How do I get health insurance in North Carolina?

The short version: three main paths to coverage

If you live in Charlotte or anywhere else in North Carolina and you need health insurance, there are really only a few doors to walk through. Knowing which door is yours makes the whole process far less overwhelming. Most people fall into one of these three paths:

• A job-based plan from your employer (or a family member's employer), if one is offered to you.
• The ACA Marketplace at HealthCare.gov, where you buy your own individual plan and may qualify for financial help to lower the cost. North Carolina uses the federal Marketplace rather than running its own state exchange.
• NC Medicaid, which is free or very low-cost coverage for people and families with lower incomes.

This guide walks through each one in plain English, with the North Carolina specifics that matter, so you can figure out where you belong and what to do next.

Path 1: Check for job-based coverage first

If you or your spouse have a job that offers health insurance, that is usually the first place to look. Employer plans often come with the employer paying part of your monthly premium, which can make them a strong value. If you have a job-based offer, weigh it against a Marketplace plan before deciding — in some cases the Marketplace makes more sense, but an employer contribution is real money that individual plans do not come with.

If you do not have a job-based option, or you are self-employed, between jobs, retired before 65, or your employer's plan does not fit your budget, the Marketplace and Medicaid are where most North Carolinians turn.

Path 2: The ACA Marketplace at HealthCare.gov

The Marketplace (sometimes called "Obamacare" or ACA coverage) is the main way people in North Carolina buy their own Health Insurance when they do not get it through work. Every plan sold on the Marketplace has to cover a core set of benefits and cannot turn you down or charge you more for a pre-existing condition. For 2026, six insurers offer individual Marketplace plans across North Carolina, though the specific companies and plans available to you depend on your county and ZIP code. Blue Cross and Blue Shield of North Carolina is the one carrier that offers plans in all 100 NC counties, as it has since 2014.

Step 1 — Gather your information

Before you apply, it helps to have a few things handy for everyone in your household who needs coverage:

• Names, dates of birth, and Social Security numbers.
• An estimate of your household income for the coverage year (this determines any financial help you qualify for).
• Information about any current health coverage.
• Details on any job-based plan available to you, even if you are not taking it.

Step 2 — Apply and compare plans

There are several ways to apply for a Marketplace plan in North Carolina. You can:

• Enroll online at HealthCare.gov, which is the fastest do-it-yourself option.
• Have The Jordan Insurance Agency handle it with you, at no cost — we can compare your options, check your subsidy, and complete your Marketplace enrollment for you.
• Complete a paper application by mail, with eligibility results arriving within about two weeks.

When you apply, the system checks whether you qualify for savings and shows you the plans available in your area, sorted into metal levels (Bronze, Silver, Gold, and sometimes Platinum). These levels describe how you and the plan split costs — Bronze plans have lower monthly premiums but you pay more when you use care, while Gold plans cost more per month but less at the doctor. Silver plans sit in the middle and unlock extra savings for some lower-income households.

A quick word on choosing a metal level

People often assume the plan with the lowest monthly premium is automatically the best deal. It is not always. The right metal level depends on how you expect to use care and, importantly, on your income.

• Silver plans are frequently the best value for lower-income households, because people below roughly 250% of the poverty level can qualify for built-in cost-sharing reductions that quietly lower deductibles and copays — but only on Silver plans.
• Bronze or Gold plans can actually beat Silver on net price for households above that income range in 2026, which is one reason Silver's overall popularity dropped this year. If you rarely see a doctor, a Bronze plan's low premium may win; if you have ongoing prescriptions or expect regular care, a Gold plan's higher premium can pay for itself.

This is exactly the kind of trade-off where running the actual numbers for your household beats guessing — and where a second set of experienced eyes helps.

Step 3 — See if you qualify for financial help

A large share of Marketplace shoppers qualify for a premium tax credit — a subsidy that lowers your monthly premium based on your income and household size. For 2026, this help is generally available to households between 100% and 400% of the federal poverty level. To put that in perspective, 400% of the poverty level works out to about $62,600 for a single person and about $128,600 for a family of four (based on the 2025 poverty guidelines that 2026 coverage uses). Households above that level get no premium tax credit for 2026, so knowing where you fall matters.

It is worth being candid about the current landscape: the enhanced subsidies that were in place through 2025 expired at the end of that year, and as of July 2026 Congress has not passed an extension. Combined with insurers raising 2026 premiums by an estimated 26% on average nationally, many people are seeing higher costs than in prior years. That is exactly why comparing plans carefully — and getting help doing it — pays off more now than ever. To dig into how the credits work, see our guide on how ACA subsidies (premium tax credits) work.

Step 4 — Enroll and pay your first premium

Once you pick a plan, you enroll and your coverage does not actually begin until you pay your first month's premium. Do not skip this last step — an unpaid first premium means no active coverage, even after you have chosen a plan.

