Health insurance in North Carolina for 2027

Cigna’s page for individual and family plans says Cigna Healthcare “will no longer offer Individual and Family medical plans as of January 1, 2027.” In its quarterly report for the period ending June 30, 2026, The Cigna Group says that in April 2026 it “announced its planned exit from the Individual and Family Plans medical business as of January 1, 2027.” (The Cigna Group is a separate company from the Cigna insurance companies that issue these plans, and it isn’t responsible for their financial condition or their obligations under their policies.) The North Carolina Department of Insurance’s list of 2027 individual-market filings, revised July 27, 2026, has no Cigna company on it. Your Cigna plan runs through December 31, 2026. After that, whether you bought it on HealthCare.gov or straight from Cigna, plan on a different company’s plan.

In 2026, Cigna sold HealthCare.gov plans in 87 of North Carolina’s 100 counties. They’re HMO plans from Cigna HealthCare of North Carolina, Inc. That’s a lot of people choosing a new plan at once, so don’t wait for the last week.

Your letters. If you have a HealthCare.gov plan, HealthCare.gov says you should get two letters by November 1: one from your insurance company, and one from the Marketplace, which is HealthCare.gov itself. The insurance company’s letter should say whether your plan is available for 2027 and, if it isn’t, whether the company is offering a similar plan. The Marketplace’s letter also tells you anything you need to do to keep getting a tax credit. Keep both.

If you do nothing. HealthCare.gov says: “If your company isn’t offering plans for next year, we’ll re-enroll you in a plan with a different insurance company. Your plan doesn’t start until you pay your first monthly premium.” So if that happens, watch for the new company’s first bill and pay it. The federal rule says the Marketplace “may” make that move: where North Carolina’s insurance regulator directs, or, if the regulator gives no direction, into a similar plan the Marketplace chooses. CMS’s enrollment manual says it then looks for a plan that covers where you live, at the same level (like silver) and of the same type (like HMO) where it can, weighing which company can take on new members and which plan has the lowest premium. Your doctors and prescriptions aren’t on that list. HealthCare.gov also says that in some cases you won’t be re-enrolled at all.

If you bought your Cigna plan outside HealthCare.gov, the Marketplace won’t move you. It re-enrolls only people it enrolled, and CMS’s standard letter for a plan ending off HealthCare.gov says to pick a different plan by a set date or go without coverage. You can pick one on HealthCare.gov or off it, but only a plan bought through HealthCare.gov can come with a tax credit.

If you miss December 15. Because your plan is ending, you also get a special enrollment period. HealthCare.gov counts a discontinued plan as losing coverage, and gives you 60 days before and 60 days after your coverage ends to pick a new plan. Pick one before your coverage ends and it starts the first day of the month after your coverage ends, so a plan picked by December 31 would start January 1. Pick one later and it starts the first day of the month after you pick. Either way, you may be asked for documents showing the loss, and if you’re new to HealthCare.gov, CMS says you’ll have to send them before you can use the plan. You have 30 days after picking to send them, and if you’re asked and don’t, you won’t qualify. And if you’re already on HealthCare.gov, it may only let you choose from your current plan category, like bronze or silver. Don’t plan around the special enrollment period. December 15 is simpler.

What I’d do now:

• Watch for those two letters and keep them. If you’re asked for proof, you’ll need “documents showing the lost coverage and the date it ends,” in HealthCare.gov’s words.
• Write down your doctors, your hospital and every prescription you take.
• Update your 2027 application on HealthCare.gov, income included.
• When 2027 plans show up on HealthCare.gov, check each one you’re considering for your doctors and drugs, including any plan you’re matched with, and call your doctors’ offices to ask whether they’ll take that plan in 2027.
• Pick your plan by December 15, and pay the new company’s first bill, so it starts January 1.

If you’re weighing the companies against each other, my comparison of Aetna, Cigna and UnitedHealthcare shows where each one sold in North Carolina in 2026.

North Carolina uses HealthCare.gov. For plan year 2027, CMS lists North Carolina as a federally facilitated marketplace state. I help people in North Carolina enroll through HealthCare.gov and HealthSherpa.

Open enrollment starts November 1, 2026. A plan you pick by December 15 starts January 1, 2027. A plan you pick from December 16 through January 15, 2027 starts February 1.

