North Carolina Health Insurance Cost Calculator
North Carolina's 2026 benchmark health plan: $661/mo, $546-$845 across 16 rating areas. See what you pay monthly after the ACA premium tax credit at your income.
Health insurance in North Carolina costs $661/mo in 2026 before any subsidy — the second-lowest-cost Silver "benchmark" premium for one 40-year-old, non-tobacco, individual on-exchange enrollee, or $7,932 a year. County matters: rating-area benchmarks run $546-$845/month across North Carolina's 16 rating areas, so the state figure is an average, not a quote. After the premium tax credit, a single filer earning $31,300 (200% of the 2025 federal poverty line) pays about $172/mo for that same benchmark plan.
Enter Your Details
Adjust values to see instant results
Pre-filled: Census Bureau
Pre-filled: CMS PY2026 Rate + Plan Attributes PUFs (age-40 SLCSP; unweighted rating-area mean)
Additional Details
Annual Premium Cost
Estimated • Based on your inputs
Net Annual Premium (After Subsidy)
$7,932.00
Total Annual Healthcare Cost
$11,332.00
Detailed Breakdown
Disclaimer: This calculator provides estimates for informational purposes only. Results should not be considered financial, tax, or legal advice. Consult a qualified professional for your specific situation.
How This Calculator Works
Calculation methodology and assumptions
Health insurance cost estimation for North Carolina. The $661/month default is the plan-year 2026 second-lowest-cost Silver benchmark for a 40-year-old, non-tobacco, individual on-exchange enrollee. The CMS-derived state figure is an unweighted mean across 16 rating areas; the published-benchmark range is $546-$845/month. Enrollment weights are not present in the PUFs. It is a benchmark for one age-40 person, not a family premium or a quote for every age, county, or plan. The age input was removed because federal law allows state-specific age curves and a single federal curve would not be valid nationwide. The premium-tax-credit estimate uses the official 2025 HHS Poverty Guidelines (90 FR 5917, the year used for 2026 coverage eligibility) and IRS Revenue Procedure 2025-25's 2026 applicable-percentage table (2.1%-9.96% of income). It assumes the household is otherwise eligible; it does not test immigration/tax-filing rules, Medicaid/CHIP eligibility, or access to affordable employer coverage. Income above 400% FPL receives no federal premium tax credit for 2026 because the temporary 2021-2025 enhanced-subsidy rules expired. Out-of-pocket costs include deductible plus coinsurance on medical expenses, capped at the 2026 federal maximum ($10,600 individual / $21,200 family). Actual premiums vary by age, plan tier, insurer, county, tobacco use, and covered family members. Replace the editable premium with your own SLCSP before relying on the subsidy estimate. Recheck the benchmark sources by 2026-11-15.
Key State Information
North Carolina health insurance context: 2026 age-40 Silver benchmark $661/mo (CMS rating-area range $546-$845) | Median income $73,958 | HSA contributions may receive a state tax benefit subject to state rules.
Example Calculation
Let's estimate 2026 health-insurance costs for one 40-year-old in North Carolina.
The editable second-lowest-cost Silver benchmark is $661/month. With $50,000 household income, a $3,000 deductible, 20% coinsurance, and $5,000 of expected medical costs, the calculator applies the 2026 premium-tax-credit formula and out-of-pocket estimate.
Result: Estimated annual premium before credit: $7,932; estimated premium tax credit: $2,952; estimated total annual premium plus out-of-pocket cost: $8,380. This is planning math, not a quote — replace the benchmark with the exact SLCSP for your age, county, and household.
How much is health insurance in North Carolina per month in 2026?
$661/mo. That is the plan-year 2026 second-lowest-cost Silver ("benchmark") premium for one 40-year-old, non-tobacco, individual on-exchange enrollee in North Carolina — $7,932 a year at full price, before any premium tax credit. The benchmark plan matters beyond its own price tag: federal law sets your subsidy from it, so it is the single figure that determines what every other marketplace plan costs you.
