ACA health insurance in 2026: A Look Ahead
You’re not alone in asking: Why does it have to be so hard? Why is it so complex – and so expensive? The truth is, many factors outside of your control (and ours) affect what you pay.
At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), we know rising health care costs are frustrating – and confusing. Here’s a look at what’s driving changes for individual ACA (Affordable Care Act) plans in 2026 – and what we’re doing to help.
Watch to learn what's changing
[Speaker] Just like everything else the last few years, the cost of health care is rising.
[Text on screen] Clothing. Housing. Groceries.
[Speaker] In 2025, medical costs jumped 8%, the biggest increase in more than a decade. In North Carolina, health care costs have been rising faster than the rest of the country, making it one of the most expensive states for care.
[Text on screen] NC is one of the most expensive states for care
[Speaker] And it's not just one thing driving prices up. It's a system under pressure. Everything from fewer doctors and system consolidation to more chronic illness and expensive treatments to complexity and unclear prices. It's just not sustainable.
[Text on screen] Limited access to care. Consolidation. Chronic health conditions. Expensive treatments. Fragmentation and complexity. Price variation.
[Speaker] But that's only part of the story. Changes coming to the ACA marketplace in 2026 will add even more strain.
[Text on screen] Changes are coming.
[Music]
[Text on screen] The cause and effect of ACA changes
[Speaker] In addition to rising health care costs overall, federal policy changes will mean thousands of North Carolinians with ACA plans will pay more for coverage in 2026.
Since 2021, the federal government has offered most people extra help with their ACA premiums through an enhanced premium tax credit.
[Text on screen] Affordable Care Act Enhanced Premium Tax Credit
[Speaker] It's like a coupon that makes monthly payments more affordable.
But starting in 2026, that help is expiring and what you pay out of pocket could go up, sometimes by a lot.
[Text on screen] Insurance costs
[Speaker] When health plans become unaffordable, some people may drop their health insurance coverage, driving up costs for those that remain. It's like six people splitting the cost of a trip versus only two. Fewer people traveling means a higher cost per person.
[Text on screen] ACA price changes for a single adult
[Speaker] So, if you're a single adult paying $50 a month through your ACA plan, you could see your bill jump to $150 a month in 2026 or more.
[Text on screen] ACA price changes for a middle-income family
[Speaker] A family of four paying $250 a month could see a significant increase up to $600 a month or more.
[Text on screen] Health care price increases are frustrating and stressful. Blue Cross NC’s promise: We’re here to for you.
[Speaker] We know health care price increases are beyond frustrating and stressful. That's why at Blue Cross and Blue Shield of North Carolina, we're here to help.
For those that buy on the ACA marketplace, here are some steps you can take now.
[Text on screen] Visit healthcare.gov or call 800-318-2596.
[Speaker] Check your information on the marketplace and update it during open enrollment.
[Speaker] Use the tax credit calculator to see what your new costs may be.
[Text on screen] Customer service 800-258-3334
[Speaker] Talk to a Blue Cross North Carolina agent to compare options and find the coverage that's best for you.
[Text on screen] BlueCrossNC.com or a neighborhood center.
[Speaker] You can also find help online or at one of our Beyond Blue neighborhood centers.
Remember, open enrollment is November 1, 2025, through January 15, 2026.
[Text on screen] Putting our members first. Member resources: growing network of doctors, tools to save money, and customer advocates.
[Speaker] As the state's only not for-profit health insurer, Blue Cross North Carolina is putting our members first, not shareholders, by improving access to care, helping you make smart, cost-saving decisions, and supporting you when you need it most.
Through it all, we're working to make health care better, simpler, and more affordable for everyone.
[MUSIC]
1. Fewer healthy people in the marketplace
When healthier people leave the ACA Marketplace, the people who stay often need more care. That makes costs go up for everyone.
2. Loss of extra help (enhanced premium tax credits expiring)
Since 2021, many people have received extra savings, called enhanced premium tax credits, from the federal government to offset the cost of their ACA health plans. But starting in 2026, those extra savings are going away.
However, while the enhanced premium tax credits are going away, other federal subsidies, which have been in effect since 2014, will still be in place in 2026. Use our subsidy calculator to see if you qualify for one of these subsidies.
3. New rules that may affect eligibility
Starting in 2026, new federal regulations may change who qualifies for ACA plans. If fewer healthy people stay in the market, costs could go up for those who remain.
4. Rising medical and prescription costs
Like everything else, health care is getting more expensive. Hospital services, outpatient care, and medications are all seeing steep cost increases. In fact, industry experts project 2025 will bring the highest medical cost growth in over a decade – around 8% year-over-year.
Understanding what's driving costs can help you prepare for what’s ahead – and make confident decisions about your health plan.
A closer look: where your premium dollar goes
We know you want to understand how your money is being spent—and you deserve transparency.
At Blue Cross NC, 87 cents of every premium dollar goes directly to your medical care.
Here’s the full breakdown:
By law we must spend at least 80% of your premium on your care. If we don’t, we return the difference to you. That’s called the Medical Loss Ratio (MLR), and it helps ensure you get value—not just coverage.
What we're doing to help
We’re working to build a health care system that works for you — not just for companies.
- Putting members first: As a purpose-driven, not-for-profit health insurer that doesn't answer to shareholders, we are doing more than making commitments. We’re making progress to advance care for all North Carolinians.
- Improving access to care: We’re making it easier for doctors to join our network and removing outdated rules that block care.
- Supporting you when it matters most: Our customer service team is here to help you understand your options and get the care you need.
- Helping you save money: We’re simplifying how members navigate their care by giving them tools to make informed, cost-saving decisions.
- Listening to our communities: We’re investing in big issues like youth mental health to improve care for all North Carolinians.
We're here for you
We know change can be hard. But you’re not in this alone. We’ll keep sharing updates as we get closer to 2026. In the meantime, you can:
- Visit enroll.bluecrossnc.com
- Call the number on your Blue Cross NC ID card
- Stop by one of our Beyond Blue Neighborhood Centers for help
- While enhanced subsidies are going away, you can check to see if you qualify for subsidies that will remain in place for 2026. Use this subsidy calculator.
Because you deserve care that’s simple, affordable, and built around your needs.
Browse Related Articles
- content-types:blogs
- topics:cost-savings