This guide explains current health insurance options for low-income residents in North Carolina, including NC Medicaid (available year-round), ACA Marketplace enrollment periods, and critical changes coming in 2026. Our licensed agents can help you find affordable coverage.
If you're a low-income North Carolinian looking for health coverage, significant policy changes in 2025 have affected your options. Here's what you need to know:
The year-round low-income Special Enrollment Period (SEP) ended August 25, 2025. Low-income consumers can no longer enroll in ACA Marketplace plans at any time during the year simply based on income.
Enhanced ACA premium subsidies expire December 31, 2025. Without Congressional action, premiums are expected to more than double for many enrollees in 2026.
NC Medicaid remains available year-round. North Carolina expanded Medicaid in December 2023, covering adults up to 138% of the federal poverty level with no enrollment deadline.
North Carolina expanded Medicaid under the Affordable Care Act in December 2023, covering more than 600,000 additional adults. Unlike ACA Marketplace plans, you can apply for Medicaid at any time—there's no enrollment deadline.
Eligibility Requirements:
Age 19 to 64 years old
North Carolina resident
U.S. citizen (certain immigrants may also qualify)
Household income at or below 138% of the federal poverty level
2025 NC Medicaid Income Limits (138% FPL):
Household Size | Annual Income Limit |
1 person | $21,597/year |
2 people | $29,187/year |
3 people | $36,777/year |
4 people | $44,367/year |
How to Apply for NC Medicaid:
Online: Apply at epass.nc.gov or HealthCare.gov
In Person: Visit your local county Department of Social Services (DSS) office
Phone/Navigator: Call the NC Navigator Consortium at 1-855-733-3711 or schedule online at ncnavigator.net
If your income is above the Medicaid limit (138% FPL) but you don't have access to affordable employer coverage, you may qualify for subsidized ACA Marketplace coverage. However, enrollment is now limited to specific periods.
2026 Open Enrollment Period:
Start: November 1, 2025
Deadline for January 1 coverage: December 15, 2025
Final deadline: January 15, 2026 (coverage starts February 1)
Important: The year-round low-income Special Enrollment Period (for those with income up to 150% FPL) ended on August 25, 2025. You can no longer enroll at any time during the year based on low income.
From 2021 through August 2025, consumers with household incomes at or below 150% of the federal poverty level could enroll in ACA Marketplace coverage at any time during the year through a special enrollment period (SEP). This allowed low-income Americans to sign up for $0 or near-$0 premium plans whenever they needed coverage, not just during annual open enrollment.
This special enrollment period was tied to the enhanced premium tax credits introduced by the American Rescue Plan and extended by the Inflation Reduction Act. These subsidies made it possible for people with incomes up to 150% FPL to access benchmark Silver plans with $0 premiums.
As of August 25, 2025, CMS discontinued the low-income SEP. Without a qualifying life event (such as losing other coverage, getting married, having a baby, or moving), you must now wait for open enrollment to sign up for ACA Marketplace coverage.
The enhanced premium tax credits that have made ACA coverage affordable since 2021 are scheduled to expire on December 31, 2025. Unless Congress acts to extend them, many North Carolinians will face significantly higher premiums in 2026.
Impact Category | Details |
Average premium increase | 114% ($888/year → $1,904/year) |
Low-income enrollees (under 150% FPL) | Will go from $0 premiums to paying 2% of income |
Enrollees over 400% FPL | "Subsidy cliff" returns—no financial help available |
Projected coverage loss | Up to 4 million Americans may lose coverage |
Most affected groups | Early retirees, self-employed, small business workers |
Source: KFF analysis, Congressional Budget Office projections
If you missed open enrollment or need coverage mid-year, you may still qualify for a Special Enrollment Period (SEP) if you've experienced specific life changes. You typically have 60 days from the qualifying event to enroll.
Qualifying Life Events Include:
Loss of coverage: Losing job-based insurance, aging off a parent's plan, losing Medicaid/CHIP eligibility
Household changes: Getting married, having a baby, getting divorced
Moving: Relocating to a new state or county with different plan options
Income changes: No longer qualifying for Medicaid
Note: Low income alone is no longer a qualifying event as of August 2025.
The federal poverty level is used to determine eligibility for Medicaid and ACA premium subsidies. For 2026 coverage, the 2025 FPL numbers apply:
Household Size | 100% FPL | 138% FPL (Medicaid) | 150% FPL |
1 | $15,650 | $21,597 | $23,475 |
2 | $21,150 | $29,187 | $31,725 |
3 | $26,650 | $36,777 | $39,975 |
4 | $32,150 | $44,367 | $48,225 |
Source: 2025 HHS Poverty Guidelines
If your income is between 100% and 250% of the federal poverty level and you're enrolling in ACA Marketplace coverage, Silver plans are generally the best value because they include cost-sharing reductions (CSR) that lower your deductibles, copays, and out-of-pocket maximums.
Cost-sharing reductions are only available on Silver plans—they don't apply to Bronze, Gold, or Platinum plans. Even if another metal tier has a lower premium, a Silver plan with CSR can save you more money overall when you actually use your coverage.
CMS reduced federal Navigator funding by 90% for the 2026 plan year, from $100 million to $10 million nationally. In North Carolina specifically, Navigator funding was reduced from $7.4 million in 2025 to just $750,000 in 2026. This makes it more important than ever to work with licensed agents and brokers who can provide free enrollment assistance.
With these significant changes to health insurance enrollment and subsidies, navigating your options can be confusing. Our local, licensed health insurance agents throughout North Carolina can help you at no cost.
We can help you:
Determine if you qualify for NC Medicaid (year-round enrollment)
Enroll in ACA Marketplace coverage during open enrollment
Check if you are eligible for a Special Enrollment Period
Compare plans and understand how the 2026 subsidy changes affect your costs
Find the most affordable coverage option for your situation
Contact us today: Our agents are ready to answer your questions and help you access affordable health insurance in North Carolina.