Affordable Care Act premiums are about to soar in North Carolina

While Republicans in D.C. are blocking renewed Affordable Care Act subsidies, North Carolina is passing along steep rate hikes for health care coverage. It’s expected to push costs even higher.

As health care costs continue to climb, North Carolina has approved steep rate hikes for coverage under the Affordable Care Act, Mike Causey, the state’s insurance commissioner, announced Oct. 28.

The hikes to the underlying cost of Affordable Care Act coverage in North Carolina — which range from 16.88% to 36.4% — come as enhanced federal subsidies are also set to expire starting next year, pushing out-of-pockets costs even higher for enrollees.

“I ask people purchasing ACA health insurance to go to healthcare.gov and find which plan works best for you,” Causey said in a statement. “Increased costs in healthcare as well as the expiration of federal subsidies result in premiums going up for many on the individual market.”

The enhanced premium tax credits have been in place since 2021 and are at the center of the ongoing government shutdown, now in its fifth week. Democrats are vowing to withhold support for a funding bill unless it includes an extension of the subsidies.

About 1 million North Carolina residents purchase health coverage under the ACA, with most receiving tax credit.

Gov. Josh Stein speaks during a media briefing in Downtown Asheville on January 2, 2025. Stein signed five executive orders Jan. 2 to support the Helene recovery effort. (USA Today via Reuters)

Skyrocketing costs

Even before the announced rate hikes, cost of coverage through the Affordable Care Act was already expected to skyrocket in 2026.

With enhanced premium tax credits ending after this year, the average North Carolina enrollee is expected to pay $672 more annually for the same health insurance plan, according to a state estimate from September. Residents in rural parts of the state, like Western North Carolina, would likely see an even greater cost increase.

In a letter sent to federal lawmakers in September, Gov. Josh Stein warned that 157,000 North Carolina residents were at risk of losing coverage because they won’t be able to afford it.

“Loss of insurance would put family finances and health in peril; increase costs for everyone, including those who get private or commercial insurance from their employers; drive up medical debt; and leave hospitals and providers on the hook for more uncompensated care,” Stein wrote.

Mike McDonald, managing director of Pisgah Legal Services’ WNC health and economic opportunity program, told the Asheville Citizen Times on Nov. 3 that while much of the nonprofit’s attention has been on subsidies expiring, the rate increase, which he described as larger than normal, will also have a substantial effect on the region’s residents covered under the Affordable Care Act.

“The underlying rate kind of sets the benchmark for these plans,” McDonald said. “Any increase is going to impact folks, and a 30% increase would have had a pretty sizable impact anyway, even if we weren’t talking about a change to subsidies.”

@cardinalandpine

Stacy Staggs traveled from Mecklenburg County to Raleigh last month to ask NC Republicans to fully fund Medicaid so that her 11-year-old daughter Emma, who has severe disabilities and needs 24/7 care, would not be at risk of losing the home care that keeps her alive and with her family instead of at some far-away facility. Instead, lawmakers went home without passing a budget or Medicaid funding and won’t be back until next year. Follow for updates @cardinalandpine

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How much are rates rising?

Approved premium increases for Affordable Care Act plans in North Carolina:

Ambetter: 23.4%

AmeriHealth Caritas: 36.4%

Blue Cross & Blue Shield: 29.36%

CIGNA HealthCare: 27.49%

Oscar Health Plan: 16.88%

UnitedHealthcare: 32.27%

Open enrollment for ACA coverage runs from Nov. 1, 2025 to Jan. 15, 2026. To sign up, visit healthcare.gov. Pisgah Legal Services also provides free enrollment assistance. To learn more visit pisgahlegal.org/free-legal-assistance/healthcare.

Supporters hold signs during a press conference at Pack Square Park in Asheville on Oct. 14, 2025, where North Carolina Democrats called on Republicans to end the government shutdown and lower health care costs. (USA Today via Reuters)

Reporting by Jacob Biba, Asheville Citizen Times / Asheville Citizen Times