Medicaid Eligibility in North Carolina: Income Limits & How to Apply
Medicaid Eligibility in North Carolina
Thanks to ACA Medicaid expansion, North Carolina offers coverage through NC Medicaid for adults earning up to 138% FPL — approximately $21,597/year for an individual and $44,367/year for a household of four in 2026.
Key threshold: If your income is below $21,597 (individual) or $44,367 (family of 4), you likely qualify for NC Medicaid with free or very low-cost coverage. No premiums, no deductibles.
Under North Carolina's expanded program, coverage extends to:
- Adults aged 19-64 with income up to 138% FPL
- Children in families with income up to 200-300% FPL (varies by age)
- Pregnant women with income up to 185-200% FPL
- Seniors and people with disabilities who meet income and asset requirements
About NC Medicaid
Navigating healthcare coverage in North Carolina can seem complex, but understanding your options for NC Medicaid or marketplace subsidies is key to getting affordable care. NC Medicaid has expanded its eligibility, now covering adults with incomes up to 138% of the Federal Poverty Level (FPL). For a single adult, this means an annual income of about $20,782 in 2024, and for a family of three, it's about $35,631 per year. Beyond income, eligibility also extends to children (up to 215% FPL for ages 0-5 and 138% FPL for ages 6-18), pregnant women (up to 201% FPL, with 12 months of postpartum coverage), seniors, and individuals with disabilities. This is a substantial program, with over 3 million North Carolinians covered by Medicaid in 2024, representing about 27.5% of the state's population.
If your income is close to the NC Medicaid cutoff, you might find yourself transitioning between Medicaid and marketplace coverage. For example, a single adult earning just above $20,782 might not qualify for NC Medicaid but would likely be eligible for significant subsidies on HealthCare.gov. The benchmark Silver plan in North Carolina is around $588 per month, which is moderate compared to the national average. With subsidies, your actual monthly payment could be much lower, depending on your income. It's important to remember that income changes can shift your eligibility, so if you've recently lost Medicaid coverage during the "unwinding" period, you can reapply at any time if your circumstances change. North Carolina's Medicaid enrollment actually increased during this unwinding period due to expansion, making it unique among states.
NC Medicaid provides comprehensive benefits with little to no cost-sharing. This includes primary care, inpatient and outpatient hospital services, maternity and postpartum care, behavioral health services, and prescription drug benefits. North Carolina also has specific waiver programs that offer unique benefits. For instance, the NC Innovations Waiver supports individuals with intellectual and developmental disabilities (I/DD) by providing home and community-based services, such as help with daily activities, job coaching, and respite for caregivers. This waiver can even waive some typical Medicaid income requirements, though there can be a waitlist, so applying early is crucial. Other waivers include programs for medically fragile children and disabled adults.
When applying for NC Medicaid, be aware that while there are no asset limits for income-based Medicaid, other programs, like disability-based Medicaid, do have asset limits. Exempt assets typically include your primary residence, one vehicle, personal belongings, and certain burial funds. North Carolina's uninsured rate has improved, but at around 9.2% in 2023, it's still higher than the national average. The state has also experienced some delays in implementing its Tailored Plans, which are specialized managed care plans for individuals with complex behavioral health needs, I/DD, and traumatic brain injuries. These plans are now scheduled to launch on July 1, 2024. To take action, visit HealthCare.gov or ePass to apply online, or contact your local County Department of Social Services.
North Carolina Medicaid Income Limits 2026
The following table shows the key income thresholds for North Carolina in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | $21,597 | $62,600 |
| 2 | $21,150 | $29,187 | $84,600 |
| 3 | $26,650 | $36,777 | $106,600 |
| 4 | $32,150 | $44,367 | $128,600 |
| 5 | $37,650 | $51,957 | $150,600 |
| 6 | $43,150 | $59,547 | $172,600 |
If your household income falls below the 138% FPL column, you qualify for NC Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
The benchmark Silver plan in North Carolina costs about $588/month before subsidies, which is in line with the national average. Subsidies can significantly reduce this cost for qualifying households.
Marketplace Insurance in North Carolina
North Carolina residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in North Carolina costs approximately $588/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in North Carolina might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Residents of North Carolina shop for marketplace insurance through HealthCare.gov, the federal exchange. The application process screens for Medicaid eligibility first, so you'll be directed to North Carolina's program if you qualify.
North Carolina adopted Medicaid expansion, bringing NC Medicaid coverage to low-income adults who previously had no affordable option. The transition between Medicaid and marketplace coverage is handled through HealthCare.gov.
How to Apply for NC Medicaid
- Apply through the marketplace — HealthCare.gov will determine whether you qualify for NC Medicaid or marketplace subsidies when you submit your application.
- Apply with the state — Contact North Carolina's Medicaid agency directly. There is no deadline — Medicaid enrollment is open year-round.
- Call for help — Reach North Carolina's Medicaid helpline to check your eligibility or get application assistance over the phone.
- Visit a local office — Your county human services department or a certified application counselor can help in person.
To complete your application, you'll need income documentation (pay stubs, tax returns), a North Carolina address for residency verification, Social Security numbers for household members, and information about existing coverage.
Calculate Your Subsidy in North Carolina
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in North Carolina.
Check Your Eligibility →Frequently Asked Questions
How much can I earn and still qualify for NC Medicaid?
In 2026, the Medicaid income limit in North Carolina is 138% of the federal poverty level: $21,597 per year for an individual, $29,187 for a household of 2, $36,777 for 3, and $44,367 for a family of 4.
Is Medicaid expanded in North Carolina?
Yes, North Carolina has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for NC Medicaid.
How do I get help paying for health insurance in North Carolina?
Yes. North Carolina residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the name of North Carolina's Medicaid program?
North Carolina's Medicaid program is known as NC Medicaid. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
What should I do if my NC Medicaid coverage is ending?
If your NC Medicaid coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Am I eligible for NC Medicaid if I'm employed?
Yes. Medicaid eligibility in North Carolina is based on your Modified Adjusted Gross Income (MAGI), not your employment status. If your household income is at or below 138% FPL ($21,597 for an individual), you qualify for NC Medicaid even if you work full-time. Many NC Medicaid enrollees are working adults.
What's the difference between Medicaid and marketplace insurance in North Carolina?
Medicaid (NC Medicaid) is free or near-free with no premiums or deductibles. Marketplace plans in North Carolina average $588/month before subsidies. If you qualify for Medicaid, it's the more affordable option. If your income puts you just above the cutoff, subsidized Silver plans with cost-sharing reductions are the next best thing.
Medicaid Eligibility in Nearby States
- Georgia Medicaid Eligibility — Non-expansion state
- South Carolina Medicaid Eligibility — Non-expansion state
- Tennessee Medicaid Eligibility — Non-expansion state
- Virginia Medicaid Eligibility — Expansion state