Open Enrollment Without the Overwhelm (NC Edition): A Friendly Guide for Families —And Where DPC Fits

Written By Elsie Osei-Nkansah

Educational information only. Not legal, financial, or tax advice. For personal guidance, talk with a licensed insurance agent/broker or Marketplace Navigator in North Carolina.

 

First, let’s talk what’s happening this season?

Open Enrollment for most states—North Carolina included—runs from Nov 1, 2025 to Jan 15, 2026. If you choose a plan by Dec 15 and pay the first premium, coverage typically begins Jan 1. NC uses HealthCare.gov, so the federal calendar applies.

Premiums are under pressure; initial 2026 filings in NC request increases roughly in the mid-20% to mid-30% range, though final approvals will vary by plan, carrier, and region. Treat those filings as directional and check your own options and any subsidy eligibility.

**Big takeaway: don’t shop by premium alone—compare total cost (deductible, coinsurance, copays, prescription tiers, and the out-of-pocket maximum).

Here’s what the cost picture looks like right now:

In 2025, the average employer family plan runs about $26,993, with workers contributing roughly $6,850 toward the premium.

For 2026, small-group (ACA-compliant) plans are seeing median rate filings around 11% increases, though the exact number varies by state and insurer.

On the individual side, Marketplace premiums are projected to rise by about 18% on average for 2026, influenced in part by uncertainty around the enhanced premium tax credits set to expire at the end of 2025 unless extended. Your actual cost depends on subsidies and plan choice.

**Bottom line: plan ahead, compare carefully, and use professional help to make sense of subsidies, networks, and your total out-of-pocket exposure.

60-Second Direct Primary Care Refresher

DPC is not insurance—it’s a simple membership for high-access primary care.

  • Longer visits

  • Easy messaging

  • Same- or next-day help for acute issues

  • Care from a team that knows you

  • DPC doesn’t cover: hospitalizations, surgeries, specialists, imaging, or expensive medications.

    • You still need an insurance “safety net” (or another risk arrangement) for big costs.

  • Popular pairings:

    • Marketplace plan + DPC → lower monthly premium + everyday care via DPC

    • HSA-qualified HDHP + DPC → keep pre-tax savings while using DPC for routine care

  • 2026 HSA & HDHP figures (starting Jan 1, 2026):

    • HSA contribution limits: $4,400 (self-only) | $8,750 (family)

    • HDHP minimum deductibles: $1,700 (self-only) | $3,400 (family)

    • Out-of-pocket maximums: $8,500 (self-only) | $17,000 (family)

  • New federal guidance (effective 2026):

    • Being in a DPC does not disqualify HSA eligibility.

    • You can use HSA funds tax-free to pay ongoing DPC fees.

    • (Confirm specifics with your HSA custodian/plan.)

  • For employers:

    • DPC can improve access, reduce avoidable urgent care/ER visits, and boost employee satisfaction.

    • Pair with a solid group plan and pharmacy strategy for major expenses.

**Bottom line: DPC is the access, insurance is the safety net—and with the 2026 HSA updates, the DPC + HDHP combo is even easier to use and save with. hsabank.com+5IRS+5psca.org+5

North Carolina Specific Notes For 2025-26

Marketplace Open Enrollment (NC): Nov 1 – Jan 15

  • Pick a plan by Dec 15 and pay first premium → coverage typically starts Jan 1

  • NC enrolls through HealthCare.gov

  • Free, unbiased help statewide:

    • NC Navigator Consortium: 855-733-3711 | ncnavigator.org

  • Rates & carriers:

    • See ACA rate filings at the NC Department of Insurance

    • 2026 requests show increases for several carriers; final approvals may differ

How DPC smooths open enrollment—and the rest of the year

  • Fewer surprises with fast access

    • Same- or next-day visits

    • Easy secure messaging

    • Often prevents costly urgent care/ER trips

  • Navigation support

    • Formularies and medication options

    • Imaging choices (cash vs. insurance pricing)

    • Smart referrals to trusted specialists

  • Prevention & chronic care that stays on track

    • Proactive follow-ups

    • Longer, unrushed visits

    • A care plan that actually fits your life

Print-this-out checklist (NC-ready)

  • Must-have doctors/hospitals (confirm in-network): ____________

  • Monthly budget ceiling (premium + any DPC): _______________

  • “Worst-case” tolerance (OOP max): _________________________

  • Top meds & tiers (coverage/PA confirmed): _________________

  • Planned life events (baby, surgery, travel): _______________

  • HSA eligibility? Yes / No / Not sure

  • Compared Plan A (lower deductible) vs Plan B (lower premium + DPC)? Yes / No

  • Spoke with Navigator/agent? (NC Navigator: 855-733-3711) Yes / No NC Navigator

Friendly wrap-up

You don’t have to be an insurance expert. Take one quiet hour: list your real needs, check networks, compare total cost, and decide whether a lower-premium plan paired with Direct Primary Care gives your family or team the access + protection you want. When in doubt, loop in a licensed NC Navigator/agent—and keep your primary care close.C

Contact us to learn more about our DPC membership. 

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Elsie Osei-Nkansah
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