What to do about health insurance premium increases in North Carolina

What's going on:

If you buy your health insurance through Healthcare.gov:

With federal enhanced premium tax credits scheduled to expire at the end of

2025, the Affordable Care Act (ACA) premium rates are expected to increase on

average 102% in North Carolina. Many will pay significantly more

depending on their family size, age, income, and residence.

By reviewing your premium tax credit eligibility and comparing all available plan

options, you can plan for these increases.

I. REVIEW YOUR PREMIUM TAX CREDIT ELIGIBILITY

Eligibility for premium tax credits will revert to pre-2021 values, which will

increase rates significantly for many current enrollees. Understanding your new

financial assistance levels is the most crucial step. 

• Use a Quick and Easy ACA subsidy calculator. Log in to Healthcare.gov or

use https://www.kff.org/interactive/subsidy-calculator/

• Assess your household income. If you are self-employed or your income

varies, estimate your subsidy under different income scenarios. What’s

included as income | HealthCare.gov

II. COMPARE PLAN OPTIONS DURING OPEN ENROLLMENT

Instead of automatically renewing your current plan, shop for coverage during the open enrollment period, which runs from November 1 2025 to January 15, 2026. 

• Evaluate more than just the premium. Look closely at the deductible, copay structure, and out-of-pocket maximums. A plan with a slightly higher deductible and lower premium may be a better value.

• Consider High-Deductible Health Plans. For generally healthy individuals, such plans can offer lower premiums while protecting against major medical events.

• Compare provider networks. Confirm that your doctors and hospitals are still in-network to avoid unexpected, higher costs. 

Consider a Health Savings Account (HSA).  If you choose a high deductible plan, you may be eligible to open a Health Savings Account. These accounts may be a useful, tax-advantaged tool to help with future healthcare costs. 

III. RE-EVALUATE YOUR BUDGET

Anticipate higher costs now and make adjustments to your budget to prepare you for open enrollment starting November 1.

IV. GET PROFESSIONAL ASSISTANCE

Navigating these changes can be complicated, and expert help is often available for free.  A free, reliable non-profit source in our state is the NC NAVIGATOR CONSORTIUM at https://ncnavigator.org/ or 1-855-733-3711.

You also may visit localhelp.healthcare.gov to find licensed insurance agents and ACA navigators who can help you understand your options.