If you live in North Carolina and shop for health insurance through the ACA Marketplace, it’s important to know your options—and what’s changing heading into 2026.
Which ones are exiting or entering
Proposed premium changes and policy shifts for 2026
Tips for picking a plan in this evolving landscape
Who’s Insuring North Carolina on the Marketplace Now
In 2025, nine insurers offer individual/family plans through North Carolina’s Marketplace (HealthCare.gov) to residents who don’t have employer plans, Medicare, or Medicaid.
Here are some of the key players:
Ambetter of North Carolina One of the more prominent insurers in NC’s marketplace.
Blue Cross and Blue Shield of NC (BCBS NC) A long-standing, well known insurer in the state.
AmeriHealth Caritas North Carolina Marketed as part of the individual health insurance offerings in NC.
CareSource North Carolina Also listed among insurers in the NC marketplace.
CIGNA HealthCare of North Carolina Another insurer offering policies in NC’s exchange.
Oscar Health Plan of North Carolina Market presence in NC’s ACA offerings.
UnitedHealthcare of North Carolina Included among NC’s marketplace insurers.
Celtic / WellCare of NC Underwrites some plans (e.g. “WellCare of North Carolina” is underwritten by Celtic) and participates in marketplace plans.
What’s Changing for 2026
Insurers Exiting / Exiting the State Market
Aetna Health, Inc. is withdrawing from NC’s individual market.
Celtic / WellCare (Celtic Insurance) is also exiting the NC individual market.
That means fewer options in some counties and more pressure on remaining insurers to absorb those enrollees.
Insurers Remaining / Entering in 2026
The following seven insurers are expected to continue offering Marketplace plans in NC for 2026:
Ambetter / Centene
AmeriHealth Caritas
Blue Cross & Blue Shield of NC
Blue Cross NC
CareSource
Cigna
Oscar
UnitedHealthcare
Proposed Premium Increases & Rate Trends
Insurers have requested steep increases going into 2026, due in part to the expiration of enhanced premium tax credits and rising health care costs.
Some of the requested increase percentages:
Ambetter/Centene: ~25.6%
AmeriHealth Caritas: ~36.4%
Blue Cross & Blue Shield NC: ~29.4%
CareSource: ~13.9%
Cigna: ~27.5%
Oscar: ~6.9%
UnitedHealthcare: ~32.3%
These are proposed rates (not final) and are before applying subsidies. The actual premiums you pay (after tax credits) may be different.
Nationally, proposed increases for ACA Marketplace plans average ~18–20% for 2026.
Health System Tracker
What These Changes Mean for You (NC Consumer)
Fewer insurer choices in some areas: With Aetna and Celtic/WellCare exiting, your available options may shrink depending on your county.
Higher sticker prices before subsidies: The proposed rate hikes are steep, especially with the likely rollback of enhanced federal subsidies after 2025.
Subsidy importance increases: With the potential scaling back of subsidy enhancements, being eligible for premium tax credits or cost-sharing reductions will matter more than ever.
Network shifts & plan redesigns: Insurers may restructure provider networks, formularies, and benefit tiers to offset costs.
Stricter enrollment verification rules: Some policy changes will tighten documentation and eligibility verification.
Tips for Choosing a Marketplace Plan in 2026
Start early during Open Enrollment (Nov 1 – Jan 15)
Enter accurate income & household data to estimate subsidies
Compare not just premiums but total costs (deductible + copays + out-of-pocket max)
Check provider networks to ensure your preferred doctors/hospitals are in network
Review prescription drug coverage (formularies, tiers, restrictions)
Monitor insurer exits in your county — your plan might no longer be offered
Conclusion
North Carolina’s ACA Marketplace is entering a more turbulent period in 2026. While some insurers are leaving the market, several major players remain. The proposed premium hikes—combined with subsidy changes—could make health insurance more expensive for many. That said, if you approach open enrollment prepared, understand your subsidy eligibility, and carefully compare your options, you can still find a plan that fits your health needs and budget.