Path 3: NC Medicaid, if your income is lower

North Carolina expanded Medicaid on December 1, 2023, which opened up free or very low-cost coverage to many more adults. Adults ages 19 to 64 can now qualify with income up to 138% of the federal poverty level, and there is no asset test. In 2026 dollar terms, that threshold is roughly $22,025 a year (about $1,835 a month) for a single person and roughly $45,540 a year (about $3,795 a month) for a family of four — figures derived from the official poverty guidelines.

If your income lands in Medicaid range, you generally do not need a Marketplace plan at all. You can apply for NC Medicaid in a few ways:

• Online through ePASS at epass.nc.gov (recommended) or through HealthCare.gov.
• By phone through the NC Medicaid Contact Center at 1-888-245-0179 (TTY 711), or your local Department of Social Services.
• In person, by mail, fax, or drop-off at any local Department of Social Services office.

One nice feature of applying through HealthCare.gov is that a single application checks you for both Medicaid and Marketplace subsidies, so you do not have to guess which one you qualify for. If you want to understand the differences between the two, our guide on Medicaid vs. Marketplace insurance breaks it down.

Timing: when can you actually sign up?

You cannot buy Marketplace coverage on any random day of the year. There are windows.

Open Enrollment

Open Enrollment is the once-a-year window when anyone can sign up for or change a Marketplace plan. For 2026 coverage, that window ran from November 1, 2025 through January 15, 2026 on HealthCare.gov. Within that window, timing still matters: if you enrolled by December 15, your coverage started January 1, and if you enrolled between December 16 and January 15, your coverage started February 1. Open Enrollment for future years follows a similar rhythm each fall, so it is worth marking your calendar. For a fuller walkthrough, see when is health insurance Open Enrollment.

Special Enrollment Periods (life events)

Outside of Open Enrollment, you can still get coverage if you have a qualifying life event. This is called a Special Enrollment Period, and it generally gives you 60 days after the event to enroll. Common triggers include:

• Losing other coverage — such as losing a job-based plan (whether you quit, were laid off, or were let go).
• Household changes — getting married, having or adopting a baby, or a divorce that causes you to lose coverage.
• Moving — relocating to a new ZIP code or county, or moving to the U.S. from abroad.

Here is a common one for North Carolina workers, framed as a clearly hypothetical example: suppose you leave a job in Charlotte on March 7 and your employer health plan ends that day. Losing that coverage opens a Special Enrollment Period. If you pick a Marketplace plan by March 31, your new coverage starts April 1 — no gap. The key is not to wait; the 60-day clock is real, and missing it usually means waiting until the next Open Enrollment. You can read more in our guide on what a Special Enrollment Period is.

Medicaid is different in a helpful way: because it is not a Marketplace plan, you can apply for NC Medicaid at any time of year. There is no enrollment window to wait for.

A special note if you are close to 65

If you are approaching age 65, your path may run through Medicare rather than the Marketplace, and the timing rules are completely different. If that is your situation, or you are retiring early and need a bridge until Medicare begins, it is worth understanding how that program works before you make any Marketplace decisions. Our overview of what Medicare is and how it works is a good starting point. Getting the sequence right here can save you from costly late-enrollment penalties down the road.

What to watch out for

A few honest cautions as you shop:

• Be careful with plans that are not real Marketplace coverage. Short-term plans and "fixed indemnity" products are sometimes marketed as cheap health insurance, but they can exclude pre-existing conditions and leave out essential benefits like maternity or mental health care. They are not a substitute for comprehensive coverage.
• Do not assume you make too much to get help — many people are surprised to qualify for a premium tax credit. It costs nothing to check.
• Do not let the deadline pass. The single most common mistake is waiting until the enrollment window has closed.

How The Jordan Insurance Agency helps

The Jordan Insurance Agency is an independent, licensed insurance agency based in Charlotte, North Carolina, serving clients across the state. Because we are independent, we represent multiple carriers rather than just one — so we can compare the Marketplace plans available in your county side by side, check whether you qualify for a premium tax credit or NC Medicaid, and explain the honest trade-offs for your household instead of steering you toward a single company's products.

Here is the part people are often surprised by: our help costs you nothing. Licensed agents are paid by the insurance carriers, and your premium is exactly the same whether you enroll on your own at HealthCare.gov or let us walk you through it. You get a real person who knows the North Carolina market, keeps up with each year's plan and rule changes, and can help you avoid gaps in coverage and missed deadlines. For any current-year figure or plan detail not shown here, The Jordan Insurance Agency can confirm it for you at no cost. When you are ready, reach out to The Jordan Insurance Agency and we will help you find the right coverage, one step at a time.