North Carolina Health Insurance: Marketplace, Private Plans & 2027 Changes

Shopping for health insurance in North Carolina? 2027 brings another important change to the individual market: Cigna is leaving individual and family medical coverage after 2026.

Even if you're not with Cigna, premiums, provider networks, prescription coverage, Marketplace financial assistance, and plan choices can change from year to year.

We help self-employed workers, individuals, families, early retirees, and small business owners compare HealthCare.gov plans with other available private coverage based on their doctors, prescriptions, budget, and needs.

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North Carolina Health Insurance at a Glance

Topic What North Carolina Residents Should Know
Marketplace North Carolina uses the federal Marketplace at HealthCare.gov.
2027 Open Enrollment November 1, 2026 through January 15, 2027.
January 1 Coverage Select a Marketplace plan by December 15, 2026.
Leaving for 2027 Cigna will no longer offer Individual & Family medical plans for 2027.
2027 Marketplace Filings Ambetter, AmeriHealth Caritas, Blue Cross Blue Shield of North Carolina, Oscar, and UnitedHealthcare currently have on-exchange individual filings.
2027 Proposed Rate Changes Current carrier filings range from approximately 8.5% to 27.41%. Final approved rates may differ.
NC Medicaid North Carolina expanded Medicaid in December 2023 for eligible adults ages 19 through 64.
New for 2027 Work and community-engagement requirements begin January 1, 2027 for many Medicaid adults, with numerous exemptions.

Cigna Is Leaving North Carolina's Individual Market for 2027

Cigna has announced that it will stop offering Individual & Family medical plans after the 2026 plan year.

That means North Carolina residents currently enrolled in Cigna individual medical coverage need to review replacement coverage for 2027.

Don't wait for automatic re-enrollment to make the decision for you. If your current plan is no longer available, HealthCare.gov may match you with another plan. The replacement may have a different provider network, drug formulary, deductible, or out-of-pocket structure.

Have a Cigna Plan? What to Check Before Choosing a Replacement

1. Check Your Doctors

Make a list of your primary care doctor, specialists, preferred hospital, and other facilities you regularly use.

A doctor who participates with Cigna may not participate with the replacement plan you're considering.

2. Check Your Prescriptions

Compare your medications using the exact drug name and dosage.

Check the drug tier, pharmacy network, prior authorization requirements, and whether a separate prescription deductible applies.

3. Compare Total Costs

Don't stop at monthly premium. Compare your deductible, specialist copays, coinsurance, hospital costs, prescriptions, and annual out-of-pocket maximum.

4. Enroll Before December 15

Choose a Marketplace plan by December 15, 2026 if you want the replacement coverage to begin January 1, 2027.

North Carolina Marketplace Insurers for 2027

Current North Carolina Department of Insurance filings show five insurers with individual products filed for both on- and off-exchange coverage in 2027:

  • Ambetter of North Carolina
  • AmeriHealth Caritas North Carolina
  • Blue Cross and Blue Shield of North Carolina
  • Oscar Health Plan of North Carolina
  • UnitedHealthcare of North Carolina
Your ZIP code still matters. An insurer participating in North Carolina does not necessarily mean every plan or network from that company is available everywhere in the state.

Proposed North Carolina Health Insurance Rates for 2027

North Carolina insurers have submitted initial rate filings for the 2027 individual ACA market.

The proposed average changes vary considerably by carrier:

Insurance Company Initial Proposed Average Change
Ambetter of North Carolina +8.50%
AmeriHealth Caritas North Carolina +9.26%
Blue Cross and Blue Shield of North Carolina +17.686%
Oscar Health Plan of North Carolina +16.478%
UnitedHealthcare of North Carolina +27.410%
These are proposed carrier averages, not your personal premium increase. North Carolina's Department of Insurance is still reviewing the filings, and final approved rates may differ. Your own price also depends on your age, county, plan, tobacco status where applicable, and financial assistance.

If you receive a Marketplace Premium Tax Credit, compare your net monthly premium after assistance, not just the insurance company's full premium.

North Carolina Open Enrollment for 2027

North Carolina uses HealthCare.gov and follows the federal Marketplace Open Enrollment schedule.

Open Enrollment for 2027 coverage runs from November 1, 2026 through January 15, 2027.

  • November 1, 2026: Open Enrollment begins.
  • December 15, 2026: Select a plan by this date for coverage beginning January 1, 2027.
  • January 15, 2027: Open Enrollment ends. Coverage selected after December 15 generally begins February 1.
Already have Marketplace coverage? Update your expected 2027 income and household information, compare your renewal with the alternatives, and recheck doctors and prescriptions before accepting automatic re-enrollment.

