North Carolina Health Insurance & Medical Costs
Complete guide to healthcare costs in North Carolina. Compare insurance premiums, understand ACA marketplace options, and find medical procedure prices.
About Healthcare in North Carolina
Major Cities: Charlotte, Raleigh, Greensboro, Durham, Winston-Salem
Marketplace: North Carolina uses federal marketplace. Recently expanded Medicaid. Blue Cross Blue Shield dominates the marketplace.
Quick Cost Overview
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Couple
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Family of 4
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Explore North Carolina Healthcare Costs
Health Insurance Costs
Find detailed premium information for different household sizes and plan types.
ACA Marketplace
Learn about subsidies, income limits, and marketplace options in North Carolina.
Medical Procedure Costs
Understand out-of-pocket costs for common medical procedures.
Medical Procedure Costs in North Carolina
MRI Scan
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ER Visit
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CT Scan
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Understanding Healthcare Costs in North Carolina
North Carolina expanded Medicaid in December 2023, becoming one of the most recent states to do so. This expansion is expected to cover over 600,000 additional residents. The state's ACA marketplace has historically been dominated by Blue Cross Blue Shield of North Carolina, though competition has improved in recent years with Ambetter, Cigna, and Oscar entering various counties.
North Carolina Healthcare Landscape
North Carolina is home to world-class medical institutions including Duke University Health System, UNC Health, Wake Forest Baptist Health (part of Atrium Health), and Atrium Health (one of the largest health systems in the Southeast). The Research Triangle (Raleigh-Durham-Chapel Hill) has exceptional concentration of medical expertise. Rural North Carolina faces significant healthcare access challenges.
Regional Cost Variations
Healthcare costs in North Carolina vary between the major metros (Charlotte, Raleigh-Durham, Greensboro) and rural areas. The Research Triangle has higher costs due to academic medical centers but also more provider options. Charlotte's costs are influenced by the dominance of Atrium Health. Rural Eastern and Western North Carolina face provider shortages and limited competition.
Key Factors Affecting North Carolina Healthcare Costs
- Urban vs. Rural: Healthcare costs in cities like Charlotte and Raleighare typically higher than rural areas, but rural areas often have fewer provider options.
- Insurance Market Competition: North Carolina has 4+ major insurance carriers competing in the marketplace, including Blue Cross Blue Shield of NC and Ambetter.
- Hospital Pricing: Hospital-based services typically cost 2-4x more than independent clinics and imaging centers for the same procedures.
- State Marketplace: North Carolina residents use HealthCare.gov for ACA enrollment, which may offer state-specific programs or extended enrollment periods.
North Carolina Insurance Shopping Tips
- Blue Cross Blue Shield of NC has the most extensive statewide network and is available in all 100 counties
- Ambetter (Centene) offers competitive pricing in many NC counties
- Oscar Health has entered the Charlotte and Triangle markets with tech-forward plans
- Check if your preferred providers are in-network—NC has significant network variation
- With Medicaid expansion, check eligibility before purchasing marketplace coverage
How to Save Money on Healthcare in North Carolina
- NC Medicaid expansion means many more adults now qualify for free or low-cost coverage
- Community health centers across NC use sliding-scale fees regardless of insurance status
- Duke and UNC Health both have robust financial assistance programs for qualifying patients
- Free clinics operate in many NC communities for uninsured patients
- Many NC hospitals offer prompt-pay discounts for self-pay patients—always ask
Quick Tips for North Carolina Residents
Check Subsidy Eligibility
Many North Carolina residents qualify for ACA subsidies but don't apply. Use HealthCare.gov to see if you qualify for premium tax credits.
Compare Imaging Centers
For MRIs, CT scans, and X-rays, independent imaging centers in North Carolina often charge 50-70% less than hospital-based facilities.
Know Your Medicaid Options
North Carolina's Medicaid program (NC Medicaid) provides free or low-cost coverage for eligible residents. Income limits vary by household size.
Review Plans Annually
Insurance plans and carrier networks change yearly. During Open Enrollment, compare your current plan against new options in North Carolina's marketplace.
🏥NC Medicaid (Medicaid in North Carolina)
North Carolina expanded Medicaid in December 2023 after years of legislative debate. The expansion covers adults up to 138% of the Federal Poverty Level. NC Medicaid provides comprehensive coverage including medical, behavioral health, and some dental/vision services. The state uses managed care organizations (Prepaid Health Plans) to coordinate most Medicaid benefits.
Unique North Carolina Healthcare Programs
- NC Medicaid Expansion: New coverage for adults up to 138% FPL (began December 2023)
- NC Health Choice for Children: CHIP program covering children up to 211% FPL
- Carolina Pregnancy Care: Support for pregnant women enrolled in Medicaid
- NC Breast and Cervical Cancer Control Program: Free screenings for qualifying women
- Healthy Opportunities Pilots: Addressing social determinants of health through Medicaid
🚨Emergency Room Alternatives in North Carolina
North Carolina has growing urgent care options including Duke Urgent Care, UNC Urgent Care, Atrium Health Urgent Care, and FastMed. Retail clinics at CVS, Walgreens, and some Harris Teeter locations handle minor conditions. Telehealth services are increasingly popular and covered by most NC insurers. Major health systems offer virtual care platforms.
✅Medicaid Expansion Update
IMPORTANT UPDATE: North Carolina expanded Medicaid in December 2023. If you previously didn't qualify for coverage, check your eligibility now. Adults with incomes up to 138% of the Federal Poverty Level may now qualify for free or low-cost Medicaid coverage. Visit epass.nc.gov to apply.
💰Price Transparency in North Carolina
North Carolina hospitals must comply with federal price transparency requirements. The NC Department of Health and Human Services publishes hospital quality data. Blue Cross Blue Shield of NC provides cost estimator tools for members. North Carolina law requires hospitals to inform patients of financial assistance policies.
Need More Detailed Information?
Explore specific cost breakdowns, subsidy calculators, and real-world examples for North Carolina.
Disclaimer: The cost ranges shown above are estimates based on publicly available data from CMS, state insurance filings, and hospital price transparency reports. Actual costs vary by provider, location within North Carolina, age, and individual circumstances. Always verify specific costs with your insurance carrier or healthcare provider before receiving services.
Sources & Disclaimer
Sources:
- HealthCare.gov — Official ACA marketplace information and plan data
- CMS Public Use Files — Federal marketplace enrollment and premium data
- KFF Health Reform Analysis — Independent analysis of marketplace premium trends
Last Updated: January 2026
Disclaimer: The information provided is for educational purposes only. Actual costs vary based on individual circumstances, location, age, plan selection, and other factors. Always verify current information with official sources or licensed professionals. This site does not sell insurance or provide medical advice and is not affiliated with any insurance company or healthcare provider.