Two doors to coverage, sorted by income

If you live in Charlotte or anywhere in North Carolina and you are shopping for your own health insurance, you will keep running into two words: Medicaid and the Marketplace. They are not competing products you get to freely pick between. They are two separate systems, and which one you land in depends mostly on how much your household earns. Understanding the difference up front saves you from applying in the wrong place, missing money you qualify for, or buying a plan you did not need to pay for.

Here is the short version. NC Medicaid is government-run coverage that is free or nearly free for people with lower incomes. The Marketplace at HealthCare.gov sells private insurance plans, and if your income falls in a certain range the government helps pay your premium through a tax credit. The good news is you do not have to guess which one is for you: the same HealthCare.gov application checks both and points you to the right door.

What is NC Medicaid?

Medicaid is a joint federal-and-state program that provides health coverage to people with limited income. North Carolina expanded Medicaid on December 1, 2023, which was a major change. Before that, a lot of working adults in North Carolina earned too much to qualify for the old Medicaid but too little to realistically afford a Marketplace plan, and they simply went uninsured. Expansion closed that gap.

Today, NC Medicaid covers adults ages 19 to 64 with income up to 138% of the federal poverty level, and there is no asset test for this group, meaning your savings or your car do not disqualify you. In 2026 dollars, 138% of poverty works out to roughly $22,025 a year (about $1,835 a month) for one person and about $45,540 a year (about $3,795 a month) for a family of four. Those figures are derived from the official 2026 federal poverty guidelines, so treat them as close estimates and let the application confirm your exact eligibility.

Expansion has reached a lot of people. Approximately 732,000 North Carolinians were enrolled through Medicaid expansion as of state data cited in spring 2026. If you qualify, the trade is hard to beat: Medicaid coverage in North Carolina has no monthly premium and very low or no cost when you actually use care.

What NC Medicaid covers

  • Doctor visits, hospital care, and emergency services
  • Prescription drugs
  • Preventive care and screenings
  • Behavioral health and substance use services
  • Maternity and newborn care

Because it is comprehensive coverage that meets the standard for minimum essential coverage, NC Medicaid also satisfies any place you are asked whether you have health insurance. And unlike a Marketplace plan, there is no premium bill to keep up with each month, which removes one of the most common reasons people lose coverage: falling behind on a payment. For a household living close to the edge, that predictability is often the single biggest advantage Medicaid has over a private plan.

One more North Carolina note that matters for parents: NC Health Choice, the old separate children's program, no longer exists as its own thing. Those children moved into NC Medicaid effective April 1, 2023, which eliminated enrollment fees and copays and added benefits. Children's coverage at the former children's income levels, up to 211% of poverty, is now delivered through NC Medicaid. So a family can sometimes have the parents on a Marketplace plan while the kids qualify for NC Medicaid. If that sounds like your household, our page on health insurance for your family and kids walks through how that split actually works.

What is the Marketplace?

The Marketplace is the government-run shopping site for private health insurance created by the Affordable Care Act. North Carolina uses the federal Marketplace, so residents enroll through HealthCare.gov rather than a state-run exchange. You browse plans from private insurance companies, compare them, and buy one. For 2026, six insurers offer individual Marketplace plans somewhere in North Carolina, though which ones are available depends on your county and ZIP code.

The reason the Marketplace is worth using instead of buying a plan blindly off an insurer's website is the premium tax credit, a subsidy that lowers your monthly premium. It is only available through the Marketplace. If you qualify for a credit and buy directly from a carrier instead, you leave that money on the table. For a fuller walkthrough of the subsidy math, see how ACA subsidies work.

Who gets Marketplace subsidies

Premium tax credits are aimed at households earning between 100% and 400% of the federal poverty level. In a Medicaid-expansion state like North Carolina, Medicaid covers you up to 138% of poverty, so in practice the Marketplace subsidy range for most people starts where Medicaid leaves off, around 138%, and runs up to 400%.

That 400% ceiling matters in 2026. The subsidy cliff is back: households earning above 400% of poverty get zero premium tax credit, no matter how expensive the plan is. For one person, 400% of poverty is about $62,600; for a family of four it is about $128,600, based on the 2025 poverty guidelines that 2026 coverage uses. Cross that line by a dollar and the help disappears, so if your income is near the edge it is worth planning carefully.

How much you pay toward your premium is capped as a percentage of your income on a sliding scale. In 2026 that runs from about 2.10% of income at the lowest end up to a flat 9.96% at the top of the subsidy range. One honest change to know about: the enhanced subsidies that were in place for the last few years expired at the end of 2025, so 2026 premiums after subsidy are higher than many people had gotten used to. That is a real shift, and it is exactly the kind of thing worth having someone check for your specific numbers.

The big differences side by side

Cost

  • NC Medicaid: no monthly premium; very low or no cost at the point of care.
  • Marketplace: you pay a monthly premium (reduced by a tax credit if you qualify), plus deductibles, copays, and coinsurance when you use care.

Who qualifies

  • NC Medicaid: adults 19 to 64 up to 138% of poverty, with no asset test; children up to 211% of poverty; plus other groups such as pregnant women and people with disabilities.
  • Marketplace with subsidy: roughly 138% to 400% of poverty for most North Carolinians, based on income.