Marketplace Financial Help in North Carolina for 2027

Eligible North Carolina households may qualify for federal Premium Tax Credits when purchasing Marketplace coverage through HealthCare.gov.

The temporary enhanced subsidy rules that applied from 2021 through 2025 have expired.

Under the general federal rules now in effect, Premium Tax Credit eligibility generally applies to households with income between 100% and 400% of the federal poverty level, along with other eligibility requirements.

For 2027, the federal applicable percentage table ranges from 2.15% at the lowest income band to 10.22% for households between 300% and 400% of the federal poverty level.

Income isn't the only factor. Employer coverage, Medicaid eligibility, Medicare eligibility, household size, tax filing status, age, location, and benchmark-plan pricing can also affect your eligibility and the amount of assistance.

Self-Employed Health Insurance in North Carolina

We work with North Carolina consultants, technology contractors, real estate professionals, truck drivers, tradespeople, farmers, small business owners, gig workers, film and creative professionals, and other people who buy health insurance without an employer.

Self-employed applicants often have an additional challenge: estimating annual income for Marketplace financial assistance.

Use Expected Annual Income

HealthCare.gov asks you to estimate household income for the year in which you want coverage.

For self-employment, that generally involves expected net business income after eligible business expenses rather than simply gross business revenue.

Income Can Change

Commission income, contract work, seasonal businesses, and entrepreneurship can make income difficult to predict.

Update significant changes rather than waiting until the next Open Enrollment period.

Understand MAGI

Marketplace financial assistance uses Modified Adjusted Gross Income, or MAGI.

MAGI generally begins with Adjusted Gross Income and then applies certain federal adjustments.

Tax Planning Can Matter

Certain allowable tax deductions and contributions can affect Adjusted Gross Income and therefore may affect Marketplace income.

Discuss tax strategies with a qualified tax professional before making decisions solely for health insurance purposes.

Advance Premium Tax Credits are reconciled when you file your federal return. If your actual annual household income differs from what you estimated, the final amount of your credit can also change.

Learn more about self-employed health insurance →

North Carolina Medicaid Expansion

North Carolina expanded Medicaid on December 1, 2023.

Expansion allows many qualifying adults ages 19 through 64 to receive NC Medicaid based on household income and other eligibility requirements.

For expansion adults, eligibility generally reaches income up to approximately 138% of the federal poverty level after the applicable Medicaid income methodology is considered.

NC Medicaid enrollment is available year-round. You do not need to wait until Marketplace Open Enrollment to apply if you think you may qualify.

New NC Medicaid Work Requirements Begin January 1, 2027

Beginning January 1, 2027, most NC Medicaid adults ages 19 through 64 who are subject to the new federal rules will need to meet a work and community-engagement requirement unless an exemption applies.

North Carolina currently describes the general requirement as either:

  • Completing at least 80 hours per month of qualifying activities, or
  • Meeting the applicable monthly earnings requirement.

Qualifying activities can include:

  • Working
  • Going to school
  • Volunteering
  • Other qualifying work or community activities
Not everyone on NC Medicaid has to meet this requirement. North Carolina lists many exemptions, including certain parents and caregivers, pregnant people, people with disabilities, and other qualifying individuals.

NC Medicaid Renewals Also Change in 2027

For many adults affected by the new work requirement, Medicaid renewal will occur every six months instead of once per year.

North Carolina says affected members generally need to meet the work or community-engagement requirement during three of the six months before recertification.

American Indians, Alaska Natives, and certain members eligible for Indian Health Services continue to have different renewal rules.

If you have NC Medicaid, keep your contact information current. Open letters and electronic notices from your local Department of Social Services and respond before any listed deadline.

What If You Lose NC Medicaid?

Losing Medicaid can create a Special Enrollment Period for Marketplace coverage through HealthCare.gov.

If your income increases or your Medicaid eligibility changes, review your options promptly rather than waiting for the next annual Open Enrollment.

Depending on your circumstances, your options might include:

  • A HealthCare.gov Marketplace plan
  • Employer-sponsored health insurance
  • A spouse's employer plan
  • Other available individual coverage

What Happened to NC Health Choice?

NC Health Choice was North Carolina's separate children's health insurance program.

On April 1, 2023, existing NC Health Choice beneficiaries were moved into NC Medicaid.

That transition simplified children's public coverage and gave affected children access to the broader Medicaid benefit structure.

Families should not assume every person in the household needs the same type of insurance. Children may qualify for NC Medicaid even when their parents use Marketplace or employer-sponsored coverage.

