See the 2027 income limits in dollars for NC Medicaid, ACA premium tax credits, and cost-sharing reductions by household size — plus the Medicaid work requirements and other changes starting in 2027.
Written by the licensed agents at Health Plans of NC, an insurance agency authorized by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
Your household income, measured against the federal poverty level (FPL), decides whether you qualify for NC Medicaid, Marketplace premium tax credits, or cost-sharing reductions.
For 2027 Marketplace coverage, premium tax credits are available from 100% to 400% FPL — $15,960 to $63,840 for one person and $33,000 to $132,000 for a family of four.
Above 400% FPL, there is no premium tax credit in 2027, because the temporary enhanced subsidies expired after 2025.
NC Medicaid covers most adults 19 to 64 up to 138% FPL, but new work requirements and six-month renewals begin January 1, 2027.
Open Enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027.
In North Carolina, three programs are tied to income: NC Medicaid, premium tax credits, and cost-sharing reductions. Each uses a different slice of the federal poverty scale, and each measures income as modified adjusted gross income (MAGI) — generally your adjusted gross income plus untaxed Social Security, tax-exempt interest, and certain foreign income.
MAGI is not your gross paycheck. Pre-tax retirement contributions and HSA contributions lower it, which can matter if you're near a cutoff.
What counts as income. MAGI generally includes wages and salaries, net self-employment income, unemployment benefits, taxable interest and dividends, capital gains, taxable retirement distributions and pension income, alimony from divorces finalized before 2019, and all Social Security benefits, including the non-taxable portion.
It generally does not include child support, gifts, Supplemental Security Income (SSI), veterans' disability payments, or money you withdraw from a Roth IRA that isn't taxable. Contributions to a traditional 401(k), traditional IRA, or HSA reduce it.
For Marketplace subsidies, your household generally follows your federal tax return: you, your spouse if you file jointly, and anyone you claim as a dependent. Income from everyone in that tax household who is required to file a return counts toward MAGI.
A few common situations trip people up. A child you claim as a dependent counts toward household size even if they have their own coverage. An adult child you don't claim generally applies separately. Married couples generally must file jointly to get a premium tax credit. Medicaid uses somewhat different household rules, so a family can have members in different programs.
Marketplace coverage for 2027 uses the 2026 federal poverty guidelines from HHS. These are annual household incomes:
Household size | 100% FPL | 138% FPL | 150% FPL | 200% FPL | 250% FPL | 400% FPL |
|---|---|---|---|---|---|---|
1 | $15,960 | $22,025 | $23,940 | $31,920 | $39,900 | $63,840 |
2 | $21,640 | $29,863 | $32,460 | $43,280 | $54,100 | $86,560 |
3 | $27,320 | $37,702 | $40,980 | $54,640 | $68,300 | $109,280 |
4 | $33,000 | $45,540 | $49,500 | $66,000 | $82,500 | $132,000 |
Medicaid uses the current year's guidelines, so Medicaid limits will update when HHS publishes 2027 guidelines in early 2027.
Up to 138% FPL. Most adults ages 19 to 64 qualify for NC Medicaid, which North Carolina expanded on December 1, 2023. Medicaid generally has no premium. If you qualify for Medicaid, you generally can't get Marketplace subsidies.
100% to 150% FPL. If you're not eligible for Medicaid, you get the largest premium tax credits and the strongest cost-sharing reductions on Silver plans.
150% to 250% FPL. Premium tax credits continue, and cost-sharing reductions still apply on Silver plans, getting smaller as income rises.
250% to 400% FPL. Premium tax credits continue, with an expected contribution of up to 10.22% of income toward the benchmark Silver plan in 2027. No cost-sharing reductions.
Above 400% FPL. No premium tax credit in 2027. You pay the full premium, so comparing Bronze plans, HSA-compatible options, and carriers by county matters more. Early retirees in this range may find our guide to bridging the gap to Medicare useful.
Near a cutoff? Small income differences can change your options. A household just above 138% FPL moves from Medicaid to the Marketplace. Just above 250% FPL, cost-sharing reductions end. Just above 400% FPL, the premium tax credit disappears entirely. If you're close to one of these lines, pre-tax retirement or HSA contributions may keep you below it.
Federal law and state policy are adding new rules for Medicaid expansion adults, according to NC Medicaid and news reports.
Work requirements. Starting January 1, 2027, most expansion adults must show 80 hours a month of work, school, job training, or community service, or earn at least $580 a month. Exemptions include people with disabilities, pregnant and postpartum individuals, parents and caretakers of children under 14, and people considered medically frail.
Six-month renewals. Eligibility will be checked every six months instead of once a year.
Immigration status. Starting October 1, 2026, fewer noncitizens are eligible for NC Medicaid.
Moving between programs is common. If your income rises above 138% FPL, you'll generally move from Medicaid to a Marketplace plan, and if it falls, the reverse. Report income changes to your county Department of Social Services and to the Marketplace promptly so there's no gap — or overlap — in coverage.
If you lose Medicaid and your income is above 100% FPL, you may qualify for a Marketplace plan with premium tax credits. Losing Medicaid generally triggers a Special Enrollment Period. Check your status with NC Medicaid.
Children. North Carolina moved its separate children's program, NC Health Choice, into NC Medicaid in April 2023. Children qualify for Medicaid at higher household incomes than adults. If your children qualify for Medicaid, you may still buy a Marketplace plan for the adults.
Employer coverage. You can get Marketplace subsidies only if the employer plan is unaffordable or doesn't meet minimum value. For 2027, a plan is considered affordable if the employee-only premium is no more than 10.22% of household income, according to IRS Revenue Procedure 2026-26.
Since 2023, affordability for family members is tested separately using the cost of family coverage. That means a spouse or children may qualify for Marketplace subsidies even when the employee does not.
Estimate 2027 MAGI carefully. Starting with tax year 2026, you repay the full amount of any excess advance credit, so a low estimate can mean a large tax bill. See our explainer on how NC tax credits work.
Find your range. Use the table above to see which programs you're likely eligible for, then confirm on HealthCare.gov.
Enroll on time. Open Enrollment runs November 1, 2026 through January 15, 2027. Enroll by December 15 for January 1 coverage. See our enrollment deadline guide for details.
Expect new 2027 prices. Premiums are rising for 2027. Preliminary filings with the NC Department of Insurance show Blue Cross NC requesting an average 17.7% increase for individual plans, and Cigna plans to leave North Carolina's individual market. If you're above 400% FPL, you'll feel increases in full, so compare plans instead of auto-renewing.
Get help at no cost. A licensed agent can check Medicaid and Marketplace eligibility together and compare plans in your county.
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.