Brace for impact: health insurance costs on the rocks

Aug. 13—As many as 9,000 individuals in Haywood County could see their health insurance costs raise dramatically or their health coverage just disappear next year.

Some 5,500 Haywood County residents get their insurance through the Affordable Care Act marketplace. As of January 2026, this group will see insurance premium costs explode, and another 4,200 who receive health care through the expanded Medicaid program could become ineligible, depending on actions taken by the N.C. General Assembly.

KFF, a nonprofit health policy research, polling, and news organization, found that initial rate filings for marketplace plans in all 50 states show the median proposed increase for 2026 is 18%, more than double last year's 7% median proposed increase.

That's on top of the Biden-era tax credit allowance that expires in 2025 and is expected to increase premiums an average of 75%.

This calculator provides an estimate of the cost increase for ACA plans once the tax credit expires.

Health navigators worried

Local health care navigators who work directly with consumers to help them find the most suitable marketplace plan predict many will simply drop their insurance coverage in 2026.

"Many won't be able to afford the coverage," said Jessi Stone, a Waynesville-based director for the WNC Health and Economic Opportunities Program with Pisgah Legal Services. "A lot of people will go uninsured, especially if they are younger."

Being able to find access to comprehensive health insurance regardless of pre-existing conditions has been a game-changer for many in the nation.

Insurance companies interested in offering plans can do so through an online marketplace, and there has been federal funding for "navigators" to help people decipher the options. That funding has markedly decreased, but agencies are pursuing other options to continue the service.

"I think about all the people who have been able to work for themselves or start their own business. The ACA gives workers a lot of freedom to not beholding to a company that has insurance," Stone said.

Jan Plummer, a healthcare navigator with Mountain Projects, said the 2026 insurance plans will be released in phases, with the first ones available by Aug. 25. When people who get insurance through the Affordable Care Act get notices from their insurance provider, they should open them, she advised, "because a lot of things are changing."

"Plans change annually, so it is important to visit the marketplace or see someone like us," Plummer said. "People will need to evaluate options."

Amid the projected premium hikes, Plummer said there is "one small silver lining," which is that all the bronze and catastrophic plans are now eligible for a health savings account. That means people can purchase high-deductible policies, and then deposit funds into a tax deductible savings account. The account can cover medical costs to help close the gap between costs and when the catastrophic plan kicks in.

As individuals plan for large rate hikes, both Plummer and Stone recommended taking a look at the available plans as soon as possible and scheduling an appointment with a navigator if help is needed.

The open enrollment period starts Nov. 1 and ends Jan. 15, though certain exceptions are available to enroll at other times.

During the last open enrollment period, 5,484 people in Haywood County enrolled in a marketplace plan, Plummer said. Forty-three percent, or 2,341, allowed their plans to automatically roll over to the 2025 plan year, without actively updating their application.

"This is not the year to rely on auto-re-enrollment," she said.

Resources for working through the changes include Mountain Projects, GetCoveredWNC, 828-452-1447. Or contact Stone at [email protected], 828-210-3404 or visit www.pisgahlegal.org.

Insurance plans are available through HealthCare.gov.

Medicaid eligibility

The next group whose health insurance is up in the air are those who became eligible for coverage after the N.C. General Assembly adopted the expanded Medicaid program in 2023.

As of July 31, Haywood has 4,198 individuals enrolled in Medicaid due to that expansion, said Dillon Huffman, Haywood County public information officer.

Medicaid expansion was endorsed by health care providers across the state, who covered the 10% state match required to draw down the federal funds. That contribution has been limited to 6% under the new law that President Trump dubbed "One Big Beautiful Bill."

The law includes an extra requirement that doubles the workload for state and county workers who now must make sure expanded Medicaid applicants qualify for the program every six months by either working, going to school or performing community service for at least 80 hours a week.

Both new requirements significantly increase state costs for the program by 2027 and threaten the continued existence of the state participation. (See separate story.)

Stone, with Pisgah Legal, said the organization worked diligently with individuals in the region with incomes that were up to 138% of the federal poverty level and were thus eligible for the expanded Medicaid.

Traditional Medicaid sets maximum incomes for individuals and for families based on the number in a household. Before the program was expanded in North Carolina, many fell into the "gap" area where they were neither eligible for Medicaid or for health insurance through the ACA Marketplace program.

"It was two years of work in a very slow process," Stone said of getting those eligible for the expanded Medicaid program enrolled. "I think of that and of how long it will take to reassess all these people."

Stone fears that if the expanded Medicaid program goes away, there will be a large group of people who won't qualify for either Medicaid or the marketplace program, meaning people will go back to not having preventive care and will end up getting care only in emergencies at the hospital.

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