NC’s 1 million ACA enrollees set to see higher health care costs in 2026
Providers are raising premiums by an average of 28.6% in North Carolina, and the tax credits that significantly lower costs for many enrollees are set to expire at the end of 2025 unless Congress decides to extend them. (Photo by Jan Sonnenmair/Getty Images)
NC’s 1 million ACA enrollees set to see higher health care costs in 2026
by Galen Bacharier, NC Newsline
October 31, 2025
North Carolinians who plan to buy health insurance through the Affordable Care Act’s marketplace are set to see significant cost hikes as the open enrollment period begins Nov. 1.
That increase could soon be twofold. Providers are raising premiums by an average of 28.6% in North Carolina, and the tax credits that significantly lower costs for many enrollees are set to expire at the end of 2025 unless Congress decides to extend them.
Almost 1 million North Carolinians are enrolled in the ACA, which provides federally-approved private health care plans to those without employer-sponsored insurance.
Around one-third (34%) of uninsured North Carolinians are eligible for Medicaid or public coverage, according to Kaiser Family Foundation data. And more than a quarter (28%) are eligible for tax credits, which are set to expire at the end of the year.
Individual rates in North Carolina will increase between 16.88% and 36.4% in 2026, Insurance Commissioner Mike Causey said in a statement Wednesday. Small group rates will increase between 12.66% and 17.5%.
Those hikes exceed national trends: the average proposed premium increase is 20%, according to the Peterson-KFF Health System Tracker. That’s the highest rate change requested by providers since 2018, fueled by higher costs of labor, drugs and the uncertain future of tax credits.
“Increased costs in health care as well as the expiration of federal subsidies result in premiums going up for many on the individual market,” Causey said. “It’s more important than ever to begin researching your health insurance options early.”
A spokesperson for the NC Department of Insurance did not respond to inquiries about whether the department was seeing an increase in calls or concerns about rates ahead of open enrollment.
How politics have put ACA tax credits in peril
Providers have raised 2026 rates in part because of the looming expiration of enhanced premium tax credits. Those tax credits,established in 2021, were later extended through the end of this year. They have led to a massive expansion of the ACA marketplace, and drive down costs for many enrollees.
Earlier this year, Congressional Republicans voted to allow the tax credits to sunset on schedule, d saying they’re too costly to extend.
Congressional Democrats, who are in the minority in both chambers, are using the budget continuation bill as leverage to convince Republican lawmakers to change their minds. In the Senate, Democrats are using parliamentary rules to block the passage of the spending bill unless it contains a provision to extend the ACA credits again.
So far, Republicans have refused to negotiate that issue. That’s what caused the current federal government shutdown standoff that has now dragged on for a month.
The standoff has fueled political battles around the country, including in North Carolina.
In a news conference Thursday, state Sen. Gale Adcock (D-Wake) said the majority party was “shutting down the government instead of fixing the health care crisis they created.”
Republican House Speaker Mike Johnson has called the tax credits “subsidizing bad policy.” He said GOP lawmakers “believe in the private sector and the free market and individual providers.”
Open enrollment for the Affordable Care Act opens Saturday, Nov. 1 and runs through Jan. 15, 2026. If you sign up by Dec. 15, your coverage will begin on Jan. 1.
NC Newsline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. NC Newsline maintains editorial independence. Contact Editor Laura Leslie for questions: info@ncnewsline.com.
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