How you choose a plan

  • NC Medicaid: managed through the state; most beneficiaries pick an NC Medicaid managed care health plan.
  • Marketplace: you choose a private plan by metal tier (Bronze, Silver, Gold), comparing premiums, deductibles, networks, and drug coverage.

When you can enroll

  • NC Medicaid: you can apply any time of year — there is no limited enrollment window.
  • Marketplace: you generally must enroll during Open Enrollment or qualify for a Special Enrollment Period after a life event.

The Silver plan wrinkle if you are just above Medicaid

If your income lands just above the Medicaid line, in that 138% to 250% of poverty range, there is a Marketplace feature worth knowing about called cost-sharing reductions, or CSRs. These lower your deductible and copays, but only if you pick a Silver plan. CSRs are available to households from 100% to 250% of poverty and are richest below 200%. So for a lot of lower-income Marketplace shoppers in North Carolina, a Silver plan quietly delivers far better value than its sticker price suggests, because the out-of-pocket costs are knocked down. This is one of the most commonly missed savings in the whole system, and it is a good example of why the specific plan you pick matters as much as the premium.

It is worth being clear about the flip side too. On the Marketplace you will still owe out-of-pocket costs when you use care — a deductible before coverage kicks in, then copays or coinsurance — and those add up in a way they generally do not on NC Medicaid. That does not make the Marketplace a bad deal; for people over the Medicaid line it is usually the best coverage available, and the subsidy makes it workable. It just means the two systems feel different day to day. Medicaid is closer to all-inclusive; a Marketplace plan is private insurance that shares costs with you. Knowing which one you are in helps you budget for the year instead of being surprised at the pharmacy counter or the doctor's office.

A quick hypothetical to make it concrete

The following is a hypothetical example, not a quote or a guarantee.

Imagine a single person in Charlotte earning about $20,000 a year. That is under 138% of poverty, so they would most likely qualify for NC Medicaid — no premium, low costs, and they can apply any time. Now imagine that same person gets a raise to $35,000 a year. They have crossed above the Medicaid line, so Medicaid is off the table, but they now fall in the Marketplace subsidy range. They would shop on HealthCare.gov, likely receive a premium tax credit, and because their income is in CSR territory a Silver plan could sharply cut their deductible. Same person, two very different doors, decided almost entirely by that income change. This is why a mid-year income change is one of the top reasons to re-check your coverage.

How to apply for each

NC Medicaid

You can apply for NC Medicaid several ways:

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

To dig into eligibility details, see do I qualify for Medicaid in North Carolina?

Marketplace

Marketplace plans are enrolled through HealthCare.gov, and the HealthCare.gov application screens for both Medicaid and Marketplace subsidies, so you generally do not have to decide in advance which one you are eligible for — the application tells you. The simplest way to get it done right is to let The Jordan Insurance Agency handle the whole application with you, at no cost. We will compare your plan options, make sure the screening captures every credit you qualify for, and complete the enrollment on HealthCare.gov alongside you so nothing is missed.

A couple of North Carolina changes on the horizon

As of July 2026, two NC Medicaid changes are coming that expansion adults should have on their radar. First, work and community engagement requirements are scheduled to begin January 1, 2027 for expansion adults ages 19 to 64 — you would need to earn at least $580 a month or complete 80 hours a month of approved activities like work, job training, school, or volunteering, with several exemptions (for example, pregnancy and 12 months postpartum, parents or caregivers of children under 14, people with disabilities, and Medicare beneficiaries). Second, eligibility redeterminations for expansion adults move from once a year to every six months starting at the end of December 2026. Neither is in effect yet, but both are worth knowing so your Medicaid coverage does not lapse by surprise.

Which one is right for you?

You do not really pick — your income picks for you, and the rules decide. But there are gray areas: a family whose kids qualify for Medicaid while the parents use the Marketplace, an income that is bouncing around the 138% line, or a raise that is about to push you over the 400% cliff. Those are the situations where a second set of eyes pays off. If your money is tight overall, our guide on what to do if you cannot afford health insurance lays out every option in one place.

How The Jordan Insurance Agency helps

The Jordan Insurance Agency is an independent, full-time, licensed insurance agency based in Charlotte, North Carolina, serving clients across the state. Because we are independent, we are not tied to one insurance company — we can look at your household income and your family's situation and tell you honestly whether you are looking at NC Medicaid, a Marketplace plan, or a mix of both. We will help you find the right Marketplace plan, make sure you capture every premium tax credit and cost-sharing reduction you qualify for, and flag the Silver-plan detail and the 400% cliff before they cost you money.

Working with a licensed agent costs you nothing. Agents are paid by the insurance carriers, and your premium is exactly the same whether you enroll on your own or with our help. If it turns out NC Medicaid is your best route, we will point you straight to ePASS or the NC Medicaid Contact Center rather than sell you something you do not need. That is the whole idea: honest, plain-English guidance, no pressure. When you are ready, reach out to The Jordan Insurance Agency and we will sort out which door is yours.