North Carolina Obamacare Enrollees Could Get a $500 Rebate
About one million Obamacare enrollees — including many in North Carolina — are in line for a $500 rebate from a surplus in a little-known marketplace fee. Here's who qualifies and why.
About one million Obamacare enrollees — including many in North Carolina — are in line for a $500 rebate from a surplus in a little-known marketplace fee. Here's who qualifies and why.
About one million Americans who purchase Affordable Care Act marketplace coverage — including enrollees in North Carolina — are set to receive $500 rebates from the federal government. The payments come from a surplus collected through a little-known fee that funds the operation of the ACA marketplace.
The federal government charges a "user fee" to operate HealthCare.gov, the marketplace used by North Carolina and other states that do not run their own ACA exchange. The fee covers costs including information technology, the consumer call center, and enrollment and eligibility services.
The fee is not billed to consumers separately. It is set annually as a percentage of monthly premiums, built into the premium amounts insurance companies collect, and then remitted by insurers to the federal government. States that operate their own marketplaces without relying on the federal system do not charge this particular fee.
For 2025, the fee was 1.5 percent of premiums in states using the full federal marketplace, including North Carolina, and 1.2 percent in states running their own exchange with federal support. For 2026, those rates increased to 2.5 percent and 2 percent, respectively.
The increase coincided with the scheduled expiration of enhanced premium tax credits that had been in place since 2021. Those subsidies had contributed to increased ACA enrollment, and their expiration at the end of 2025 led some analysts to project a significant decline in coverage for 2026. A drop in enrollment would have reduced user fee revenue while the fixed costs of operating the marketplace remained largely unchanged.
The federal government finalized the higher 2026 rates on January 13, 2025, a week before President Biden left office, citing the anticipated enrollment decline as a factor.
Enrollment for 2026 did decline nationally, but by about 6 percent — less than half of what some analysts had projected. Before the 2026 enrollment period began, the government had projected user fee collections of $2.1 billion for the year. The combination of higher rates and smaller-than-expected enrollment losses resulted in fee collections exceeding the cost of operating the marketplace, producing the surplus now being returned to consumers.
According to the White House, not all Obamacare enrollees will receive a rebate. About 15.8 million people enrolled this year across the states that use the federally supported marketplace, but eligibility is limited by two factors.
State of enrollment. Only enrollees in states that use the federally facilitated marketplace qualify. North Carolina is one of 30 such states, along with Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Hawaii, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, and Wyoming. Other states, along with the District of Columbia, operate their own marketplaces and do not pay this federal fee.
Subsidy status. Only enrollees who did not receive an advance premium tax credit — a government subsidy — are eligible. Subsidized enrollees do not pay the user fee directly; only those paying the full premium themselves do.
The White House has not specified which enrollment years generated the surplus, the total size of the surplus, or the methodology used to calculate the rebate amount. A White House spokesperson referred questions to the Centers for Medicare and Medicaid Services, which declined to comment.
Neither the Obama nor the Biden administration returned surplus user fees to consumers. The total cost of operating the federal marketplace has not been made public, so it is unclear in which years a surplus may have existed previously.
The Biden administration did propose a related but different use of the fee mechanism in 2023. That proposal would have rescinded a religious and moral exemption in the Affordable Care Act that allows some employers to decline covering contraceptives, reimbursing insurers through a reduction in their marketplace user fee instead. The proposal was withdrawn after opposition from some Republicans and conservative organizations.
President Trump linked the rebate announcement to his broader healthcare policy agenda, which he has pursued through executive action. He said the administration intends to reduce payments to insurance companies and direct funds to individuals instead, allowing consumers to purchase coverage at lower cost.
If you purchased ACA marketplace coverage without a subsidy this year or in a recent year, you may be eligible for the rebate. The administration has not released a timeline for distributing payments or additional detail on how the surplus was calculated, so watch for official communication from CMS or HealthCare.gov rather than unsolicited offers claiming to process the rebate for a fee.
If you're unsure whether you received a subsidy, or you have questions about your current ACA coverage ahead of the next Open Enrollment period, a licensed health insurance agent can help you review your enrollment history and plan options.
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.