Virginia Gilbert opened her health insurance renewal notice last week and felt her stomach drop. Her monthly premium: jumping from $930 to $2,042. More than double. For the exact same coverage.
“There’s no way I can afford that,” she told North Carolina Health News. She’s not alone.
Across Buncombe County and Western North Carolina, thousands of people who buy health insurance through the Affordable Care Act marketplace face the same brutal math. Enhanced premium tax credits expired December 31, 2025. Congress failed to extend them during government shutdown negotiations. Now the bill’s coming due.
The result? Premiums more than doubling for many enrollees. Coverage becoming unaffordable for moderate-income families. And a January 15, 2026 deadline forcing impossible decisions: pay the higher premium, drop coverage entirely, or scramble for alternatives with limited help available.
What Happened to ACA Subsidies in North Carolina?
Enhanced premium tax credits started as COVID-19 relief under the American Rescue Plan Act. They expanded the original ACA subsidies, making coverage affordable for millions who earned too much for traditional help but couldn’t handle full market-rate premiums.
Those enhanced credits? Gone as of December 31, 2025.
Subsidies now revert to the original 2010 ACA structure. That means help only kicks in if you earn under 400% of the federal poverty level—roughly $65,000 for a single person. Earn above that? You’re paying full freight.
For someone like Gilbert, the math shifted overnight:
- Before: Enhanced subsidies covered a significant chunk of her premium, bringing her monthly cost down to $930.
- After: With subsidies gone and insurers hiking rates to compensate for a sicker risk pool, her premium more than doubled to $2,042.
- Annual impact: That’s an extra $13,344 per year—money most moderate-income households simply don’t have.
Western North Carolina isn’t unique. This pattern’s repeating across every state with ACA marketplace enrollees who relied on enhanced credits.
Why Insurers Raised Rates So Drastically
Insurers saw this coming months ago. When they filed 2026 rates with state regulators, they built in two assumptions:
First assumption: Without enhanced subsidies, healthier people will drop coverage because premiums become unaffordable. That leaves a sicker, more expensive risk pool behind.
Second assumption: A sicker risk pool drives up claim costs, which requires higher premiums to break even.
The Kaiser Family Foundation research backs this up. Nationally, insurers requested a median 18% rate increase for 2026. But KFF’s analysis found that adverse selection—healthy people dropping out—adds another 4 percentage points on top of that base increase.
| Factor | Premium Impact |
|---|---|
| Base medical cost inflation | +18% (median) |
| Adverse selection from subsidy loss | +4% |
| Combined effect in some markets | 100%+ increase |
In Buncombe County, that combined effect pushed Gilbert’s premium increase past 119%. Other enrollees report similar jumps.
It’s a vicious cycle. Higher premiums push out healthier enrollees. That makes the remaining pool sicker. Which drives premiums even higher next year.
60K North Carolinians Face Coverage Decisions Before Jan 15
The clock’s ticking. ACA open enrollment ends January 15, 2026. That gives Buncombe County residents roughly 8 weeks to:
- Review new premium costs with expired subsidies
- Compare available plans on Healthcare.gov
- Determine if they still qualify for any subsidies under the original ACA formula
- Decide whether to keep coverage, switch plans, or drop insurance entirely
Normally, this process involves ACA navigators—trained professionals who help consumers understand their options. But there’s a problem.
David Riggs, an ACA insurance advisor quoted in the North Carolina Health News report, said it plainly: “We don’t have as much capacity as we did last year at a time when a lot of people need more help than ever.”
Navigator programs got reduced funding. Meanwhile, demand for assistance skyrocketed as confused enrollees tried to understand their new costs. The math doesn’t work.
For Gilbert and thousands like her, that means navigating premium shock largely on their own.
Political Deadlock Left Consumers Stranded
This wasn’t inevitable. Democratic senators attempted to negotiate an extension of enhanced subsidies during government shutdown talks in early November 2025. They made it clear: no subsidy extension, no deal to reopen the government.
Republicans refused. President Trump posted on social media that enhanced ACA subsidies are “a windfall for Health Insurance Companies and a DISASTER for the American People.”
The government reopened without a subsidy extension. Senate Democrats promised a standalone vote on extending the credits, but that vote remains unlikely before January 2026—well after the enrollment deadline.
Translation: Political negotiations failed. Consumers pay the price. Literally.
The Centers for Medicare & Medicaid Services oversees ACA implementation but has no authority to extend subsidies without Congressional action. They’re stuck administering a system where affordability just collapsed for millions of enrollees.
3 Options for Buncombe County Residents Facing Premium Shock
If your premium doubled, you’re not powerless. You have choices—none perfect, but worth exploring before January 15:
- Switch to a bronze or catastrophic plan. Lower premiums, higher deductibles. You’ll pay more out-of-pocket when you use care, but at least you maintain coverage. Check Healthcare.gov for available plans in your county. Some bronze plans cost 40-50% less than silver plans.
