Affordable Care Act rates set to skyrocket in NC

About a million North Carolinians who rely on the federal Affordable Care Act are in for a double-whammy on health care costs next year.

Insurers who offer ACA plans are asking for steep increases for 2026. And those rate increases will come on top of the end of federal subsidies that have made ACA plans more affordable for many. Those subsidies will expire in December after Congress declined to extend them.

The insurers say rising healthcare costs and federal changes enacted over the past few months are driving the increase.

Different insurers that provide ACA plans in North Carolina are requesting different rate increases. Amerihealth Caritas is the highest at 36% next year. UnitedHealthcare of NC is seeking 32%. Blue Cross is seeking a 29% increase, and Cigna is asking for 27%.

Those rates are under review by state Insurance Commissioner Mike Causey, says spokesman Jason Tyson, but Causey doesn’t have the power to set health insurance rates. He says that’s handled by federal regulators.

“Healthcare costs are going up. Obviously, that's a big thing. You know, it's costing more and more,” Tyson told WRAL.

However, Tyson says Causey does have the authority to review the rate increase requests and can deny them if he finds they’re unjustified, unreasonable or discriminatory. Tyson says that last happened in 2010, when the commissioner at that time rejected a rate increase request by Blue Cross Blue Shield, requiring the insurer to reduce and renegotiate its request.

Rates for ACA plans vary widely according to age, location, benefits and other factors, but Tyson says the average monthly premium for a healthy 21-year-old is $486. For an older adult, it’s $800 to $1200 a month. The average ACA enrollee is saving $705 a year through the subsidies that are set to expire at the end of the year.

That means the average enrollee will see their monthly cost rise about $58 per month when the subsidies expire. And the new rate increase will be added on top of that.

For an average older adult paying $1000 a month for ACA coverage, their monthly bill after the rates rise and the subsidies expire could be closer to $1400. For a healthy 21-year-old, it could go from under $500 a month to about $710.

And the increases could be even larger. Hollis Smith helps people sign up for ACA through the NC Navigator Consortium. She says many younger people are likely to drop their coverage if it gets too pricey, and that drives up the costs for everyone else.

“When those healthy and younger individuals drop coverage,” Smith said, “it makes the entire risk pool more expensive, so that people who are enrolled in insurance are using it more, are sicker, so [insurers] are preemptively raising those rates.”

“I think this is going to mean a lot of difficult decisions for individuals,” Smith said.

WRAL News asked Blue Cross NC and UnitedHealthcare of NC why their rate increase requests were so high. Blue Cross NC said in a statement, “WRAL is right to ask these questions. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has and will continue to sound the alarm on the affordability crisis facing our state.”

UnitedHealthcare did not respond to our question.

Open enrollment for the ACA for 2026 begins in November.