North Carolina is $36/month above the $625/mo US benchmark (+5.8%), a difference of $432 a year at full price.
This page's North Carolina figure is derived reproducibly from CMS's own PY2026 Rate and Plan Attributes Public Use Files: individual-market, non-dental Silver standard-component plans, age-40 IndividualRate, second-lowest distinct premium in each rating area, then the unweighted mean across North Carolina's 16 rating areas. CMS does not publish enrollment weights in those files, which is why the aggregation is unweighted and why that is disclosed here rather than hidden. KFF's independently weighted North Carolina figure is $638/mo, a 3.6% difference that is the weighting method, not a disagreement about the underlying rates.
| Figure | Per month | Per year | Provenance |
|---|---|---|---|
| North Carolina benchmark (second-lowest-cost Silver, age 40) | $661/mo | $7,932 | Official — CMS PY2026 PUFs |
| Lowest of North Carolina's 16 rating areas | $546/mo | $6,552 | Official — CMS PY2026 PUFs |
| Highest of North Carolina's 16 rating areas | $845/mo | $10,140 | Official — CMS PY2026 PUFs |
| KFF's enrollment-weighted North Carolina figure (independent cross-check) | $638/mo | $7,656 | Modeled — KFF weighted |
| US benchmark, all states (KFF 2026) | $625/mo | $7,500 | Modeled — KFF weighted |
Sources: CMS PY2026 Marketplace Rate and Plan Attributes PUFs (PY2026 (2026-01-01 through 2026-12-31)), and KFF Marketplace Average Benchmark Premiums, 2026. All figures are pre-subsidy prices for the benchmark plan covering one 40-year-old, non-tobacco, individual on-exchange enrollee; they are not quotes, and they do not describe job-based coverage, Medicare, or Medicaid. Sources are scheduled for recheck by 2026-11-15.
The North Carolina state average is a planning figure: $546-$845/month across 16 rating areas
North Carolina is split into 16 geographic rating areas, and insurers price each one separately. In CMS's PY2026 files the benchmark premium runs from $546/mo in the cheapest rating area to $845/mo in the most expensive — a $299/month ($3,588/year) gap, or 1.55x between the two ends of the same state.
That in-state gap is larger than the $36/month difference between North Carolina and the US benchmark — so for North Carolina households, which county you live in can matter more than which state you live in. Any single "average premium in North Carolina" number — including the one on this page — is therefore a starting point for planning, not a price. Enter your own county's benchmark in the calculator above to replace it.
| Rating area | Per month | Per year | vs the state figure |
|---|---|---|---|
| Cheapest of 16 | $546/mo | $6,552 | -$115/mo (-17%) |
| State figure (unweighted mean, this page's default) | $661/mo | $7,932 | — |
| Most expensive of 16 | $845/mo | $10,140 | +$184/mo (+28%) |
Derived from CMS PY2026 Marketplace Rate and Plan Attributes PUFs (PY2026 (2026-01-01 through 2026-12-31)). Each rating area's benchmark is the second-lowest distinct age-40 Silver premium filed in that area; the state figure is their unweighted mean because CMS does not publish enrollment weights in these files. CMS does not publish a county-to-rating-area crosswalk in the rate file itself, so this page reports the range rather than guessing which end of it applies to you.
What you actually pay per month in North Carolina after the premium tax credit
The $661/mo figure is the sticker price. If your household income falls between 138% and 400% of the federal poverty line, the ACA premium tax credit caps what you pay for the benchmark plan at a set share of your income — the "applicable percentage," which for 2026 runs from 2.10% to 9.96% under IRS Revenue Procedure 2025-25. The credit pays whatever is left over.
That produces a result most people do not expect, and it is the most useful thing to know about North Carolina's premium: as long as your benchmark premium is higher than that income cap, North Carolina's premium level does not change what you pay — it changes the size of your credit. North Carolina's higher-than-average benchmark buys a bigger tax credit, not a bigger bill. Two things break that: crossing 400% of the poverty line, and a benchmark that is already cheaper than your cap.
