Becky Johnson: Why are health coverage costs increasing under the Affordable Care Act in North Carolina?

Dec. 17—Rate hikes paired with the expiration of enhanced premium tax credits will increase out-of-pocket costs for North Carolina residents purchasing health care coverage under the ACA in 2026.

What you need to know

What is the Affordable Care Act?

Signed into law in 2010 by then-President Barack Obama, the Affordable Care Act expanded health care coverage for millions of Americans.

The law created tax credits to help lower out-of-pocket costs. It also barred insurers from charging people with pre-existing health conditions higher premiums or denying coverage altogether.

Since its passage, the ACA, also known as Obamacare, has survived several legal challenges and attempts by Republican lawmakers to repeal it.

More than 24 million people nationwide receive coverage under the ACA, according to KFF, a health policy nonprofit. In North Carolina, nearly one million people, or 10% of the population, are enrolled.

Why will ACA coverage be more expensive in 2026?

Insurance through the marketplace will be more expensive next year for two reasons:

1. Increased rates

State Insurance Commissioner Mike Causey approved a nearly 30% average rate hike for ACA plans purchased through the federal marketplace, healthcare.gov.

Causey said the increases were necessary due to rising healthcare costs and the One Big Beautiful Bill Act, which President Donald Trump signed into law July.

2. End of enhanced premium tax credits

Enhanced tax credits that went into effect during the pandemic are set to expire at the end of the year. Those tax credits, which were at the center of the longest government shutdown in history, did two things to help individuals who needed health insurance coverage. They increased the financial assistance ACA enrollees received, and they expanded eligibility to people earning more than 400% of the federal poverty level.

In 2025, nearly 900,00 people in North Carolina received the enhanced premium tax credit, according to KFF, with the average subsidy totaling $574 per month.

Congress is expected to vote on extending the tax credits in December. If passed and signed into law by Trump, the move would help reign in out-of-pocket costs for enrollees.

If the enhanced premium tax credits aren't extended, North Carolina enrollees can expect to pay significantly more for ACA coverage.

How much more can you expect to pay in 2026?

Use this calculator from KFF to estimate your total cost with or without the tax credits.

How many people in NC are expected to lose coverage under the ACA because of higher costs?

An estimated 157,000 North Carolina residents enrolled in the ACA are at risk of losing coverage in 2026 because they would no longer be able to afford it, according to a letter North Carolina Gov. Josh Stein sent to federal lawmakers in September,

"Too many North Carolinians risk either being priced out of health insurance entirely or paying

exorbitant costs to continue to get essential health coverage," Stein wrote in the letter urging lawmakers to extend the subsidies. "The small percentage of North Carolinians who purchase health insurance on the Marketplaces without premium tax credits are not spared either."

Recipients of Deferred Action for Childhood Arrivals, or DACA, will also lose eligibility for ACA coverage and tax credits beginning in 2026 because of the One Big Beautiful Bill Act. As of March 2023, there were more than 22,000 DACA recipients in North Carolina.

How to sign up for ACA coverage in North Carolina

Open enrollment for ACA coverage runs from Nov. 1, 2025 to Jan. 15, 2026. For coverage to begin Jan. 1, the last day to enroll is Dec. 15, otherwise coverage will begin Feb. 1, 2026.

In North Carolina, enrollees can sign up through the federal marketplace, healthcare.gov.

Additionally, a statewide network of health insurance navigators are available to provide assistance. Visit ncnavigator.org to learn more.

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This story was originally published by NC Local, a nonprofit newsroom delivering public service journalism about statewide issues.

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