How to Switch Health Plans in NC for 2027
Rates are rising and carriers are changing for 2027. Here's how to compare and switch North Carolina Marketplace plans during Open Enrollment, step by step, before the December 15 deadline.
Rates are rising and carriers are changing for 2027. Here's how to compare and switch North Carolina Marketplace plans during Open Enrollment, step by step, before the December 15 deadline.
Open Enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027. Switch by December 15 for a new plan that starts January 1.
2027 is a year to shop rather than auto-renew: premiums are rising, a carrier is leaving North Carolina's individual market, and subsidy rules have changed.
Update your 2027 income estimate before you compare plans. Starting with tax year 2026, you repay the full amount of any excess advance tax credit.
Your premium tax credit moves with you to a new plan, but your deductible starts over.
Medicare has its own window, October 15 through December 7, 2026.
If you do nothing during Open Enrollment, HealthCare.gov will generally renew you into the same plan or a similar one. That's convenient, but several changes make it risky for 2027.
Prices are rising. Final 2027 rates had not been announced as of late September 2026. According to preliminary filings with the NC Department of Insurance, Blue Cross NC requested an average 17.7% increase for individual plans, and Cigna indicated it will stop offering individual coverage in North Carolina.
Carriers come and go. Aetna left North Carolina's Marketplace after 2025. If your insurer is leaving, you'll get a notice, and you should choose a new plan yourself rather than accept whatever you're moved into.
Subsidy rules changed. The temporary enhanced subsidies expired after 2025, so premium tax credits stop at 400% of the federal poverty level. See our guide to 2027 ACA subsidies in NC for who qualifies.
Plans change every year. Networks, drug lists, deductibles, and copays can all change even when your plan name stays the same.
Old information carries over. If you auto-renew without updating your application, your 2027 tax credit may be based on outdated income or household details. That can mean paying too much each month, or owing money at tax time.
For 2027 coverage, Open Enrollment on HealthCare.gov runs November 1, 2026 through January 15, 2027, as confirmed by CMS. Choose a new plan by December 15 for coverage that starts January 1. Plans chosen from December 16 through January 15 start February 1.
Outside Open Enrollment, you can switch only with a qualifying life event — such as losing other coverage, moving, marriage, or a new child — that opens a Special Enrollment Period, usually 60 days. Our enrollment deadlines guide lists every window.
1. Read your renewal notice. Your insurer sends one before Open Enrollment. Look for changes to your premium, deductible, out-of-pocket maximum, drug list, and network.
2. Log in to HealthCare.gov and update your application. Enter your household size and expected 2027 income. This sets your premium tax credit, so be as accurate as you can. Report household changes too, such as a marriage, a new baby, or a child turning 26.
3. Compare every plan in your county. Sort by estimated total yearly cost, not just the monthly premium. The site shows each premium after your tax credit.
4. Check doctors and prescriptions. Confirm your primary care doctor, specialists, and preferred hospital are in network for 2027, and that your prescriptions are on the plan's drug list.
5. Enroll by the deadline. Choose the plan and submit by December 15 for January 1 coverage. Your old Marketplace plan ends automatically when the new one starts — you don't need to cancel it.
6. Pay your first premium. Enrollment isn't complete until you pay your first month's premium to the new insurer. Missing it can keep coverage from starting.
Focus on four numbers: the monthly premium, the deductible, the out-of-pocket maximum, and your copays or coinsurance for the care you actually use.
Bronze plans have the lowest premiums and highest cost-sharing. Starting in 2026, all Marketplace Bronze plans can be paired with a health savings account. Silver plans are the only level with cost-sharing reductions for incomes between 100% and 250% of the poverty level. Gold plans cost more each month but less when you get care. Our guide to comparing metal tiers goes deeper.
Check the network type. HMO and EPO plans generally cover only in-network care and may need referrals, while PPO plans cost more but let you see out-of-network providers at a higher cost. If you travel, have a child in college out of state, or see specialists at more than one health system, the network type can matter as much as the price. See our comparison of HMO and PPO plans in NC.
Above 400% FPL? You won't get a premium tax credit in 2027, but since 2026, CMS lets people who can't get a credit because of their income buy a catastrophic plan through a hardship exemption. Catastrophic plans have low premiums and very high deductibles, so weigh them carefully.
Your premium tax credit is based on your income and the benchmark Silver plan in your area, not on the plan you pick. When you switch, the same credit applies to your new plan. Choose a cheaper plan and your net premium drops. Choose a pricier one and you pay the difference.
Getting your income estimate right matters more now. Beginning with tax year 2026, the IRS no longer caps repayment of excess advance credits. If your 2027 income ends up higher than you estimated, you repay the full difference. Our explainer on how NC tax credits are calculated walks through an example.
A new plan means a new deductible and out-of-pocket maximum. At Open Enrollment that's rarely an issue, because every plan resets on January 1 anyway.
It matters more if you switch mid-year through a Special Enrollment Period. Amounts you've paid toward your old plan's deductible generally don't carry over. If you're close to your out-of-pocket maximum late in the year, it may make sense to stay put until January 1.
If you're in the middle of treatment, ask your new plan about transition-of-care rules and any prior authorization you'll need to redo before your first appointment in January.
If you have Medicare, your plan changes follow a different calendar. Medicare's Annual Enrollment Period for 2027 coverage runs October 15 through December 7, 2026. Marketplace plans don't replace Medicare. See our guide to 2027 Medicare open enrollment in NC.
Watch for your renewal notice. Compare it with your current plan as soon as it arrives.
Estimate 2027 income. Use your best projection, not last year's number.
Mark December 15. That's the last day to switch for coverage starting January 1, 2027.
Keep your confirmation. Save your enrollment confirmation and first premium receipt until your new insurance card arrives.
Get help at no cost. A licensed agent can compare every plan in your county, check your doctors and drugs, and handle the enrollment with you.
Watch for scams. The Marketplace won't call to demand payment or ask for your password. Enroll through HealthCare.gov or a licensed agent you contact yourself.
This article is for general information and is not insurance, legal, or tax advice. Contact a licensed agent or the Health Insurance Marketplace for guidance specific to your situation.