NORTH CAROLINA · 100 COUNTIES · 2027 APPROVED RATES · NOVEMBER 2026
What does employer health coverage cost in North Carolina?
Regulators approved 15.8% on marketplace plans in North Carolina for 2027. The national median is 14.8%.
Employer group plans were approved at 19.5%. Out-of-network coverage is the thing to check first. 90 of the 100 counties have a PPO or POS filed, and the other 10 have neither.
North Carolina, by the filings
What did regulators approve for North Carolina?
Every figure below comes from the filings insurers submitted to regulators. The 2027 numbers are what regulators approved, not what insurers asked for.
| North Carolina | Figure | What it tells you |
|---|---|---|
| 2027 approved change, marketplace plans | +15.8% +8.3% to +27.4% across 5 insurers | 24th highest of 51. The national median is 14.8%. Insurers had asked for 16.5%. |
| 2027 approved change, employer group plans | +19.5% +18.8% to +19.5% across 3 insurers | Group came in 3.7 points above marketplace here. |
| 2026 approved change | +29.8% marketplace +15.0% group | Compounded with 2027, that's roughly 37% to 50% on top of 2025. |
| Lowest cost silver plan, age 40, typical county | $686 per month $540 to $834 across counties | The number a CHOICE Arrangement contribution has to cover to pass the IRS affordability test. |
| Counties with a PPO or POS plan filed | 90 of 100 | 10 North Carolina counties have neither, so the answer changes inside the state line. Check the county your people live in. |
| Typical county, lowest cost silver by plan type | $686 HMO · $842 PPO | A PPO costs about $156 per month more here. |
| Marketplace vs group cost per member per month, 2026 | $814 marketplace $766 group | Group plans cost less per member here. North Carolina is not one of the 22 states where marketplace wins on price. |
| Insurers competing per county | 2 to 6 | Every North Carolina county has at least 2 insurers competing. |
| Out-of-network plans sold off the marketplace | 7,221 enrolled 35 POS and PPO plans | POS and PPO coverage is sold off the marketplace in North Carolina, and a CHOICE Arrangement can pay for it. Buying off the marketplace costs the employee any premium tax credit, which an affordable arrangement rules out anyway. |
What it means for a North Carolina employer
Your renewal is a number. What are you allowed to change about it?
An approved 15.8% sits above the national median of 14.8%. The market number isn't your number, though. Two North Carolina employers the same size can land 20% apart on the same filings.
The North Carolina-specific read: group plans cost less per member per month here, so a CHOICE Arrangement isn't the obvious lever. What North Carolina does have is out-of-network coverage still on the shelf, which means the door stays open if your census makes the math work.
Where the money actually is at these rates: not the plan type, the design changes inside it. Sourcing 2,000+ medications at a $0 copay for the whole household. Unlimited virtual primary and behavioral care so a $0 visit replaces an urgent care trip. A supplemental layer that pays the employer back every pay period instead of adding a line item.
Those have landed at $2,000+ per employee per year in real client projects, with about $988 per employee per year in new cashflow on top of that and independent of it. About $100K per year for every 50 people. $0 upfront, billed out of savings, live in 30 to 45 days. Same broker, same doctors, same cards.
Compare the 12 plan designs · All 50 states and DC · PPO availability by county · Benchmark your cost
If your North Carolina renewal came back flat instead of 15.8%, what would you put the difference into first?
Results vary by group size, plan design, and utilization.
Sounds concerning? You have options.
So what are the actual options in North Carolina?
North Carolina still has out-of-network coverage on the shelf, so nothing here is closed off. The question isn't whether you have options. It's which one costs less on your census.
Here's the part that isn't anyone's fault. The systems that surface plan options only surface what's already inside them. The marketplace shows you what insurers filed for the marketplace. Your broker shows you the markets their appointments reach. Both are doing their job. Neither one can show you what sits outside it.
99% of the brokers we talk to have never had visibility to our programs. They sit outside their commissioned channels.
| What you run today | What changes | Range observed |
|---|---|---|
| Fully insured, mid-market | Level-funded, shelf-rated, or a partially self-funded design, so a good claims year comes back to you instead of staying with the carrier. | 15 to 25% of plan cost |
| Already self-funded | Stop-loss restructured, a captive layer, and claims priced off a defensible benchmark instead of a billed charge. | 20 to 30% of plan cost |
| Any plan, any funding | Layers that sit on top of what you already run. 2,000+ medications at $0 to the whole household. Unlimited virtual primary and behavioral care. A supplemental layer that pays the employer back every pay period. | $2,000+ per employee per year plus up to about $988 per employee per year in new cashflow about $100K per year for every 50 people |
| A group plan you can't move yet | A GCHRA or EBHRA running alongside it, so people buy what they actually need with pretax dollars without touching the plan itself. | No audited range published. Depends entirely on take-up. We won't print a number we haven't measured. |
| Ready to leave the group plan | A CHOICE Arrangement. Defined contribution instead of a defined plan. Your cost becomes a number you set rather than a renewal you receive. | Priced per census. Whether it beats your group plan depends on the county mix in your census, not the state average. |
Why the ranges are keyed to what you run today and not to a product name: that's how they were measured. Every range above comes from completed client projects, grouped by the employer's starting point. We don't publish a savings percentage next to "level-funding" or "captive" as a category, because nobody measured a category. If you see a number like that anywhere, ask what it was measured on.