- Check if you qualify for Medicaid expansion. North Carolina expanded Medicaid in 2023. If your income dropped or changed, you might now qualify for Medicaid instead of ACA marketplace coverage. Medicaid has no premiums and minimal cost-sharing. Visit NC DHHS to check eligibility.
- Explore employer-sponsored insurance options. If you or a spouse have access to workplace coverage, compare those premiums to your new ACA costs. Employer plans might now be cheaper, especially if the employer contributes to your premium. Open enrollment periods at work might align differently, so check with HR immediately.
- Consider short-term health plans (with extreme caution). These plans cost less but offer significantly less protection. They can deny coverage for pre-existing conditions, cap benefits, and leave you exposed to catastrophic medical bills. Only consider if you’re young, healthy, and desperate for any coverage. Not recommended for most people.
Whatever you choose, act before January 15. Miss that deadline, and you’re uninsured until the next open enrollment period—unless you qualify for a special enrollment period due to a life event like job loss or marriage.
Will Healthier People Drop Coverage?
Insurers are betting on it. KFF’s research suggests that’s exactly what happens when subsidies disappear and premiums spike.
Healthier enrollees calculate the risk differently. Someone who rarely visits the doctor might look at a $2,042 monthly premium—$24,504 per year—and decide to roll the dice uninsured. Especially if they’re under 40, exercise regularly, and haven’t had serious health issues.
But that gamble can backfire catastrophically. One car accident, one cancer diagnosis, one unexpected hospitalization can generate six-figure medical bills. Without insurance, those bills can trigger bankruptcy.
Still, faced with unaffordable premiums, many healthy people will drop coverage. That leaves the ACA marketplace with a sicker, older, more expensive risk pool. Premiums rise again in 2027. More people drop out. The cycle continues.
Insurance economists call this the “death spiral.” North Carolina might be watching it unfold in real time.
Frequently Asked Questions
Why are ACA premiums doubling in North Carolina for 2026?
Enhanced premium tax credits expired December 31, 2025, removing significant federal subsidies that made coverage affordable. Insurers also raised base rates by a median 18%, anticipating that healthier enrollees would drop coverage once subsidies disappeared. The combination—lost subsidies plus higher base rates—pushed many premiums past 100% increases in Buncombe County and across Western North Carolina.
What happens if I miss the January 15 ACA enrollment deadline?
You’ll be uninsured until the next open enrollment period, which typically runs November through January of the following year. The only exceptions are special enrollment periods triggered by qualifying life events—job loss, marriage, divorce, birth of a child, or moving to a new state. Without coverage, you’re responsible for 100% of medical costs, which can quickly reach tens of thousands of dollars for unexpected health issues.
Do I still qualify for any ACA subsidies after the enhanced credits expired?
Maybe. Original ACA subsidies remain available if your household income falls between 100% and 400% of the federal poverty level—roughly $15,060 to $60,240 for a single person in 2026, or $31,200 to $124,800 for a family of four. If you earn above 400% FPL, you receive zero subsidies and pay full market-rate premiums. Check Healthcare.gov’s calculator to see if you qualify based on your projected 2026 income.
Should I drop my ACA coverage if premiums doubled?
Not without exploring alternatives first. Going uninsured exposes you to catastrophic financial risk—a single hospitalization can cost $50,000 to $150,000 without insurance. Before dropping coverage, compare lower-cost bronze or catastrophic plans, check if you now qualify for Medicaid expansion in North Carolina, or see if employer-sponsored insurance became more affordable relative to your new ACA premium. Only drop coverage as a last resort if you’ve exhausted all other options.
Will Congress extend ACA subsidies before the 2026 enrollment deadline?
Unlikely before January 15. Democratic senators promised a vote on extending enhanced subsidies, but Republicans oppose the extension, and President Trump publicly called the subsidies “a windfall for Health Insurance Companies.” Even if a vote happens in early 2026, it won’t affect the current enrollment period. Don’t count on subsidy restoration when making your coverage decision. Plan based on current costs, not political promises.
Bottom Line: Act Before January 15 or Face Unaffordable Consequences
Virginia Gilbert’s premium shock isn’t unique. It’s the new reality for thousands of North Carolina residents who relied on enhanced ACA subsidies to afford health insurance.
Congress failed to extend those subsidies. Insurers raised rates anticipating a sicker risk pool. Navigator assistance capacity dropped just when demand surged. And the January 15 enrollment deadline forces decisions on a compressed timeline.
If your premium doubled, you have 8 weeks to compare plans, check Medicaid eligibility, explore employer options, or make the difficult choice to drop coverage entirely. Whatever you decide, don’t wait until January 14.
The math might feel impossible. But going uninsured creates risks far worse than high premiums. One unexpected health crisis can bankrupt you. At least with coverage—even expensive coverage—you have protection.
Check Healthcare.gov now. Compare every available plan in Buncombe County. Run the numbers. Make the decision based on facts, not frustration.
Your deadline: January 15, 2026. Don’t miss it.