Education · North Carolina prescription savings

Lost your health insurance in North Carolina in 2026? How to keep affording your prescriptions

Last updated September 13, 2026 · Reviewed by the LowerScript editorial team · Español

The enhanced ACA Marketplace premium tax credits that had been in place since 2021 expired at the end of 2025, and 2026 premiums rose for many enrollees as a result (KFF). North Carolina has separately expanded Medicaid, effective December 1, 2023 — more than 690,000 newly eligible North Carolinians have enrolled since expansion began (NC Governor's Office) — a separate fact about a separate program, not a claim that one change offset the other. If you lost job-based coverage, you generally have 60 days to enroll in a new Marketplace plan. Whatever happens with your coverage, the cash price of your prescriptions is a separate question — it varies widely between nearby pharmacies, and comparing prices with a free discount card is one of the fastest ways to lower it.

What changed in 2026

The enhanced premium tax credits available since 2021 expired at the end of 2025: "when those enhancements expired at the end of 2025, premium payments rose sharply for many enrollees" (KFF). North Carolina expanded Medicaid effective December 1, 2023; more than 690,000 newly eligible North Carolinians have enrolled since expansion began, and total NC Medicaid/CHIP coverage across all programs is more than 3 million people statewide — roughly one in four North Carolinians (NC Governor's Office, as of December 2025). These are two separate facts about two separate programs, not a claim that expansion offset the 2026 subsidy change.

Separately, the state Medicaid program itself went through its own funding scare in spring 2026: state health officials identified a $319 million shortfall in the money set aside to cover non-expansion Medicaid enrollees. North Carolina lawmakers closed that gap when Gov. Josh Stein signed a bill on April 30, 2026, and the state's full budget, signed July 7, 2026, funds Medicaid for the current fiscal year (NC Newsline). That near-term shortfall is resolved, but a longer-term risk has taken its place: state health officials project significant federal funding reductions over the next decade under 2025 federal law, Medicaid eligibility for some non-citizen groups (including refugees and asylees) ends October 1, 2026 (more than 66,800 documented non-citizens were enrolled in NC Medicaid as of late August 2026, though about a third — children, pregnant women, and other exempt groups — are unaffected by the change), and new work-requirement and recertification rules begin January 1, 2027 (NC Newsline, Aug. 24, 2026). That work requirement applies to most of the roughly 740,000 North Carolinians who currently have Medicaid expansion coverage: to keep it, most non-disabled adults ages 19–64 will need to earn at least $580 a month or complete 80 hours a month of work, school, or volunteering, and will need to renew their eligibility every six months instead of once a year. Parents of children under 14, people with disabilities, and pregnant or postpartum women are exempt (NCDHHS, "Know What's Next" toolkit, Sept. 1, 2026). North Carolina's ACA Marketplace enrollment also fell sharply in 2026 after the enhanced subsidies described above expired, and the state's Medicaid social-determinants program (the Healthy Opportunities Pilot) restarted in September 2026 with less funding than originally requested. It's a reminder that Medicaid and Marketplace rules can change from year to year — if your coverage changes or lapses, keep an eye on renewal notices and official NCDHHS communications, and know that a prescription discount card can help bridge medication costs in the meantime.

North Carolina’s own Marketplace reflects that shift: enrollment fell from 774,226 people in 2025 to 609,544 in 2026, a drop of roughly 164,700 enrollees (about 21%) — one of the largest percentage declines of any state — as of 2026, per CMS enrollment data reported by the Associated Press.

North Carolina’s 2027 preliminary rate filings — not yet approved — propose average increases of roughly 14.9% for individual-market plans and 19.8% for small-group plans, as of August 2026, per ACASignups.net’s analysis of federal rate-review data. Cigna has also filed to exit North Carolina’s individual market entirely for 2027, affecting an estimated 16,006 enrollees, as of 2026, per the same filings — these are proposed figures, not final, state-approved rates.

If you lost job-based coverage

If you lose job-based health coverage, you generally need to apply for Marketplace coverage within 60 days to use the Special Enrollment Period (HealthCare.gov). COBRA is another option worth asking your employer about directly — it can let some people keep their employer plan temporarily, but the specific terms depend on your employer and plan, so ask your HR department directly rather than assuming a standard cost or length.

Checking your Medicaid eligibility

North Carolina's Medicaid expansion covers adults 19–64 with income up to 138% of the federal poverty level (about $20,000 for an individual; about $34,000 for a family of three). If you're not sure whether you qualify, NC Medicaid at ncdhhs.gov is the place to check current rules. If you're already on Medicaid, your eligibility is reviewed periodically — watch for renewal paperwork and respond promptly so your coverage doesn't lapse.

What this means for your prescriptions

If you're now paying full retail price — no insurance, a high deductible, or a plan that doesn't cover a specific drug — there is no fixed cash price for most medications. The same drug in the same dose can cost very different amounts at pharmacies a few miles apart. Comparing the cash price before you fill, asking about the generic where one exists, and using a free discount card can meaningfully lower what you pay — with no enrollment, income test or waiting period. See how to lower prescription costs without insurance for more, or prescription help for the uninsured if you're between coverage right now.

Frequently asked questions

Sources: KFF, What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles; HealthCare.gov, If You Lose Job-Based Coverage; NC Governor's Office, NC Medicaid Expansion Will Launch on Dec. 1, 2023; NC Governor's Office, North Carolina Celebrates Two Years of Medicaid Expansion (Dec. 2025); NC Newsline, "NC lawmakers will fill Medicaid funding gap, but larger state budget issues remain unresolved" (Apr. 21, 2026) and "Healthcare costs, Medicaid cuts draw increased scrutiny from NC Democrats ahead of midterms" (Aug. 24, 2026); North Carolina Health News, Healthy Opportunities Pilot restart coverage (Sept. 8, 2026). Figures are dated to their source and update over time.

This page is general educational information, not medical, legal or insurance advice, and does not describe any individual's situation. It doesn't replace ACA Marketplace or Medicaid coverage for people who qualify. Never start, stop or change a medication without talking to your prescriber. LowerScript is a discount program, not insurance, and can't be combined with Medicare on the same purchase.

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Related: Prescription Help for the Uninsured in North Carolina · North Carolina Prescription Assistance Programs · Lower Costs Without Insurance · All North Carolina drug prices