$0 upfront. Billed out of savings. Live in 30 to 45 days. Same broker, same doctors, same cards. First-year ROI has landed at 10 to 16x across completed projects.
Compare all 12 plan designs · Benchmark your own cost · Get it priced on your census
If one of these came back at the low end of its range for your North Carolina group, which line in your budget would you want it to pay for first?
Ranges are what we have observed across completed engagements. They are not a guarantee, not a quote, and not an offer of coverage. Your result depends on group size, plan design, census, and utilization.
Questions North Carolina employers ask
How much are health insurance rates going up in North Carolina in 2027?
Regulators approved a median 15.8% increase on marketplace plans in North Carolina and 19.5% on employer group plans for 2027. The national median across all individual market filings is 14.8%. Individual insurer approvals in North Carolina range from 8.3% to 27.4%. Insurers had asked for 16.5%.
Is a PPO available in North Carolina on the marketplace?
In part of the state. 90 of the 100 North Carolina counties have a PPO or POS plan filed for 2026, and 10 have neither. Check the county your people live in rather than assuming the state answer.
What does a silver plan cost in North Carolina?
The lowest cost silver plan for a 40-year-old non-smoker runs $686 per month in a typical North Carolina county for 2026, ranging from $540 to $834 across counties, before any subsidy. The lowest cost PPO silver plan runs about $842.
Do I have to offer health insurance if I have fewer than 50 employees in North Carolina?
Not under federal law. The ACA employer rule starts at 50 or more full-time employees, counting full-time equivalents and averaged over the prior year. Below that line it's a choice rather than an obligation. Hawaii is the national exception: it requires coverage for anyone working 20 or more hours per week, with no headcount minimum at all. Some states run an employer assessment that helps fund public coverage, Massachusetts among them, which is a payroll charge rather than a requirement to offer a plan.
What are my options in North Carolina with fewer than 50 employees, and what changes above 50?
Under 50, the designs that carry no headcount minimum are open to you: a CHOICE Arrangement (formerly ICHRA), QSEHRA, shelf-rated (flat-rate) guaranteed issue plans, and the supplemental layers that sit on top of whatever you already have. Level-funded generally opens up in the tens of lives. At 50 and above, self-funding, a captive and reference-based pricing come into range, and the ACA reporting obligations begin. A MEC-only plan is the cheapest way to clear the larger penalty, and worth comparing against a bronze-level design before you choose it. The usual surprise is how much is available below 50, not how little.
What's my best option in North Carolina?
It depends, and the honest version of that answer is a short list of variables rather than a product. Headcount, your workforce ages, whether anyone is mid-treatment, whether you want your claims data back, and what you can fund per employee. The 10 counties without a PPO or POS are worth identifying early if any of your people live there. The range is wide: shelf-rated guaranteed issue plans, which price everyone the same regardless of age and can run alongside your existing plan rather than replacing it, bundles carrying $0 copays on prescriptions, telehealth and behavioral health, high-deductible designs with first-dollar coverage, and combinations in between. If you'd like a look at your specific situation, you can reach us here.
Do you have people in more than one state?
Filings, premiums and PPO availability all change at the state line, so a census that crosses one gets priced state by state rather than on a national average. These are the states nearest North Carolina, each with the same figures.
Georgia employer health plan costs · South Carolina employer health plan costs · Tennessee employer health plan costs · Virginia employer health plan costs
All 50 states and DC · PPO availability by county · Plain-English glossary
Where these North Carolina numbers come from
Rate changes are the midpoint of what regulators approved for each insurer in North Carolina, from the CMS rate review service, pulled November 1, 2026. All 8 North Carolina filings for 2027 carry a final determination. County premiums are the lowest cost plan per metal level for a 40-year-old non-smoker before any subsidy, from the CMS marketplace plan and rate files for plan year 2026, covering all 100 North Carolina counties.
The marketplace versus group cost comparison uses the 2026 average premium per member per month from the insurersā€™ own filings on both sides, weighted by enrollment. It is an average across each planā€™s enrolled mix, not a same-metal, same-plan-type quote. Plan-type availability counts every marketplace plan filed in every North Carolina county and asks whether any of them is a PPO or POS, because the split that matters is whether a doctor outside the network is covered at all. Off-marketplace plans are counted separately, at state level, from the insurersā€™ 2026 rate filings.
Nothing here is a quote.
