Nearly one million North Carolinians who rely on Affordable Care Act (ACA) health plans are bracing for a costly one-two punch next year: major premium hikes and the loss of federal subsidies that have kept coverage affordable, according to WRAL.
Federal subsidies, which were expanded in recent years to lower monthly costs for many, are set to expire in December after the Republican-majority Congress declined to extend them. At the same time, insurers are proposing sharp rate increases for 2026, citing rising medical costs and recent federal policy changes.
Rate hike requests vary by insurer:
- AmeriHealth Caritas: +36%
- UnitedHealthcare of NC: +32%
- Blue Cross NC: +29%
- Cigna: +27%
State Insurance Commissioner Mike Causey can review these proposals and deny them if they’re found to be unjustified, unreasonable, or discriminatory; however, rate-setting authority ultimately rests with federal regulators.
Rates for ACA plans vary depending on a number of factors such as age and location, but Commissioner Causey’s spokesman, Jason Tyson, told WRAL the average monthly premium for a healthy 21-year-old is $486. For an older adult, it’s anywhere from $800 to $1200 a month. Right now, the average ACA enrollee is saving $705 a year through the subsidies that are set to expire at the end of this year.
The financial impact will be substantial. The average ACA enrollee will see their monthly cost increase by $58 per month, and the new rate increase will be added on top of that.
For an average older adult who is paying $1000 a month for ACA coverage now, their monthly bill after the rates rise and the subsidies expire could be closer to $1400 a month. For a healthy 21-year-old, it could go from under $500 a month to over $700.
Experts warn the increases could trigger a “death spiral” in the market. Hollis Smith of the NC Navigator Consortium says younger, healthier people may drop coverage if it becomes too expensive, shrinking the risk pool and driving rates even higher.
“I think this is going to mean a lot of difficult decisions for individuals,” Smith said.
Open enrollment for 2026 ACA coverage begins in November.
Read more from WRAL.
