Health insurance in North Carolina, 2027
About 740,000 North Carolinians have Medicaid through the state’s expansion. In 2027 that coverage comes with work rules and six-month renewals.
Last checked October 16, 2026 · Written by licensed advisors · Sources are numbered and listed under Notes and sources
Two programs, one line between them
North Carolina shops on HealthCare.gov, where 761,457 people picked a plan for 2026. About 740,000 more have Medicaid through the state’s expansion. Which one fits you depends mostly on one number: 138% of the poverty level.12
- Marketplace
- HealthCare.gov
- 2026 plan selections
- 761,457
- Medicaid expansion
- About 740,000 people (Sep 2026)
Which side of 138% are you on?
Adults with income under 138% of the poverty level, $22,025 for one person, can qualify for NC Medicaid. Over that line, Marketplace plans with a tax credit take over, up to 4 times the poverty level, $63,840 for one person.3
The dates for 2027
Open enrollment for 2027 coverage runs from November 1, 2026 to January 15, 2027. Choose a plan by December 15 for coverage that starts January 1, 2027.4
- November 1, 2026Open enrollment for 2027 starts (key step)
- December 15Last day to choose a plan that starts January 1 (key step)
- January 15, 2027Open enrollment ends
- February 1, 2027Coverage starts for plans chosen December 16 to January 15
Heads up: Choose a plan after December 15 and it starts February 1, not January 1. If nothing else covers you in January, that is a month without coverage.
Expansion Medicaid in 2027: work rules and six-month renewals
Who it affects: NC Medicaid expansion adults aged 19 to 64 without a disability.
From January 1, 2027, these adults need to show 80 hours a month of work, school, job training or volunteering, or $580 a month in household earnings, unless an exemption applies, such as caring for a child under 14, a disability or pregnancy.
Most adults aged 19 to 64 will also renew every six months instead of once a year. If the county needs more information, DSS mails a letter.526
- 80 hours a month of work
- School or job training
- Volunteering
- $580 a month in household earnings
- Or an exemption
What to do: Open every letter from your county DSS. NCDHHS publishes its Know What’s Next toolkit for members.
Children and families
Children in North Carolina qualify for Medicaid at higher incomes than their parents: up to about $59,000 a year for a family of three, against about $37,700 for the adults.37
Help from a licensed agency
Our agency is licensed in North Carolina, and we work with North Carolinians by phone and video, from our Chicago office. We compare the plans in your county and show you what to keep in mind on each one, at no cost to you.8
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Obamacare Hotline and/or Medicare Po Polsku are private companies not affiliated with any local, state, or federal government agency. This guide is general information, not tax or legal advice.