually pay after subsidies.
Free comparison. No pressure, no obligation.
Metal tiers are about how you split costs with the insurer — not the quality of care. The right tier depends on how much care you expect to use and whether you qualify for cost-sharing reductions:
Lowest premium, ~$10,600 deductible. Pure emergency protection — no subsidy eligibility.
Cheapest subsidized tier. Pair an HSA-eligible bronze plan with tax-free savings if you're healthy.
The sweet spot for most. Under 250% of poverty, silver secretly upgrades to gold/platinum-level coverage.
With silver repricing in 2026, gold sometimes costs about the same as silver in NC. Always compare both.
Highest premium, lowest out-of-pocket. Rarely offered on the NC marketplace.
North Carolina has the strongest low-income safety net of any state on this list, thanks to Medicaid expansion:
Turning 65 soon? Marketplace plans stop making sense once Medicare kicks in — see your Medicare options instead.
NC expanded Medicaid — under roughly 138% of the poverty level, you likely qualify for free or nearly free coverage, year-round. Thousands of people buying marketplace plans don't realize they're Medicaid-eligible.
Credits are based on this year's income estimate, and the math changed for 2026. A mid-year income change, a new baby, or a household change can unlock help immediately.
Cost-sharing reductions only attach to silver plans. They can cut a $6,000 deductible to a few hundred dollars — a benefit bronze and gold buyers give up.
Blue Cross NC is the only non-HMO game in town, and flexibility costs extra. If your doctors are in Ambetter's or Oscar's network anyway, the cheaper HMO buys the same care.
With increases ranging from 17% to 36% by carrier, the price order changed — last year's cheapest plan may be mid-pack now. Actively re-shop every fall, especially if you're on Cigna (leaving after 2026).
Premiums are regulated: you pay the same whether you enroll alone or with an agent. The difference is having someone who compares all six carriers, checks Medicaid eligibility, and answers the phone after you enroll.
Based on 2026 rate filings, the lowest silver premiums come from Ambetter, Oscar, and Blue Cross NC, with silver plans starting around $540 a month before subsidies. Blue Cross NC's cheapest silver runs about $584 and is the only carrier available in all 100 counties. With premium tax credits, most enrollees pay much less than sticker price.
Before subsidies, silver plans for a 40-year-old generally run from about $540 to over $800 a month in 2026 depending on carrier and county — the spread between the cheapest and priciest silver HMO is about $275 a month. Rates rose roughly 28% on average this year, so what you actually pay depends heavily on your premium tax credit.
Yes. North Carolina expanded Medicaid on December 1, 2023. Adults with household income up to 138% of the federal poverty level — roughly $21,600 for a single person — can qualify regardless of whether they have children. If your income is near that line, check Medicaid before buying a marketplace plan; it's usually free or nearly free and open year-round.
Yes. The original ACA premium tax credits remain for households between 100% and 400% of the federal poverty level — roughly up to $62,600 for a single person or $128,600 for a family of four. What expired at the end of 2025 were the enhanced subsidies, which had capped premiums and extended help above 400% of poverty.
If you've had a qualifying life event in the last 60 days — losing other coverage, moving, marriage, a new baby, certain income changes — you may qualify for a Special Enrollment Period and can enroll now. Medicaid enrollment is open year-round. Otherwise, open enrollment for 2027 coverage begins November 1, 2026.
The NC Department of Insurance approved average individual-market increases of roughly 28% for 2026, ranging from about 17% (Oscar) to 36% (AmeriHealth Caritas). At the same time, the enhanced federal premium tax credits expired on December 31, 2025 — so many of NC's roughly one million enrollees saw both higher sticker prices and smaller subsidies.
Blue Cross NC is the only carrier in all 100 counties and the only one selling plans beyond HMOs — EPO, POS, and PPO options included. Its cheapest silver runs about $584. If you want maximum network flexibility it's usually the pick; if price is everything, Ambetter or Oscar may beat it in the metros.
No. Premiums are filed with regulators and are identical whether you enroll through HealthCare.gov, directly with the carrier, or with a licensed agent. Agents are paid by the insurance companies, so the guidance costs you nothing extra.
Premium figures on this page are approximate averages drawn from 2026 individual-market rate filings and analyses of CMS public-use files, including the NC Department of Insurance, healthinsurance.org, MoneyGeek, ValuePenguin, and the Peterson-KFF Health System Tracker, checked July 2026. They are illustrations, not quotes: your premium depends on your county, age, household, tobacco use, income, and the plan you choose. Official plan pricing is available at HealthCare.gov or through any licensed agent.
Zuriel is licensed in 23 states. Explore cost guides for other states we serve:
Talk with Zuriel Kinlock, a licensed insurance agent, and get a real comparison of every 2026 plan filed in your North Carolina county — free, with zero obligation.
Important: This page is for general information and reflects approximate 2026 figures from public sources; it is not a quote, and submitting information or speaking with a licensed insurance agent does not guarantee enrollment, eligibility, savings, approval, or specific benefits. There is no obligation to enroll. Smooth Health Solutions is not connected with or endorsed by the U.S. government, the federal Medicare program, CMS, HealthCare.gov, or any government agency. Plan availability, benefits, premiums, and eligibility vary by plan, carrier, location, and individual circumstances.
