November 1st is the start of health insurance open enrollment!
This is the time when you can renew or change your health insurance for the upcoming year through the Affordable Care Act (ACA) Marketplace. While insurance is always complicated, 2026 will bring new challenges for TGD and low income people.
Federal policies and budgets play a large role in regulating services through Medicare, Medicaid, and Tricare/ Veterans Health Administration. In response, private insurance companies often mirror federal policies, even when they’re not legally obligated to do so. Particularly as the North Carolina state government and the federal government have failed to pass a budget for fiscal year 2026, these factors add up to a confusing, constantly changing landscape of coverage for TGD people.
Affordable Care Act:
Passed into law in 2010 by the Obama Administration, the Affordable Care Act (ACA), also known as Obamacare, is a healthcare reform law that created a new pathway to insurance coverage for people who don’t get health insurance through their employer. Since it began offering insurance plans in 2014 it has provided health insurance to over 49.4 million unique individuals (U.S. Department of Treasury, 2024). Over 1 million North Carolinians were covered through ACA plans in 2024 (KFF, 2025).
These plans are partially funded by the federal government, through premium tax credits; people with an ACA plan can deduct a portion of their monthly insurance premiums from their income taxes each year. In 2021 as part of COVID response policies, the federal government enhanced these tax credits making insurance affordable for more people. These enhanced premium tax credits are one of the key issues at the core of our current government shutdown as they are set to expire, returning the deduction to its pre-pandemic rate. This proposed subsidy cut coincides with a 28% increase for North Carolinians with ACA plans (NC Department of Insurance, 2025). Monthly premiums for ACA plans are expected to skyrocket, particularly for people near the federal poverty level ($15,650 for a single adult in 2025). An estimated 4.8 Million people will lose their insurance coverage in the coming year (Urban Institute, 2025).
Open Enrollment:
You can browse ACA plans on Healthcare.gov at any time between November 1st and January 15th. In North Carolina, you must sign up for an insurance plan by December 15th (12/15/2025) for coverage to start on January 1st, 2026 (01/01/2026). If you need an ACA plan and don’t sign up for one at this time, you won’t be able to enroll unless you have a qualifying life event, like aging out of your parents insurance (at 26 years old), having a baby, or becoming a US citizen.
Medicaid:
Medicaid is a type of insurance regulated jointly by the federal and state government which supports low income people and people with disabilities. It covers primary care, emergency room visits, and prescription medication, as well as vision and some dental care with no monthly fees and copayments capped at $4. Medicaid is our nation’s largest public healthcare program in terms of annual spending at over $918 Billion in 2024 (KFF, 2025).
In 2024, North Carolina expanded eligibility for Medicaid and enrolled over 600,000 people. Our state legislators have failed to pass a budget that meets the needs of the program, carrying over the budget from last year and by reducing the reimbursements paid to healthcare providers. This is particularly concerning as the “One Big Beautiful Bill Act” (HR1), passed in July of 2025, will reduce nationwide Medicaid spending $900 billion ($23B in cuts in NC), resulting in over 10 million additional Americans without insurance by 2035 (Euhus et al., 2025). North Carolina state legislators will be responsible for finding funding to continue Medicaid at its current scale.
Visit the NC DHHS Website for more information about Medicaid eligibility and enrollment.
If you need help selecting an ACA plan for 2026, or applying to Medicaid CTH will be hosting an enrollment event on December 11th, 2025 from 3-7PM. Subscribe to our Monthly Newsletter or follow us on social media for more details soon!
You can also contact your representatives to demand the that enhanced premium tax credits remain in the new federal budget.
Resources:
- Out 2 Enroll– offers appointments with enrollment assisters trained in LGBT healthcare needs and insurance plan coverage guides for gender affirming care services.
- Legal Aid of NC– offers assistance and education around ACA plans, Medicaid, and Medicare.
- Call the Navigator Helpline Monday-Friday, 9am-5pm at 1(855)733-3711 for help enrolling in an ACA plan!