Marketplace Plans vs. Other Private Health Coverage

North Carolina residents may also see health insurance and health-benefit products offered outside HealthCare.gov. These products do not necessarily work the same way.

HealthCare.gov Marketplace Plans

  • ACA-compliant major medical insurance
  • Coverage for pre-existing conditions
  • ACA-required essential health benefits
  • Defined annual out-of-pocket limits
  • No medical underwriting for eligibility
  • Premium Tax Credits for eligible households

Other Private Coverage

  • May be sold outside HealthCare.gov
  • Some products use medical underwriting
  • Pre-existing-condition rules can differ
  • Benefits and exclusions can differ
  • Provider networks can be structured differently
  • Marketplace Premium Tax Credits generally cannot be used
Don't compare plans based only on monthly premium. Look at the provider network, prescriptions, deductible, hospital costs, annual out-of-pocket exposure, exclusions, underwriting, and pre-existing-condition provisions.

Provider Networks Can Vary Across North Carolina

North Carolina has several large health systems and a mix of metropolitan, suburban, rural, mountain, and coastal communities.

A plan that works well for someone in Charlotte may have different practical network considerations from a plan for someone in Raleigh, Asheville, Wilmington, Greenville, or a rural county.

Before enrolling, check:

  • Your primary care doctor
  • Your specialists
  • Your preferred hospital or health system
  • Nearby urgent care facilities
  • Your preferred pharmacy
  • Your prescriptions
  • Out-of-area coverage if you travel regularly
Give us the names of your doctors and prescriptions. We can use that information while narrowing down the plans available where you live.

Leaving a Job or Losing Employer Health Insurance?

Losing qualifying job-based coverage can create a Special Enrollment Period through HealthCare.gov.

Depending on your situation, you may want to compare:

  • COBRA continuation coverage
  • A spouse's employer-sponsored plan
  • A HealthCare.gov Marketplace plan
  • NC Medicaid if eligible
  • Other available individual coverage

COBRA can be valuable because it allows many people to keep their existing employer coverage temporarily, but the premium can increase substantially once the employer stops contributing.

Learn more about COBRA alternatives →

North Carolina Health Insurance for Early Retirees

Retiring before age 65 can create several years between employer health insurance and Medicare eligibility.

Depending on your situation, you may compare:

  • Marketplace major medical coverage
  • COBRA
  • A spouse's employer-sponsored plan
  • Other available private coverage

Income planning can be especially important for an early retiree using Marketplace coverage because taxable retirement distributions, pensions, investment income, and other income can affect household MAGI.

Retiring doesn't automatically mean you won't qualify for Marketplace assistance. Eligibility depends on household income and the other applicable Marketplace rules.

Small Business Health Insurance in North Carolina

North Carolina employers have several ways to approach employee health benefits.

Depending on the company, options may include:

  • Traditional fully insured group health insurance
  • Level-funded group coverage where available
  • Individual Coverage HRAs (ICHRA)
  • Qualified Small Employer HRAs (QSEHRA)
  • Dental and vision benefits
  • Life and supplemental coverage

The right structure can depend on employee count, employee ages and ZIP codes, participation, employer contribution, and how much predictability the employer wants in its benefits budget.

You don't have to assume traditional group coverage is the only option. We can compare different benefit structures and explain the tradeoffs before you decide.

Learn more about small business health insurance →

How We Help North Carolina Residents

Self-Employed & 1099 Workers

Consultants, technology contractors, real estate professionals, truckers, tradespeople, farmers, freelancers, film and creative workers, and other independent professionals.

Self-employed health insurance →

Cigna Members

If your individual Cigna plan is ending after 2026, we can help you compare replacement plans and recheck your doctors, prescriptions, costs, and networks.

Individuals & Families

We compare premiums, deductibles, providers, prescriptions, Marketplace financial assistance, and other available coverage.

Individual & family health insurance →

People Losing Medicaid

If your NC Medicaid coverage ends because of income or eligibility changes, we can help you understand the Marketplace and other options available to you.

Early Retirees

We help people who need coverage before Medicare compare Marketplace coverage, COBRA, spouse coverage, and other available options.

Small Business Owners

We can discuss traditional group plans, level-funded coverage, ICHRAs, QSEHRAs, and additional employee benefits.

Small business health insurance →

Serving All 100 North Carolina Counties

We work with North Carolina clients by phone and video, so you don't need to live near our office.

