Increases to Affordable Care Act premiums were approved by North Carolina state officials. They apply to premiums before subsidies, which are at the center of the federal shutdown stalemate.
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Amid sweeping changes in health care — from Medicaid cuts and coverage shifts to rising premiums for state employees — many North Carolinians will face another major cost increase.
Many of the more than 1 million people in the state who buy coverage through the Affordable Care Act marketplace, including farmers, small-business owners and others without employer-sponsored insurance, will see significant premium hikes next year.
Nationally, about 24 million people are enrolled in ACA marketplace plans. The plans are sold by private insurers but must meet federal standards.
Small employers who hire fewer than 50 workers can also purchase ACA-compliant plans, though those are not sold through the marketplace. Those plans are also seeing significant hikes.
The state’s Department of Insurance, which does not set rates but does review and approve them, has signed off on the final 2026 rates for individual and small-group ACA-compliant plans.
These increases apply to premiums before subsidies.
Approved changes in rates range from 12.66% to 36.40%.
A political fight over enhanced federal subsidies — which help lower costs for many marketplace customers — remains unresolved. Democrats want to extend those enhanced subsidies as part of a federal funding bill. Republicans have pushed for a “clean” spending bill without the extensions. The federal government has been shut down since Oct. 1.
The nonprofit KFF estimates premiums could rise by an average of 114% for many people if enhanced subsidies expire, though the exact impact would depend on factors like age, income and location.
Meanwhile, insurers requested the steepest increases since 2018 for next year.
Insurers across the nation cite various reasons for the higher premiums, including, according to the Peterson-KFF Health System Tracker, the potential expiration of the enhanced premium tax credits — which could push healthier people out of the market and raise costs — and concerns that tariffs could increase prices for drugs, equipment and medical supplies.
“All of that is combining together to make it to where there could be some real sticker shock when people get their notifications from the marketplace,” Louise Norris, a health policy analyst for HealthInsurance.org, previously told The News & Observer.
Some people “will drop their coverage altogether because it’s no longer affordable,” she added.
Approved average 2026 rate changes
Individual market
- Ambetter of North Carolina, Inc.: 23.40%
- AmeriHealth Caritas North Carolina, Inc.: 36.40%
- Blue Cross & Blue Shield of North Carolina: 29.36%
- Cigna Healthcare of North Carolina, Inc.: 27.49%
- Oscar Health Plan of North Carolina, Inc.: 16.88%
- UnitedHealthcare of North Carolina, Inc.: 32.27%
Small-group market
- Blue Cross & Blue Shield of North Carolina: 17.50%
- UnitedHealthcare Insurance Company: 12.66%
- UnitedHealthcare of North Carolina, Inc.: 14.98%
Open enrollment for 2026 starts this Saturday, Nov. 1 and runs through Jan. 15.
What is the state’s role?
North Carolina Insurance Commissioner Mike Causey, a Republican in his third term, said in a news release in July that his agency was “carefully reviewing the requested rates to ensure that they are supported and meet all statutory requirements.”
North Carolina Commissioner of Insurance Mike Causey listens during the Council of State meeting in Raleigh, N.C., Tuesday, Jan. 9, 2024. Ethan Hyman [email protected]
According to an N.C. Department of Insurance document posted online, insurers must submit rate filings for review before any changes take effect. The department’s Life and Health Division — along with its actuaries — examines each filing to make sure it meets legal requirements and that proposed increases are justified and adequate to cover claims. After the review, DOI can approve or reject a rate request.
On Wednesday, Causey said in a release: “Increased costs in healthcare as well as the expiration of federal subsidies result in premiums going up for many on the individual market. It’s more important than ever to begin researching your health insurance options early.”
DOI spokesman Barry Smith said in an email to The N&O that the department made follow-up inquiries after the initial requests were filed, including asking for actuarial verification.
He said in addition to enhanced subsidies expiring, rates are also impacted by increases in health care claims cost, such as prices charged by hospitals and doctors, along with prescription drug costs. Other factors include insurance network changes, greater use of health care services and more expensive care, he said.
He said that if more subsidies become available, companies may apply to change their rates and premiums.
This story was originally published October 29, 2025 at 1:22 PM.
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Luciana Perez Uribe Guinassi
The News & Observer
Luciana Perez Uribe Guinassi is a politics reporter for the News & Observer. She reports on health care, including mental health and Medicaid expansion, hurricane recovery efforts and lobbying. Luciana previously worked as a Roy W. Howard Fellow at Searchlight New Mexico, an investigative news organization.
