Health coverage in North Carolina

North Carolina is the one state we work in that expanded Medicaid. That single decision changes who the Marketplace is for here, so this page starts with it.

Did North Carolina expand Medicaid?

Yes. North Carolina expanded Medicaid in December 2023.

Adults with a household income below 138% of the federal poverty level now generally get coverage through NC Medicaid rather than through the Marketplace.

Is there a coverage gap in North Carolina?

No. North Carolina has no coverage gap.

In some states there is a band of income that is too high for that state's Medicaid and too low for help with a Marketplace premium, which starts at 100% of the poverty level. Expansion closed that band here, so there is nobody sitting between the two.

What about the 100% to 138% band?

In North Carolina that band is Medicaid, not the Marketplace.

In the six other states we work in, the same band sits on the Marketplace and carries the largest help with the premium there is, plus cost-sharing reductions that lower what you pay when you use the plan. North Carolina does not have that band at all, because those households are on NC Medicaid instead. Above 138% of the poverty level the Marketplace works here the same way it works anywhere else.

How many people used the Marketplace in North Carolina?

CMS counted 195,836 new Marketplace consumers in North Carolina for 2026.

Can this page tell me where I land?

No, and it should not try. Where you land depends on your household size, your exact income and a few other details.

If your income is low, it is worth applying through NC Medicaid directly — that is usually the better deal, with little or no premium. If it is above that line, a licensed agent can go through Marketplace plans with you. Both are worth checking.