The January 15 end date is contested. CMS gives that date, and so does HealthCare.gov’s own dates page. A federal rule finalized in June 2025 would have ended open enrollment on December 15 instead. A federal district court threw out that part of the rule in June 2026, the government appealed, and the appeals court set argument for October 30, 2026. Until a court changes them, CMS’s dates are the ones that count. My 2027 open enrollment guide follows the case.

These are the companies on the North Carolina Department of Insurance’s list of 2027 individual-market rate filings, revised July 27, 2026. I’ve left out the price changes they asked for, because those were requests.

Six companies sold individual plans here in 2026, by the Department’s approved 2026 list. Cigna is the one that isn’t on the 2027 list. Bankers Reserve is new, and its plans are sold only outside HealthCare.gov, so they can’t come with a tax credit.

Not every company sells in every county. HealthCare.gov shows which 2027 plans are offered where you live once open enrollment starts.

The Department says final rates “may differ from the initial rate filing and will be posted at a later date.” CMS said it planned to post final 2027 rates no later than October 30, 2026. I’ll add North Carolina’s approved 2027 rates here once the Department posts them.

The tax credit that lowers your monthly premium is still there for 2027. Between the poverty line and four times it, the credit is figured so that what you’d pay for your area’s benchmark plan, the second-lowest-cost silver plan, comes to a set share of your income. If benchmark prices go up, the credit goes up with them, though other plans’ prices can still move by more or less. The limit that came back after 2025 is at the top: above four times the poverty line, there’s no credit at all. And starting with 2027, fewer people who aren’t U.S. citizens qualify.

At the bottom, North Carolina is different from states that didn’t expand Medicaid. If you qualify for NC Medicaid, you can’t get the tax credit for a HealthCare.gov plan, because federal law doesn’t allow the credit for any month you’re eligible for Medicaid. The next section is about where that line falls.

North Carolina expanded Medicaid on December 1, 2023, to adults 19 through 64 with income up to 138% of the federal poverty line. On NC Medicaid’s eligibility page, that’s $1,835 a month or less for one person.

You can apply any time of year: online through ePASS (you’ll need an NCID), with your county Department of Social Services in person or by phone, by mail, or through HealthCare.gov. NC Medicaid’s contact center number is on its how to apply page.

What changes, and when. These come from the federal law passed in July 2025, and NC Medicaid has set the dates:

• October 1, 2026, for people who aren’t U.S. citizens. Medicaid is now limited to green card holders (most of whom must also wait five years), lawfully residing children up to 19, lawfully residing people who are pregnant or gave birth in the past 12 months, Cuban or Haitian entrants, and citizens of Micronesia, the Marshall Islands or Palau living here. If you aren’t in one of those groups, check before you count on Medicaid.
• January 1, 2027: a work requirement for adults 19 through 64 on expansion Medicaid. You’ll need 80 hours a month of work, school or volunteering, or income of at least $580 a month, unless you’re exempt. NC Medicaid’s exemptions include parents, guardians and caregivers of a child under 14 or of a person with a disability, people NC Medicaid has found to have a disability, and people who are pregnant or were in the past 12 months. Its list says “and others,” so ask if you think one fits.
• January 1, 2027: renewals every six months instead of once a year, for most adults 19 through 64. Watch your mail, because you’ll get a notice when you need to act.
• January 1, 2027: less back coverage. If you’re 19 to 64 and don’t have a disability, Medicaid will cover up to one month of care from before you applied. Children, people 65 and older, and people with a disability get up to two months.

If NC Medicaid ends your coverage, it sends a letter saying why, and you usually have 60 days from the date on the letter to appeal. The NC Medicaid Ombudsman helps for free; its number is on NC Medicaid’s page about these changes.

If you lose Medicaid only because of the work requirement, don’t count on a HealthCare.gov plan with a tax credit instead. The same federal law counts you as still eligible for Medicaid when it decides who gets the credit.

Children from birth through 18 qualify for NC Medicaid at higher incomes than adults: on NC Medicaid’s eligibility page, up to $4,804 a month for a family of three. If you’re pregnant, the limit for a family of three is $5,390 a month, and the baby you’re expecting counts in the family size. You can apply any time of year, the same ways as above. Above those limits, your children can be on your HealthCare.gov plan, where the tax credit can help pay for their coverage too.