North Carolina's current small-employer definition, for nongrandfathered, nontransitional group health plans, is the federal one. G.S. 58-50-110(22b) states that, in connection with such a plan, "small employer" means an employer who meets the definition of small employer under 42 U.S.C. § 18024(b), and that the number of employees is determined using the method in Internal Revenue Code § 4980H(c)(2). The federal small-employer definition, as applied after the Protecting Affordable Coverage for Employees Act, is the usual 1-to-50 ceiling unless a state has elected a 1-to-100 market. North Carolina's statute points at that federal definition rather than writing a separate 1-to-100 line the way California and New York do.
The employer base
The Census Bureau's Statistics of U.S. Businesses for 2022 (state detailed-size file, released April 10, 2025) counts 184,520 North Carolina employer firms with fewer than 50 employees, out of 197,185 employer firms in the state, with 1,060,196 paid employees at those under-50 firms and 4,106,761 at all North Carolina employer firms. Under-50 firms were 93.6% of North Carolina employer firms in that file.
What official surveys say about cost
Among the eight states in this update (the largest small-business states other than Florida), North Carolina has the lowest published under-50 offer rate and the lowest under-50 single premium in MEPS-IC 2025. Table II.A.2 reports that 24.3% of private-sector establishments at North Carolina firms with fewer than 50 employees offered health insurance, compared with 97.2% at firms of 50 or more (46.9% of all North Carolina establishments). The national under-50 offer rate in the same table is 32.1%. At under-50 firms, average annual premiums were $7,872 for single coverage and $23,343 for family coverage, with average employee contributions of $2,012 (single) and $10,336 (family). National MEPS-IC 2025 under-50 averages were $9,034 for single coverage and $24,176 for family coverage, with a 32.1% offer rate at establishments of firms with fewer than 50 employees. The under-50 family employee contribution is among the highest in this eight-state set. Those are statewide averages for enrolled employees at offering establishments, not a Charlotte, Raleigh, Greensboro, or Wilmington quote. See the cost of small-business health insurance. The survey tables used here do not explain why the under-50 offer rate sits below the national figure; they do mean many smaller North Carolina firms are looking at a first plan rather than a renewal.
A company that is not an applicable large employer is generally not required to offer health coverage under the ACA employer shared-responsibility rules. Some smaller employers still choose to offer a plan, or to use an ICHRA or QSEHRA, and some may qualify for the Small Business Health Care Tax Credit when the IRS size, wage, and SHOP rules are met.
Who sells small-group coverage
This update does not include a verified official 2026 North Carolina small-group issuer list, so we will not invent one. The North Carolina Department of Insurance is the official place to confirm licensed issuers. We will only compare products that can be issued for the North Carolina counties and any other states on your roster. A national brand that sells small-group coverage in another state may not offer a North Carolina fully insured small-group plan.
Continuation when someone leaves the plan
Federal COBRA generally applies to employers with 20 or more employees. An official North Carolina continuation period was not confirmed end-to-end in the research for this file, so this page does not state one. We will confirm any state continuation rule with the Department of Insurance at proposal time. See COBRA for employers.
How we help a North Carolina employer
You send a roster, work locations, what you offer today, and your renewal date if you have one. We confirm the market you sit in and compare a fully insured small-group plan, SHOP or a state small-business marketplace where one applies, a level-funded design, an ICHRA or QSEHRA, or coverage arranged through a PEO. The method is on how to compare group health plans. Request a proposal or call (813) 540-1299.Frequently asked questions
What size company is a small group in North Carolina?
For a typical nongrandfathered plan, G.S. 58-50-110(22b) uses the federal small-employer definition in 42 U.S.C. § 18024(b) and the IRC § 4980H counting method. That is generally a 1-to-50 market unless a later official change says otherwise. We will apply the current statute to your roster.
Does Ares have a North Carolina office?
No. The only address on this site is 5701 E Hillsborough Ave, Tampa, FL 33610. Our agents are licensed in all 50 states, including North Carolina.Why is the published offer rate lower than in some other states?
MEPS-IC 2025 reports a 24.3% under-50 offer rate in North Carolina, the lowest among the eight states in this update and below the national 32.1% figure. The survey does not, in the figures used here, explain that gap.
What does coverage cost for a small North Carolina employer?
MEPS-IC 2025 under-50 averages are $7,872 (single) and $23,343 (family) a year, among enrolled employees at offering establishments. Your quote is built from your census.
Can you list the carriers that sell small-group plans in North Carolina?
Not as a complete official 2026 list in this update. We will confirm current issuers with official North Carolina sources and compare only products that can be issued for your locations.
Ready for a proposal?