Premium hike sticker shock awaits federal health insurance marketplace enrollees

The statewide monthly premium increase for the 2026 federal health insurance marketplace will be in a range of 16.9% to 36.4%, the N.C. Insurance Department confirmed Wednesday.

The increase is a direct result of the Trump administration letting tax credit subsidies expires on Dec. 31.

However, consumer advocacy groups warn premium hikes could soar up to 247% depending on several enrollments factors that include: the county where the applicant lives; household income; number of people covered; age of participants 19 to 64; and the subsidy level of their 2025 plan. By comparison, premium increases were in the 4% to 7% range in previous enrollment periods.

Open enrollment starts Saturday and runs until Jan. 15 at www.HealthCare.gov. Policy holders must sign up by Dec. 15 to ensure that coverage begin Jan. 1. Coverage for those signing up after Dec. 15 will begin Feb. 1.

The N.C. Budget & Tax Center estimates as many as 36,000 North Carolinians could drop out of the marketplace because their 2025 plan will become unaffordable in 2026.

Meanwhile, the governor's office said that "without congressional action to extend the Affordable Care Act subsidies, 157,000 North Carolinians will become uninsured and another 888,000 will see their health care premiums double."

The governor's office said the average marketplace enrollee in North Carolina is expected to pay $672 more in 2026 for the same health insurance they had in 2025.

How we got here

The marketplace is a high-profile component of the federal Affordable Care Act, also known as "Obamacare."

The primary reason behind the sticker shock: the Trump administration and Republican-controlled Congress approved the expiration of federal marketplace tax credits on Dec. 31 as part of the passage of the "One Big Beautiful Bill" in July.

The insistence by U.S. Senate Democrats that the marketplace federal tax credits continue for 2026 is a pivotal issue in the federal government shutdown that began Oct. 1.

"Saturday marks a critical inflection point where the real-world impacts of Washington gridlock will start hitting home for families across the state," the N.C. Budget & Tax Center said.

"It will mark the beginning of a health care affordability crisis in North Carolina.

"Without congressional action, premiums could skyrocket, and tens of thousands in North Carolina risk losing coverage altogether."

Premium hikes by insurer

North Carolina had 975,110 marketplace enrollees for 2025, compared with 1.03 million in 2024.

Nearly 200,000 Triad and northwest N.C. residents participated in the 2025 marketplace.

Although there are six insurers providing 2026 marketplace coverage to North Carolinians on HealthCare.gov, Blue Cross Blue Shield of N.C. has by far the largest market share and is the only providers for all 100 counties. Its 2026 premium rate is increasing by 29.4% on average.

AmeriHealth Caritas N.C. Inc. has the highest average premium hike at 36.4%. The others are: UnitedHealthcare of N.C. Inc. at 32.4%; Cigna Healthcare of N.C. Inc. at 27.5%; Ambetter of N.C. Inc. at 23.4%; and Oscar Health Plan of N.C. Inc. at 26.9%.

Oscar is entering N.C. through 12 counties that include Davidson, Davie, Forsyth, Wilkes and Yadkin in the Triad and northwest N.C. Oscar's network in these areas is centered around Atrium Health and Atrium Health Wake Forest Baptist physicians, hospitals and clinics.

"Increased costs in healthcare, as well as the expiration of federal subsidies, result in premiums going up for many on the individual market," N.C. Insurance Commissioner Mike Causey said in a news release.

"It's more important than ever to begin researching your health insurance options early."

Causey said alternatives to paying the higher premium cost include: going back to employer-based coverage; coverage through your spouse's employer; a private health insurer; a student health plan for those under age 30; and if you are younger than age 26, through your parents' employer.

The state Insurance Department is providing assistance at 855-408-1212 weekdays from 8 a.m. to 5 p.m.

There's a Health Insurance Shopping Tool offered by the National Association of Insurance Commissioners at https://content.naic.org/sites/default/files/legacy/documents/health_insurance_shopping_tool.pdf.

Another resource is the N.C. Navigator Consortium, although the Trump administration cut 2026 funding to its national group by 90%.

Sticker shock

For most marketplace participants and potential applicants, Wednesday's unveiling was their first look at premium rates.

The federal Centers for Medicare and Medicaid Services made it voluntary for insurers to disclose the rates earlier, which most did not.

"Many consumers in the federally run marketplaces will not learn about premium increases unless and until they log into their HealthCare.gov accounts," said Sabrina Corlette, a research professor in the Center on Health Insurance Reforms in Georgetown University's McCourt School of Public Policy.

"A lot of marketplace people just automatically renew, figuring if they like what they have, and they like their primary care physician, they'll probably just won't do anything.

"They may not learn about the premium change until they receive their first bill from their health plan in December or January."

Corlette said another potential obstacle to renewing or applying for 2026 marketplace coverage is additional documentation proving their household income eligibility for the marketplace, and to get a premium tax credit.

"My advice to people is be prepared that the application process is going to be a little more burdensome," she said.

Kaiser Family Foundation has a website — https://www.kff.org/interactive/how-much-more-would-people-pay-in-premiums-if-the-acas-enhanced-subsidies-expired/ — that helps potential marketplace participants estimate their 2026 premium.

"If enhanced tax credits expire, many marketplace enrollees will continue to qualify for a smaller tax credit, while others will lose eligibility altogether and be hit by a 'double whammy' of losing their entire tax credit and being on the hook for rising premiums," KFF reported.

KFF cited as a national example a household with a $55,000 income paid 7.3% if their annual income, or $4,010, in 2025. They are projected to pay 10% in 2026, or $5,478.

Other changes prompted by the federal bill include: DACA recipients are no longer be eligible for healthcare.gov coverage; the low-income special enrollment period will no longer be available; and the open enrollment period for 2027 will be shorter.

DACA is the acronym for the federal Deferred Action for Childhood Arrivals Act. The act prevents eligible immigrants who came to the United States when they were children from being deported and provides them with a work permit.

The Trump administration is prohibiting beginning in 2026 health marketplace insurers from covering the treatment of gender dysphoria for transgender individuals as an "essential health benefit" coverage.

Ramifications now and later

Consumer advocates and economists are expressing concern that the premium hikes will make marketplace coverage unaffordable, resulting in people neglecting their health or seek it in hospital emergency departments.

"This shutdown — and the uncertainty it creates — is not abstract," said Alexandra Sirota, executive director of the N.C. Budget & Tax Center. "It's about whether people can keep seeing their doctors, afford their prescriptions, and ensure their kids are covered."

Corlette said that "when you talk about people being priced out of their ability to get health insurance, there's ramifications now and years down the road from that."

"I think millions of people will probably decide that they can no longer afford to health insurance and they'll just roll the dice.

"Unfortunately, with health care, none of us know if we're going to get a bad diagnosis or get injured," Corlette said. "If that happens, the financial consequences can be devastating."

Corlette said in a center-right state as North Carolina, there could be more Republican than Democratic supporters dropping their marketplace coverage due to the premium hikes.

"If you look at the people who seek out marketplace insurance coverage, they tend to be small business owners, self-employed truck drivers, entrepreneurs, part-time workers, farmers, people hustling by on two to three jobs," Corlette said.

"This is not like a liberal versus conservative issue, so why this has become such a political fight?

"It's more, I think, a reflection of the polarization in our system."