Who Can Buy Marketplace Coverage and Who Gets Help
Anyone who lives in North Carolina and is a U.S. citizen or lawfully present can buy a marketplace plan at full price. Getting a premium tax credit to lower that price depends on income and other coverage.
Basic Eligibility for the Premium Tax Credit
To qualify for the premium tax credit in 2027, your household income generally has to fall between 100% and 400% of the federal poverty level. Marketplace coverage for 2027 uses the 2026 poverty guidelines: $15,960 for one person, $21,640 for two, and $33,000 for a family of four. That makes the upper limit $63,840 for a single person, $86,560 for a couple, and $132,000 for a family of four. You also can't be eligible for Medicare Part A without a premium, Medicaid, or affordable job-based coverage. Married couples must file a joint return, and you can't be claimed as someone else's dependent.
When Employer Coverage Blocks the Subsidy
If you or a family member can get coverage through a job, the marketplace subsidy is off the table when that coverage counts as affordable. For 2027 the test is whether the employee's share of the cheapest employee-only plan costs no more than 10.22% of household income. Since 2023, family members are tested separately using the cost of family coverage. A spouse and children can qualify for the marketplace credit even when the worker's own coverage is affordable, if the family premium runs above 10.22% of income. State employees should compare against our NC State Health Plan 2027 guide before shopping the marketplace.
Below 138% of Poverty: NC Medicaid Instead
North Carolina expanded Medicaid in December 2023, so most adults ages 19 to 64 with income up to 138% of the poverty level qualify for Medicaid rather than marketplace subsidies. That's about $22,025 a year for one person and $45,540 for a family of four. Expansion adults face two changes on January 1, 2027. First, they must show at least 80 hours a month of work, school, job training, or volunteering, or household earnings of at least $580 a month, unless they're exempt. Exemptions include people with a disability, pregnant people, and parents of children under 14. Second, renewals move from once a year to every six months. If you lose Medicaid because of the work rule, you generally can't switch to a subsidized marketplace plan instead, so keep your hours documented. NCDHHS posts details at its "Medicaid is Changing" page.
Immigration Status Changes for 2027
Starting in 2027, premium tax credits are limited to U.S. citizens, lawful permanent residents (green card holders), Cuban and Haitian entrants, and citizens of the Compact of Free Association nations (Micronesia, the Marshall Islands, and Palau) living in the U.S. Other lawfully present immigrants, including many refugees, asylees, and people with temporary protected status, can still buy marketplace plans but at full price. Separate Medicaid eligibility changes for many non-citizens took effect October 1, 2026.
How the Premium Tax Credit Works in 2027
The credit is built around one plan in your area, the benchmark, and a share of your income you're expected to pay toward it.
The Benchmark Plan and Your Expected Contribution
The benchmark is the second-lowest-cost Silver plan available to you in your county. Your credit equals the benchmark's price minus your expected contribution, a percentage of household income set by the IRS. Apply the credit to a cheaper plan and you pay less, while a pricier plan costs you the difference. You can take the credit in advance, paid monthly to your insurer, or claim it when you file your tax return. Either way it's reconciled on Form 8962 with your actual income for the year.
The 2027 Contribution Percentages
Rev. Proc. 2026-26 sets the percentages for 2027. Within each band, the percentage rises gradually from the low end to the high end:
| Household Income (% of Poverty Level) | Single Filer Income | Share of Income You Pay for the Benchmark |
|---|
| Up to 133% | Up to $21,227 | 2.15% |
| 133% to 150% | $21,227 to $23,940 | 3.23% to 4.30% |
| 150% to 200% | $23,940 to $31,920 | 4.30% to 6.78% |
| 200% to 250% | $31,920 to $39,900 | 6.78% to 8.66% |
| 250% to 300% | $39,900 to $47,880 | 8.66% to 10.22% |
| 300% to 400% | $47,880 to $63,840 | 10.22% |
| Above 400% | Above $63,840 | No credit |
Under the enhanced rules that expired after 2025, nobody paid more than 8.5% of income, and people under 150% of poverty paid nothing for a benchmark plan. Those protections are gone for 2027 unless Congress acts. The House passed a three-year extension in January 2026, but the Senate has not, and no extension has become law as of late October.
What You'll Pay for a Benchmark Silver Plan
Your expected contribution doesn't depend on your age or county, so these figures hold anywhere in NC as long as the benchmark costs more than the amount shown:
| Household | Annual Income | % of Poverty Level | Your Benchmark Cost per Year | Per Month |
|---|
| Single | $25,000 | 157% | $1,157 | $96 |
| Single | $30,000 | 188% | $1,855 | $155 |
| Single | $40,000 | 251% | $3,472 | $289 |
| Single | $50,000 | 313% | $5,110 | $426 |
| Single | $60,000 | 376% | $6,132 | $511 |
| Family of four | $50,000 | 152% | $2,188 | $182 |
| Family of four | $80,000 | 242% | $6,700 | $558 |
| Family of four | $100,000 | 303% | $10,220 | $852 |
| Family of four | $120,000 | 364% | $12,264 | $1,022 |
The credit covers the rest of the benchmark's price, so it grows with age. Premiums for a 64-year-old can be up to three times those for a 21-year-old. KFF's analysis of the 2027 plan data puts North Carolina's average benchmark for a 40-year-old at $660 a month, up from $638 in 2026. That's only about 3%, well below the 14% average rate increase, because the benchmark is set by the cheaper Silver plans in each county, and some lower-priced insurers held their rates down. Using the federal standard age curve, a single filer earning $45,000 would pay about $362 a month for the benchmark at any age. The credit would be roughly $298 a month at age 40, about $560 at 50, and about $1,040 at 60. Your county's benchmark will differ, so check the plan listings on HealthCare.gov.
