Significant Decline in ACA Enrollments in North Carolina for 2026

Preliminary data from the Centers for Medicare & Medicaid Services (CMS) reveals a significant decline in Affordable Care Act (ACA) enrollments across most North Carolina counties for 2026. This trend coincides with the expiration of federal premium subsidies introduced during the COVID-19 pandemic, identified as a primary factor contributing to the enrollment decrease.

North Carolina saw the sharpest drop nationwide, with approximately 214,000 fewer enrollments compared to the previous year, marking a 22% decrease. Meanwhile, only two counties in the state's western region reported an increase in ACA enrollments. In 2025, over 975,000 residents, representing around 9% of the state's population, participated in ACA plans. However, the 2026 data indicates a national enrollment decline from over 24 million to under 23 million.

Further reports reveal that some enrollees were removed from plans due to non-payment of the initial premium, as highlighted by internal CMS documents. Additionally, insured individuals faced higher costs, choosing either to pay more for existing coverage or opt for cheaper alternatives with higher deductibles. Preliminary data also shows some counties experiencing up to a 30% increase in out-of-pocket costs, impacting care affordability.

As a response, uninsured individuals might explore private pay options, short-term policies with limited coverage, or services from community health centers and local health departments. Professional associations offer additional options; for instance, NC Realtor and the NC Dental Society provide specific health plans for members, aiming to improve access to affordable insurance coverage.