Above 400% FPL there is no credit at all for 2026 — the temporary 2021-2025 enhancements expired at the end of 2025, so the "subsidy cliff" is back. In North Carolina that means a one-person household earning $62,700 pays the full $661/mo, while the same household earning $62,600 — $100 less — pays $520/mo. Earning $100 more costs $141 a month, or $1,692 a year, in lost credit.
| Household income | % of 2025 FPL | Applicable % | Premium tax credit | You pay per month |
|---|---|---|---|---|
| $23,475 | 150% | 4.19% | $579/mo | $82/mo |
| $31,300 | 200% | 6.60% | $489/mo | $172/mo |
| $39,125 | 250% | 8.44% | $386/mo | $275/mo |
| $62,600 | 400% | 9.96% | $141/mo | $520/mo |
| $62,700 | 401% | None — above the cliff | $0 — no credit above 400% FPL | $661/mo |
Computed with the same Form 8962 / IRC 36B(b)(2) arithmetic the calculator on this page runs: 2025 HHS Poverty Guidelines (90 FR 5917 — the guidelines that govern 2026 coverage), the 2026 applicable-percentage table from IRS Rev. Proc. 2025-25, and North Carolina's $661/mo benchmark. One-person tax household, enrolled in the benchmark plan for all 12 months. It assumes the household is otherwise eligible; it does not test immigration or tax-filing rules, Medicaid/CHIP eligibility, or access to affordable employer coverage. North Carolina expanded Medicaid, so marketplace credit eligibility starts at 138% FPL.
How household size changes health insurance costs in North Carolina
Marketplace coverage is priced per enrolled person, so a family's premium is larger than one person's — but the subsidy math moves in the opposite direction, and that is what decides the bill. Every threshold in the table below is a multiple of the federal poverty line for your TAX household, and the poverty line rises by $5,500 for each additional member. The same income is therefore a lower percentage of FPL — and earns a larger credit — for a bigger household.
Worked through: in North Carolina, a one-person household stops qualifying for any premium tax credit above $62,600, while a four-person household still qualifies up to $128,600. The same $62,600 income is 400% of the poverty line for one person — the last subsidized dollar, capped at 9.96% of income — and 195% for a family of four, where the cap is 6.31% instead.
Two traps worth naming. First, the denominator is your TAX household — everyone you claim on your return — not just the people you enroll in the plan; children covered by CHIP or Medicaid still count toward the poverty-line threshold even though they are not on the marketplace policy. Second, the cap on what you pay applies to your household's own benchmark premium, so it only helps while that benchmark exceeds the cap. This page's $661/mo default covers one 40-year-old; enter your household's own benchmark premium in the calculator above before relying on a multi-person estimate.
| Tax household size | 2025 federal poverty line | Credit eligibility starts (138% FPL) | Credit ends (400% FPL) |
|---|---|---|---|
| 1 person | $15,650 | $21,597 | $62,600 |
| 2 people | $21,150 | $29,187 | $84,600 |
| 3 people | $26,650 | $36,777 | $106,600 |
| 4 people | $32,150 | $44,367 | $128,600 |
| 5 people | $37,650 | $51,957 | $150,600 |
| 6 people | $43,150 | $59,547 | $172,600 |
2025 HHS Poverty Guidelines, 90 FR 5917 (published January 17, 2025) — these are the guidelines that govern eligibility for 2026 coverage. North Carolina expanded Medicaid, so incomes below 138% FPL generally route to Medicaid rather than to a marketplace credit. Above 400% FPL no federal premium tax credit is available for 2026.
Looking for a different North Carolina number?
This page prices HEALTH insurance — ACA marketplace medical coverage in North Carolina. It is not about insuring a house, an apartment's contents, or a car, and it does not price job-based coverage, Medicare, or Medicaid. If you landed here looking for one of those, the direct links below go to the right calculator.
