Education · North Carolina prescription savings

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

Last updated September 4, 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.

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

What happened to ACA subsidies in 2026?

The enhanced premium tax credits that had been in place 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).

Has North Carolina expanded Medicaid?

Yes — effective December 1, 2023. More than 690,000 newly eligible North Carolinians have enrolled since expansion began, as of the two-year mark in December 2025 (NC Governor's Office).

How long do I have to enroll in a Marketplace plan after losing job-based coverage?

Generally 60 days from the date you lose job-based coverage, under the Special Enrollment Period. "You need to apply for Marketplace coverage within 60 days of losing your job-based coverage" (HealthCare.gov).

Does a discount card replace health insurance?

No. A discount card lowers the cash price of prescriptions but doesn't cover doctor visits, hospital care or other benefits. LowerScript is a discount card, not insurance, and can't be combined with Medicare on the same purchase.

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). 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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