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From the scenic Blue Ridge Mountains to the Atlantic shoreline, North Carolina remains a desirable place to live — and understanding your health insurance options here is key to protecting your health and finances.
As of 2025, the uninsured rate in North Carolina reflects steady enrollment and expanding access efforts. If you’re currently without coverage, here’s what you need to know about getting insured in North Carolina.
Health Insurance Options in North Carolina
North Carolina offers a variety of health insurance options based on age, income, employment status, and family size. Below are the most common types of coverage:
Employer-Sponsored Insurance
Many North Carolinians receive coverage through their employer. If your workplace offers insurance, this is usually the most affordable and convenient option.
ACA Marketplace Plans
The Affordable Care Act (ACA) provides access to individual and family coverage via the federal health insurance marketplace. These plans cover essential health benefits, preventive care, and preexisting conditions.
If you don’t have employer coverage, you may qualify for subsidies to lower your premiums. Use our ACA Subsidy Calculator to check your eligibility.
Starting this year, the Centers for Medicare & Medicaid Services (CMS) is requiring income verification to confirm eligibility for premium subsidies. As part of this effort, CMS will reduce the ACA subsidies by $5 per month for individuals who are automatically re-enrolled in fully subsidized plans without verified eligibility.
ACA Plan Types
ACA marketplace plans come in Bronze, Silver, Gold, and Platinum tiers, each with different costs and coverage levels. Plans also vary by provider networks and out-of-pocket expenses, so compare carefully to find what fits your needs.
Marketplace Plans:
- Bronze: Low monthly premiums, higher out-of-pocket costs; ideal for minimal healthcare usage.
- Silver: Moderate costs; eligible for cost-sharing reductions (CSRs).
- Gold: Higher monthly premiums with lower out-of-pocket costs; best for frequent healthcare users.
- Platinum (if available): Highest premiums, lowest out-of-pocket costs.
Metal Tier Breakdown:
| Metal Tier | Insurance Company Pays | Consumer Pays |
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
Medicaid
North Carolina Medicaid offers free or low-cost coverage to eligible low-income individuals and families. Services typically include hospital care, doctor visits, behavioral health, prescription drugs, and more.
Children’s Health Insurance Program (CHIP)
Known as NC Health Choice, this program provides low-cost health coverage to uninsured children in families that earn too much to qualify for Medicaid but still need affordable insurance.
Student Health Insurance
College students in any state have multiple health insurance options, including staying on a parent’s plan until age 26, enrolling in a school-sponsored plan, or applying for coverage through the ACA Marketplace. Depending on your income and location, you may also qualify for Medicaid, CHIP, or low-cost catastrophic or short-term plans, making North Carolina student health insurance accessible and flexible for a wide range of needs.
Medicare
Medicare plans are available for residents aged 65+ and younger individuals with qualifying disabilities. Options include:
- Medicare Advantage (Part C)
- Medicare Advantage is an alternative to Original Medicare offered by private insurers to those enrolled in Parts A and B. These plans often include extra benefits and cost protections but typically require using a specific network of providers.
- Prescription Drug Plans (Part D)
- Medicare Part D provides prescription drug coverage for anyone with Medicare, helping pay for medications and many vaccines. Offered by private insurers, these plans vary in cost and coverage and can be joined during specific enrollment periods.
- Medicare Supplement (Medigap)
- Medicare Supplement plans, or Medigap policies, help cover the out-of-pocket costs that Medicare Part A and Part B don’t pay. Since Original Medicare (Parts A and B) lacks an out-of-pocket maximum, these plans can limit your expenses for medical services.
COBRA Coverage
If you’ve recently lost job-based insurance, COBRA allows you to continue your employer coverage temporarily—typically at full cost.
Short-Term Plans
Short-term medical (STM) plans offer flexible, low-cost coverage for up to four months, ideal for healthy individuals in transition. However, STM plans aren’t guaranteed issue, lack subsidies, and may exclude key benefits like maternity, mental health, and pre-existing conditions, making them less suitable for long-term or comprehensive needs.
Explore all non-ACA health plans that may fit your needs and lifestyle.
Enrollment Periods in North Carolina
Open Enrollment for 2025 Coverage
November 1, 2025 – January 15, 2026
This is the annual period when eligible individuals and families can enroll in ACA Marketplace plans, renew existing policies, or change plans.
Special Enrollment Period:
Available year-round for those experiencing qualifying life events, (QLE), such as:
- Job loss
- Marriage or divorce
- Birth/adoption of a child
- Relocation
- Change in income
You typically have 60 days from the event to enroll.
Health Insurance Providers in North Carolina
As of 2025, these insurers typically offer individual and family plans through Healthcare.gov:
- Blue Cross Blue Shield of North Carolina
- Cigna HealthCare of North Carolina
- Ambetter of North Carolina
- Bright Health of North Carolina (availability may vary)
- Oscar Health Plan of North Carolina
- Friday Health Plans (availability may vary)
- UnitedHealthcare of North Carolina
- AmeriHealth Caritas
- Celtic Insurance (Molina Healthcare)
- Aetna/CVS Health
Availability varies by county or zip code. Some insurers may also offer standardized plans depending on state programs.
Understanding Health Insurance Costs
When selecting a plan, be sure to understand these common cost terms:
- Premium: Monthly payment to maintain your plan.
- Deductible: What you pay before insurance covers services.
- Copayment (Copay): Fixed amount per visit/service.
- Coinsurance: Shared costs with your insurer after the deductible.
- Out-of-Pocket Maximum: Your yearly cost cap for covered services.
- In-Network vs. Out-of-Network: Staying in-network helps you avoid higher charges.
Understanding health insurance doesn’t have to be overwhelming. This glossary offers clear definitions of key terms—from agents to costs like copayments, coinsurance, and deductibles—to help you make confident coverage decisions.
Bottom Line
Health insurance in North Carolina comes with many choices—whether from your employer, through the ACA marketplace, or public programs like Medicaid and Medicare. By staying informed and comparing plans during the right enrollment periods, you can secure affordable, reliable coverage that supports your well-being and budget.
Need help choosing a plan? Use our ACA Subsidy Calculator to see if you are eligible for ACA plan financial aid or speak with a licensed insurance agent about all your options.