Charlotte & Surrounding Areas
Charlotte, Concord, Gastonia, Huntersville, Matthews, Mooresville and surrounding communities
The Triangle
Raleigh, Durham, Cary, Chapel Hill, Apex, Wake Forest and surrounding communities
The Triad
Greensboro, Winston-Salem, High Point, Burlington and surrounding communities
Eastern North Carolina
Greenville, Jacksonville, New Bern, Fayetteville and surrounding communities
Coastal North Carolina
Wilmington, Morehead City, Outer Banks and surrounding coastal communities
Western North Carolina
Asheville, Hendersonville, Hickory, Boone and surrounding communities
Plan availability and networks can vary by county and ZIP code. We'll focus on the options actually available where you live.

Official North Carolina Health Insurance Resources

HealthCare.gov
Marketplace enrollment, Premium Tax Credits, Special Enrollment Periods, and plan comparison.
Visit HealthCare.gov →

North Carolina Department of Insurance
Current ACA rate filings, insurance information, consumer assistance, and insurance complaints.
Visit NC Department of Insurance →

NC Medicaid
Medicaid eligibility, applications, expansion coverage, renewals, and 2027 program changes.
Visit NC Medicaid →

Common Questions About North Carolina Health Insurance

Does North Carolina use HealthCare.gov?

Yes. North Carolina uses the federally facilitated Marketplace at HealthCare.gov.

Is Cigna leaving North Carolina?

Cigna will no longer offer Individual & Family medical insurance for 2027.

North Carolina residents with affected Cigna coverage should compare replacement options during Open Enrollment.

What happens if I have a Cigna Marketplace plan?

Your current 2026 coverage does not continue as a Cigna individual medical plan for 2027.

Review the Marketplace plans available in your county and select replacement coverage by December 15 if you want coverage beginning January 1.

Which companies filed North Carolina Marketplace plans for 2027?

Current North Carolina filings show Ambetter, AmeriHealth Caritas, Blue Cross Blue Shield of North Carolina, Oscar, and UnitedHealthcare with individual on-exchange filings.

Final plan and county availability should be confirmed when 2027 plans are available for enrollment.

How much are North Carolina health insurance premiums increasing in 2027?

Initial individual-market filings currently range from an average proposed increase of about 8.5% to 27.41% depending on the insurer.

These are proposed carrier averages, and final approved rates and individual premiums can differ.

When is North Carolina Open Enrollment for 2027?

Open Enrollment runs from November 1, 2026 through January 15, 2027.

Select a plan by December 15, 2026 for coverage beginning January 1, 2027.

Did North Carolina expand Medicaid?

Yes. North Carolina launched Medicaid expansion on December 1, 2023.

Qualifying adults ages 19 through 64 may be eligible based on income and other NC Medicaid requirements.

Does NC Medicaid have a work requirement in 2027?

Beginning January 1, 2027, many adults ages 19 through 64 will need to meet a work and community-engagement requirement unless they qualify for an exemption.

North Carolina currently describes the general requirement as 80 hours per month of qualifying activities or meeting the applicable earnings standard.

Who is exempt from the NC Medicaid work requirement?

Multiple exemptions apply, including certain parents, caregivers, pregnant people, people with disabilities, and other qualifying individuals.

Check current NC Medicaid guidance for your specific situation.

What happened to NC Health Choice?

NC Health Choice beneficiaries were moved into NC Medicaid effective April 1, 2023.

Can self-employed people get Marketplace insurance in North Carolina?

Yes. Self-employed residents can purchase individual Marketplace coverage through HealthCare.gov and may qualify for Premium Tax Credits if they meet the applicable rules.

Can I get health insurance outside Open Enrollment?

Possibly. Marketplace enrollment outside Open Enrollment generally requires a Special Enrollment Period caused by a qualifying event such as losing coverage, marriage, having a baby, or certain moves.

NC Medicaid accepts applications throughout the year for eligible residents. Other health products may have different enrollment rules.

Is private health insurance cheaper than HealthCare.gov?

It depends on the applicant and the type of coverage.

Some non-Marketplace products may have lower premiums for certain applicants, but benefits, underwriting, exclusions, provider networks, and pre-existing-condition provisions can differ.

Compare the actual coverage rather than using monthly premium as the only factor.

Can you check whether my doctors are in network?

Yes. Give us the names of your doctors, specialists, hospitals, prescriptions, and preferred pharmacy when we compare your options.

Can you help me if your office is in Arizona?

Yes. We are licensed in North Carolina and work with North Carolina clients remotely by phone and video.

Compare Your North Carolina Health Insurance Options for 2027

With Cigna leaving the individual market, new premiums being reviewed, and NC Medicaid rules changing in 2027, this is an important year to review your coverage. We'll help you compare available options, check your doctors and prescriptions, and understand the costs and coverage before you choose.

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