Last verified against primary sources on August 17, 2026.
More people left the health insurance marketplace in North Carolina than in any
other state in the country. Enrollment fell from 975,110 to
761,457 between 2025 and 2026 — roughly 214,000
people, a 22% decline and the steepest of any state.
Two things caused it. The North Carolina Department of Insurance approved an
average individual-market rate increase of 28.6% for 2026, and the
enhanced federal premium tax credits expired on December 31, 2025.
The insurer count dropped from nine to six at the same time.
If you were one of those 214,000, this page is about what is actually available
to you now — including a North Carolina rule that catches most people by
surprise.
Before you read further — is this page even for you?
What I sell is likely a fit if:
- You are in reasonably good health
- You are self-employed, 1099, or between jobs with no employer plan
- Your income is high enough that you get little or no premium tax credit
- The unsubsidized marketplace premium is more than you can absorb
It is probably the wrong fit — and I will tell you so on
the first call — if:
- You qualify for a meaningful premium tax credit. Take the subsidy. A
subsidized marketplace plan will beat anything I can sell you. - You have a chronic or pre-existing condition. These plans are medically
underwritten and you can be declined or have that condition excluded. - You are pregnant or planning to be. Maternity is generally not covered.
- Your household income is under 138% of the federal poverty level. North
Carolina expanded Medicaid in December 2023 — apply there first, not with me.
And one that is specific to this state: if you are looking for
a short-term plan to carry you for a year, North Carolina will not let you have
one. Read the next section before you go any further.
North Carolina caps short-term plans at four months — on purpose
In August 2025 the federal government announced it would stop
enforcing the 2024 rule limiting short-term plans to four months, and encouraged
states to do the same. Most states now set their own limit. Several allow three
years.
North Carolina went the other way. On August 29,
2025, the North Carolina Department of Insurance issued
Bulletin 25-B-11, stating that no short-term product may be
offered in North Carolina that does not comply with the current federal standard,
and that the Department will continue to follow the federal definition until a new
federal rule is finalised.
In practice that means a maximum initial term of three months
and a maximum total duration of four months including renewals —
the strictest limit of any state on the federal marketplace where I am licensed.
This matters because most national websites and most agents outside the state
have not caught up. If someone offers you a twelve-month short-term plan in North
Carolina, something is wrong with the offer. In Utah the same
product runs 36 months; in Tennessee there is no state cap at
all. See the full comparison:
short-term health insurance rules
by state.
The practical consequence: in North Carolina a short-term plan
is a genuine bridge and nothing more — four months between jobs, or four months
until open enrollment. It is not a way to opt out of the marketplace for a year.
For most North Carolinians who lost coverage in 2026, the real decision is between
a marketplace plan and Medicaid, not between a marketplace plan and a short-term
one.
Medicaid expansion changed the math here in 2023
North Carolina expanded Medicaid on December 1, 2023, one of the
most recent states to do so. More than 600,000 North Carolinians
became newly eligible, and roughly 300,000 were enrolled automatically.
Coverage now reaches adults up to 138% of the federal poverty
level, and the pre-expansion coverage gap — which had left an estimated
173,000 adults with no option at all — is closed.
If your income dropped when your premium rose, check Medicaid before you buy
anything. A lot of people who were ineligible in 2022 are eligible now and do not
know it.
Your options in North Carolina
1. An ACA marketplace plan through HealthCare.gov
North Carolina uses the federal marketplace at HealthCare.gov.
Six insurers offer individual plans for 2026, down from nine in 2025, and one
narrowed its footprint to about 63% of counties — so plan availability now varies
noticeably by county.
This is the right answer for most people and the first thing I
check. Guaranteed issue, no medical questions, pre-existing conditions
covered from day one.
2. Medicaid
Expanded since December 2023, up to 138% of the federal poverty level. Free to
apply, and it beats anything I sell if you qualify.
3. A short-term plan — four months maximum
Useful as a true bridge. Not ACA-compliant, medically underwritten, not
guaranteed renewable, pre-existing conditions generally excluded, and
capped at four months total by NCDOI Bulletin 25-B-11.
4. An employer or spouse’s plan
Almost always cheaper than anything on the individual market. Check first.
North Carolina deadlines
Open enrollment for 2027 coverage runs November 1, 2026 through January
15, 2027. Enroll by December 15, 2026 for coverage that
starts January 1.
A federal rule would have shortened this window to December 15. A court
vacated that rule in June 2026, and CMS confirmed in August 2026 that the
January 15 deadline stands. An appeal was argued in late October 2026. I re-check
this page when that is decided.
Because a short-term plan here lasts only four months, timing matters more in
North Carolina than almost anywhere else. If you lose coverage in the spring, four
months will not carry you to January — you will need a special enrolment period,
which losing job-based coverage generally provides.
Common questions about health insurance in North Carolina
How long can a short-term health plan last in North Carolina?
Three months initially, four months total including renewals. NCDOI Bulletin
25-B-11, issued August 29, 2025, confirmed North Carolina will keep enforcing the
federal standard even though the federal government has paused its own enforcement.
This is stricter than most states.
Did North Carolina expand Medicaid?
Yes, effective December 1, 2023. More than 600,000 people became newly eligible,
covering adults up to 138% of the federal poverty level. The former coverage gap is
closed.
Why did so many North Carolinians lose marketplace coverage in 2026?
Enrollment fell about 22%, from 975,110 to 761,457 — the largest percentage
decline of any state. The approved average rate increase was 28.6% and the enhanced
federal premium tax credits expired on December 31, 2025, so premiums rose while
subsidies shrank.
Does North Carolina have a state health insurance exchange?
No. North Carolina uses the federal marketplace at HealthCare.gov.
Can I be turned down for coverage in North Carolina?
Not for an ACA marketplace plan — those are guaranteed issue regardless of
health history. You can be turned down for a short-term plan, because those are
medically underwritten.
Does North Carolina have Farm Bureau health plans that are exempt from insurance regulation?
No. A federal review identified only six states with laws allowing Farm
Bureau-sponsored health plans to operate outside state insurance regulation, and
North Carolina is not among them. If you see this claimed about North Carolina, it
is incorrect.
Related reading
Health insurance for the self-employed and 1099 workers
Short-term rules by state — how North Carolina compares.
About the agent
Scott Binsack — licensed health insurance agent, National
Producer Number 20492859. Licensed in North Carolina and 30 other
states. You can verify any agent’s licence through the North Carolina Department of
Insurance.
I am compensated by the insurance company when you enroll, at no additional cost
to you. I have told you above which options I am not paid for, because you should
hear that from me rather than find it out later.
