Health insurance in North Carolina
761,457 North Carolina residents bought a marketplace plan for 2026. What they were offered depended on which of the state's 100 counties they live in.
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. Figures cover the under-65 population.
Where you enroll
North Carolina uses the federally facilitated marketplace, so you enroll at HealthCare.gov on the federal calendar — the dates are here.
Medicaid covers the bottom of the range in North Carolina
North Carolina expanded Medicaid, so there is no coverage gap here: adults under 138% of the poverty guideline — about $22,025 for one person — go to Medicaid rather than falling between it and the subsidy.
899,415 under-65 North Carolina residents are uninsured all the same, 10.2% of them — 16th of the 51 states and DC, and 1.0× the 26-state median of 9.9%.
How much choice North Carolina counties get
Counties in North Carolina carry between 2 and 6 insurers, so competition is fairly even across the state without being uniform.
No county in North Carolina is down to a single insurer. No county in North Carolina changed its number of insurers since the previous plan year.
How many North Carolina residents buy on the marketplace
761,457 North Carolina residents selected a marketplace plan for 2026. Against the state's under-65 population that is 87 per thousand, above the 26-state median of 79, and 8th highest of the 26 states on this site.
Of those, 125,794 — 17% — were new rather than renewing, which is a fairly typical mix of new and renewing enrollees (5th of 26).
The spread inside North Carolina
Wake County is the largest county we publish here, with 1,047,831 under-65 residents; Henderson County is the smallest, with 87,580. Wake County has 4 insurers offering 44 plans, and Henderson County has 5 offering 57.
The widest choice in North Carolina is in Forsyth County — 6 insurers, 89 plans. The narrowest is Pitt County, with 2 insurers and 28 plans. Same state, same rules, 61 more plans to choose from.
Uninsured rates range from 7.2% in Wake County to 12.8% in Randolph County — 1.8 times as high, within one state.
The 25 largest counties in North Carolina
By under-65 population, covering 72% of the state's under-65 residents. North Carolina has 100 counties with complete federal data; we publish pages for the largest.
| County | Under 65 | Uninsured | Insurers | Plans | Per 1,000 |
|---|---|---|---|---|---|
| Wake County | 1,047,831 | 7.2% | 4 | 44 | 78 |
| Mecklenburg County | 1,031,708 | 11.2% | 5 | 81 | 108 |
| Guilford County | 436,358 | 10.1% | 6 | 83 | 79 |
| Forsyth County | 314,546 | 11.0% | 6 | 89 | 76 |
| Durham County | 277,010 | 10.1% | 3 | 31 | 75 |
| Cumberland County | 273,024 | 8.8% | 4 | 56 | 76 |
| Union County | 224,411 | 9.0% | 4 | 68 | 105 |
| Buncombe County | 213,948 | 11.7% | 5 | 59 | 114 |
| Johnston County | 212,182 | 10.5% | 4 | 44 | 68 |
| Cabarrus County | 208,098 | 9.0% | 4 | 68 | 87 |
| Gaston County | 197,709 | 11.1% | 3 | 60 | 88 |
| New Hanover County | 189,547 | 8.9% | 4 | 65 | 118 |
| Iredell County | 170,474 | 9.2% | 4 | 63 | 98 |
| Onslow County | 168,928 | 8.1% | 2 | 37 | 50 |
| Alamance County | 144,917 | 11.8% | 5 | 45 | 61 |
| Pitt County | 143,186 | 9.8% | 2 | 28 | 63 |
| Davidson County | 141,465 | 10.3% | 6 | 89 | 77 |
| Catawba County | 132,726 | 11.8% | 4 | 63 | 92 |
| Harnett County | 122,387 | 9.9% | 4 | 56 | 67 |
| Rowan County | 121,307 | 11.2% | 3 | 54 | 83 |
| Randolph County | 118,898 | 12.8% | 5 | 75 | 72 |
| Orange County | 117,265 | 8.1% | 4 | 44 | 68 |
| Brunswick County | 108,465 | 9.0% | 4 | 65 | 116 |
| Wayne County | 93,705 | 12.5% | 2 | 28 | 62 |
| Henderson County | 87,580 | 12.3% | 5 | 57 | 87 |
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. "Per 1,000" is marketplace plan selections per thousand under-65 residents.
Compare all 26 states · How the credit works · Enrollment dates