Here are KFF's 2027 statewide averages for a 40-year-old before any credit:
| Plan (40-year-old, 2027) | NC Average Monthly Premium |
|---|
| Lowest-cost Bronze | $546 |
| Lowest-cost Silver | $651 |
| Benchmark (second-lowest-cost) Silver | $660 |
| Lowest-cost Gold | $721 |
The national average benchmark for 2027 is $703, so North Carolina is a bit below average. Because the cheapest Gold plan costs only about $60 more than the benchmark, some enrollees who don't qualify for cost-sharing reductions may find Gold a better value than Silver.
The 400% Subsidy Cliff Is Back
From 2021 through 2025 there was no upper income limit for the credit. For 2027, the credit drops to zero at 400% of the poverty level, and that hits older enrollees hardest.
How the Cliff Works
Below 400% of poverty, your benchmark cost is capped at 10.22% of income. One dollar above the line and the cap disappears: you pay the full premium. For a younger person in an average county that may cost little or nothing, because the full premium is close to 10% of income anyway. For someone in their late 50s or early 60s, full-price coverage can run 25% to 30% of income at the cliff.
A Cliff Example: Age 60, Single
Take a 60-year-old in a county with an average benchmark of roughly $1,400 a month, or about $16,800 a year at full price:
| Household Income | Premium Tax Credit | You Pay for the Benchmark |
|---|
| $63,000 (395% of poverty) | About $10,400 | About $6,440 |
| $64,000 (401% of poverty) | $0 | About $16,800 |
An extra $1,000 of income costs this person about $10,400 in lost credit. A married couple, both 62, hits the same wall at $86,560. Just below it they'd pay about $8,800 a year for two benchmark plans. Just above it they'd pay full price, which could run near $35,600 a year.
No Cap on Paying Back Excess Credits
Starting with 2026 coverage, there's no longer a cap on how much excess advance credit you repay at tax time. Under the old rules, households under 400% of poverty repaid at most a few thousand dollars. Now if your income comes in higher than you estimated, you repay the full difference on your tax return. If you end the year over 400% of poverty, that means every dollar of credit paid in advance. If your income is uncertain, estimate on the high side, update HealthCare.gov when your income changes, or take less of the credit in advance and claim the rest at filing.
Choosing a Plan: Bronze, Silver, Gold, and Catastrophic
Marketplace plans come in metal levels that describe how costs are split between you and the insurer, not the quality of care. Every level covers the same essential health benefits.
The Metal Levels
| Level | Insurer Pays (on Average) | Premium | Best For |
|---|
| Bronze | About 60% | Lowest | Healthy people who want protection from big bills, and HSA savers |
| Silver | About 70%; up to 94% with cost-sharing reductions | Middle | Anyone under 250% of poverty |
| Gold | About 80% | Higher | Regular care, ongoing prescriptions, a planned surgery or birth |
| Catastrophic | Pays little until a high deductible | Low, but no credit can be applied | Under 30 or with a hardship exemption |
Compare the total yearly cost, not just the premium: premium plus the deductible and copays you'd realistically use, plus the out-of-pocket maximum as the worst case. Before choosing, check that your doctors and your nearby hospital system are in the plan's network. Atrium, Novant, UNC Health, Duke, ECU Health, and other systems contract differently with each insurer.
Cost-Sharing Reductions Under 250% of Poverty
If your income is under 250% of poverty, up to $39,900 for a single person or $82,500 for a family of four, Silver plans come with built-in cost-sharing reductions. They lower your deductible and copays at no extra premium. Under 150% of poverty, a Silver plan covers about 94% of costs on average, which is better than Platinum. From 150% to 200% it covers about 87%, and from 200% to 250% about 73%. In that income range, choosing Bronze to save on premium often means giving up thousands of dollars of protection.
Bronze Plans Now Qualify for an HSA
Starting in 2026, every Bronze and Catastrophic plan counts as a high-deductible plan for health savings account purposes, not just the few designed to meet the old rules. For 2027 you can contribute up to $4,500 with self-only coverage or $9,000 for family coverage, plus $1,000 if you're 55 or older. Contributions are deductible for both federal and NC income tax, grow tax-free, and come out tax-free for medical costs. HSA contributions also lower the income used for the premium tax credit, which matters near the cliff. Our NC HSA guide covers how to open and invest one.
