Health Insurance for Freelancers in North Carolina: 2026 Guide
North Carolina expanded Medicaid in 2023, which changed the math for lower-income freelancers. Here's what 1099 workers should look at in 2026.
North Carolina expanded Medicaid in December 2023, which was a big deal for self-employed workers in the state. Freelancers with a down year of income can now qualify for Medicaid up to 138% of the federal poverty level, which is a floor that didn't exist before.
Marketplace pricing in North Carolina
A single 40-year-old freelancer in Charlotte or Raleigh is quoted around $440 to $580 a month unsubsidized for a Silver plan. Blue Cross Blue Shield of North Carolina dominates the market, which keeps prices relatively stable but not especially competitive.
Working Owner group plans in North Carolina
The Aetna Open Choice PPO and EPO are both live in North Carolina, with a strong footprint in the Research Triangle and Charlotte. BCBS of Nebraska's plan uses BlueCard PPO, which is honored at every major North Carolina hospital (Atrium, Novant, Duke, UNC, WakeMed).
The PSN of TN PPO is also available to North Carolina residents and sometimes beats both local options on premium for similar coverage.
When the marketplace wins
For North Carolina freelancers under ~250% FPL, marketplace subsidies often bring the plan below group pricing. For anyone earning above that threshold, the group plan typically wins by $100 to $300 a month.