Benchmark sources are rechecked by 2026-11-15; the figures on this page carry the PY2026 (2026-01-01 through 2026-12-31) vintage of CMS PY2026 Marketplace Rate and Plan Attributes PUFs.
Newsletter Signups Are Paused
We're building the email delivery behind our newsletter so we can do it properly — signups aren't open yet. Check back soon.
No form here and nothing is collected. Read our privacy policy.
StateCalc Team
Editorial Team
The StateCalc team builds free financial calculators using data from official government sources including the IRS, U.S. Census Bureau, BLS, and state revenue departments. All formulas are validated by an automated test suite and cross-referenced against published data.
Our editorial standardsFrequently Asked Questions
How much does health insurance cost in North Carolina?
North Carolina's 2026 second-lowest-cost Silver benchmark for a 40-year-old, non-tobacco, individual on-exchange enrollee is $661/month ($7,932/year). CMS PUF rating-area benchmarks range from $546 to $845/month across 16 areas; the state figure is their unweighted mean. Actual premiums vary by age, county, insurer, tobacco use, plan, and covered family members; use your own marketplace SLCSP for a personal subsidy estimate.
Do I qualify for ACA subsidies in North Carolina?
You may qualify if your household income is between 100-400% of the official 2025 HHS Poverty Guidelines (roughly $15,650-$62,600 for an individual, using the guidelines that apply to 2026 coverage). Above 400% FPL, no federal premium tax credit is available for 2026 — the "subsidy cliff" returned after the temporary American Rescue Plan/Inflation Reduction Act enhancements expired at the end of 2025. Eligibility and the credit also depend on access to other minimum essential coverage and your actual benchmark premium.
How much is health insurance per month in North Carolina for one person?
$661/mo at full price in 2026 — the second-lowest-cost Silver benchmark premium for one 40-year-old, non-tobacco, individual on-exchange enrollee, which is $7,932 a year. Across North Carolina's 16 rating areas that benchmark runs $546-$845/month, so your county matters. Most enrollees do not pay the sticker price: a single filer earning $31,300 (200% of the 2025 federal poverty line) pays about $172/mo for the same plan after the premium tax credit.
Does the ACA subsidy cancel out North Carolina's premium being above average?
While your benchmark premium is higher than your income cap, largely yes. The premium tax credit caps what you pay for the benchmark plan at a fixed share of your income (2.10%-9.96% for 2026 under IRS Rev. Proc. 2025-25), and the credit absorbs the rest. So North Carolina's $661/mo benchmark — $36/month above the $625/mo US benchmark — mainly changes the size of the credit, not the size of the bill. Two exceptions matter. Above 400% of the federal poverty line no credit exists for 2026 at all, so a one-person North Carolina household earning more than $62,600 pays the full $661/mo.
Why does health insurance cost more in some North Carolina counties than others?
North Carolina is divided into 16 geographic rating areas and insurers file separate rates for each one. In CMS's plan-year 2026 files the benchmark premium ranges from $546/mo in the cheapest area to $845/mo in the most expensive — a 1.55x spread driven by local hospital and provider prices and by how many insurers compete there. The $661/mo figure on this page is the unweighted average across all 16 areas, not the price in any particular county.
At what income do I stop getting help paying for health insurance in North Carolina?
Above 400% of the 2025 federal poverty line, which for 2026 coverage in North Carolina is $62,600 for one person, $84,600 for two, $128,600 for four, and $172,600 for six. Cross it by a dollar and the credit goes to zero for the whole year — a one-person household earning $62,700 pays the full $661/mo. Eligibility also has a floor: North Carolina expanded Medicaid, so below 138% FPL ($21,597 for one person) you would generally be routed to Medicaid instead of a marketplace credit.
People Also Calculate
Frequently used together with this calculator
Related Calculators
More Health Insurance Cost Calculators
More Calculators for North Carolina
Explore related financial tools with North Carolina data
Compare North Carolina With Other States
Side-by-side tax, housing & cost of living comparisons