Marketplace Coverage When You're Self-Employed
Freelancers and small business owners are a large share of marketplace enrollees, and they have more control over their subsidy than anyone else, because they can adjust their income.
The Self-Employed Health Insurance Deduction
Self-employed people can deduct the premiums they pay for themselves and their families as an adjustment to income. That lowers both federal and NC income tax, though not self-employment tax. The deduction covers only the premium you actually pay after the credit. Because the deduction lowers your income, which raises your credit, which lowers your deduction, the two are calculated together using an IRS method. Tax software handles this automatically. The NC self-employment tax calculator shows how much tax your profit generates before this deduction.
Lowering Your Income to Stay Under the Cliff
The income that counts for the credit is modified adjusted gross income, which for most people is just AGI. Every deduction that lowers AGI moves you away from the cliff. That includes SEP-IRA or Solo 401(k) contributions, HSA contributions, half of self-employment tax, and the self-employed health insurance deduction. Take a 60-year-old freelancer heading for $66,000 of MAGI, about $2,000 over the line. A $4,500 HSA contribution with a Bronze plan plus a $3,000 SEP-IRA contribution brings MAGI to $58,500. That restores a credit worth roughly $12,500 a year, and the contributions also cut income tax. SEP contributions can be made up to your tax filing deadline, so you can finish the adjustment once you know the year's final numbers. The NC Self-Employment Guide covers retirement plan options for business owners.
Estimating Income That Changes Month to Month
HealthCare.gov asks you to estimate next year's income, which is hard when client work comes and goes. Start from last year's Schedule C profit and adjust for contracts you know are coming or ending. Update your application whenever your outlook changes by more than a few thousand dollars, so your advance credit tracks reality. Remember there's no longer a cap on repayment. Our NC 1099 tax guide covers keeping the books you'll need to make that estimate.
Marketplace Coverage for Early Retirees and Job Changers
The marketplace is the main bridge to Medicare for people who retire before 65, and a common choice for people between jobs.
Retiring Before 65
Early retirees often have modest taxable income but large savings, which makes the credit valuable and the cliff dangerous. Withdrawals from a traditional IRA or 401(k), capital gains, Roth conversions, and Social Security benefits (including the part that isn't taxed) all count toward MAGI. Withdrawals from a Roth IRA (contributions and qualified earnings) and from cash savings don't. Planning which account to draw from each year can keep a couple under $86,560 and save them tens of thousands of dollars over the years before Medicare. Our guide to retiring in North Carolina and NC retirement income tax guide cover how NC taxes each type of income.
Losing Job Coverage Mid-Year
Losing job-based coverage, whether you quit, are laid off, or retire, opens a special enrollment period. You have 60 days before or after the loss to pick a marketplace plan. Your other option is COBRA, which keeps your old plan for up to 18 months but costs up to 102% of the full premium, including the share your employer used to pay. Marketplace coverage with a credit is usually much cheaper, especially if your income for the year will be lower after the job ends. Dropping COBRA voluntarily doesn't open a special enrollment period, so make the comparison when the job ends or wait for open enrollment.
Moving to Medicare at 65
Once you're eligible for premium-free Medicare Part A, you can no longer receive the premium tax credit. Sign up for Medicare during the seven-month window around your 65th birthday and end your marketplace plan when Medicare begins. Our Medicare in North Carolina guide covers enrollment and choosing a plan. HealthCare.gov won't cancel it for you, and keeping it means paying full price. Note that Social Security benefits started before 65 count toward marketplace income. Our guide to how Social Security is taxed in NC explains the state side.
Frequently Asked Questions
When is open enrollment for 2027 health insurance in North Carolina?
Open enrollment runs November 1, 2026, through January 15, 2027, at HealthCare.gov. Enroll by December 15 for coverage that starts January 1. Plans picked from December 16 through January 15 start February 1. Outside that window you need a qualifying life event, such as losing other coverage, marriage, a birth, or a move, to enroll.
How much is health insurance per month in NC for 2027?
It depends mostly on income and age. With the premium tax credit, a single person earning $30,000 pays about $155 a month for a benchmark Silver plan, and one earning $50,000 pays about $426, at any age. Without a credit, a 40-year-old's benchmark Silver plan averages $660 a month statewide in 2027, and a 60-year-old's runs around $1,400. Bronze plans cost less, and some enrollees with a credit pay little or nothing for one.
What happens if my income ends up higher than I estimated?
You repay the extra advance credit when you file your tax return, and starting with 2026 coverage there's no cap on the repayment. If your income ends the year above 400% of poverty, you repay all of the advance credit. Report income changes on HealthCare.gov during the year so your credit is adjusted, and consider taking less in advance if your income is unpredictable.
Is there a penalty for not having health insurance in North Carolina?
No. The federal penalty for going without coverage was reduced to $0 starting in 2019, and North Carolina has no state requirement or penalty. Going uninsured still exposes you to the full cost of an accident or illness. A Bronze plan caps your yearly out-of-pocket costs and, for many people with a credit, costs very little.
