Key threshold: If your income is below $22,025 (individual) or $45,540 (family of 4), you likely qualify for NC Medicaid with free or very low-cost coverage. No premiums, no deductibles.
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 | $15,960 | $22,025 | $63,840 |
| 2 | $21,640 | $29,863 | $86,560 |
| 3 | $27,320 | $37,702 | $109,280 |
| 4 | $33,000 | $45,540 | $132,000 |
| 5 | $38,680 | $53,378 | $154,720 |
| 6 | $44,360 | $61,217 | $177,440 |
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.
About NC Medicaid
Who Qualifies for 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 You're Near the Income Line
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.
What NC Medicaid Covers
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.
Tips for Applying
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.
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 for a Silver plan after subsidies, based on the $588/month benchmark:
| Income Level | Annual Income | Your Cost | Monthly Subsidy |
|---|---|---|---|
| 150% FPL | $23,940 | ~$80/mo | $508/mo |
| 200% FPL | $31,920 | ~$173/mo | $415/mo |
| 250% FPL | $39,900 | ~$277/mo | $311/mo |
| 300% FPL | $47,880 | ~$392/mo | $196/mo |
| 400% FPL | $63,840 | ~$523/mo | $65/mo |
These estimates are for a 40-year-old individual on a benchmark Silver plan in North Carolina. Actual premiums depend on your age, household size, tobacco use, and plan choice. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays. North Carolina uses the federal marketplace at HealthCare.gov.
How to Apply for NC Medicaid
Medicaid enrollment is open year-round — there's no deadline. You can apply through any of these channels:
- Online: Apply through HealthCare.gov — the system automatically checks your NC Medicaid eligibility when you enter your income. Or apply directly through NC Medicaid.
- Phone: Call North Carolina's Medicaid helpline for guided help with your application.
- In person: Visit your local human services office or a certified application counselor.
You'll need proof of income (pay stubs or tax returns), proof of North Carolina residency, and Social Security numbers for household members.
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.
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: $22,025 per year for an individual, $29,863 for a household of 2, $37,702 for 3, and $45,540 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?
North Carolina residents with household income between 100% and 400% FPL ($15,960 to $63,840 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 ($22,025 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.