ACA Cost Increases in North Carolina: What to Expect by 2026
Upcoming Changes to ACA-Related Costs in North Carolina by 2026
The cost of acquiring health insurance through the Affordable Care Act (ACA) marketplace in North Carolina is anticipated to rise significantly by 2026. This increase results from approved rate hikes and the planned expiration of enhanced premium tax credits. Industry professionals should prepare for these changes and their implications on payer and provider engagements.
Context of the Affordable Care Act
Established in 2010, the ACA was designed to expand healthcare coverage across the United States. Integral features of the act include tax credits to lower out-of-pocket costs and provisions protecting individuals with pre-existing conditions from premium hikes or coverage denial. Despite various legislative and legal challenges, including repeal attempts, the ACA has endured, covering over 24 million individuals nationwide, with nearly one million beneficiaries in North Carolina.
Factors Contributing to Increased Costs
Several factors will drive up ACA coverage costs in North Carolina. Primarily, the North Carolina Department of Insurance has approved an average rate increase of nearly 30% for ACA plans on the federal marketplace. State officials attribute this decision to escalating healthcare costs and legislative actions such as the One Big Beautiful Bill Act, impacting regulatory compliance.
Moreover, the expiration of temporary tax credits, introduced during the pandemic, will further contribute to cost increases. These credits, set to expire at the end of the year, currently allow individuals earning over 400% of the federal poverty level to access financial aid. In 2025, around 900,000 North Carolina residents benefited from an average subsidy of $574 monthly. Congressional discussions about extending these credits are ongoing, and their potential lapse could affect ACA plan affordability significantly.
Financial Impact and Coverage Concerns
Without extending the enhanced tax credits, ACA enrollees in North Carolina will face substantial out-of-pocket expenses. An estimated 157,000 residents might find ACA coverage unaffordable under these new conditions. Additionally, starting in 2026, Deferred Action for Childhood Arrivals (DACA) recipients will lose eligibility for ACA coverage and tax benefits due to legislative changes, posing further compliance challenges.
Enrollment Information
ACA enrollment for North Carolina will occur from November 1, 2025, to January 15, 2026, through the federal marketplace at healthcare.gov. Coverage selected by December 15, 2025, will commence on January 1, 2026, while enrollment after this date will cover from February 1, 2026. A robust network of insurance navigators is ready to aid enrollees through platforms like ncnavigator.org.
Understanding these changes is crucial for industry experts advising clients on health insurance options and risk management. Proactive strategies should be implemented to address the financial and regulatory impacts of the forthcoming ACA cost adjustments.