Head-to-head, from CMS Plan Year 2026 data.
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Alabama is the cheaper of the two: a 40-year-old pays about $680/month for the median Silver plan, versus $828 — a difference of $148/month (22%) before subsidies.
| Alabama | North Carolina | |
|---|---|---|
| Median Silver @40 | $680 | $828 |
| Cheapest Silver @40 | $583 | $540 |
| Most expensive county @40 | $1,124 | $1,128 |
| Age 27 | $478 | $443 |
| Age 60 | $1,238 | $1,147 |
| Carriers | 4 | 6 |
| Counties | 67 | 100 |
| 1-carrier counties | 7 | 0 |
| Plan types | EPO, PPO | EPO, HMO, POS, PPO |
Source: CMS Plan Year 2026 Qualified Health Plan Landscape. Full-price filed rates before premium tax credits; not a quote or an offer of coverage.
This page sets two states against each other. For county-by-county carriers, plan data and help actually enrolling, I publish a page for each state on Coverage by County: Alabama or North Carolina. There is also a blog covering deductibles, subsidies and special enrollment periods.
Put your ZIP code in and I will show you the carriers filing in your county, what the cheapest plan costs, and what you would actually pay after any help you qualify for. No cost, and you talk to me — not a call center.
An Alabama-to-North Carolina move triggers a 60-day special enrollment period, so the 6 carriers filing in North Carolina are open to you outside the usual window. The catch is on both ends — you normally need to have carried qualifying coverage for a day or more in the 60 days before moving, and moves made for treatment or travel are excluded.
Your plan will not come with you. Marketplace coverage is sold state by state, so the Alabama policy ends and a North Carolina application begins — new network, new premium, even if the name on the card stays the same.
Some continuity is possible: UnitedHealthcare file in both, out of 4 in Alabama and 6 in North Carolina. Same company is easier paperwork, but it is a different plan on a different network at a different price.
Availability is uneven — 67 of 67 counties in Alabama, 90 of 100 in North Carolina sell a PPO. That makes the county you land in, not the state you pick, the thing that decides whether out-of-network care is covered.
Only one of the two can be your plan state. Marketplace eligibility runs on primary residence, so if you file from Alabama the North Carolina care is the out-of-network half, and the reverse if you file from North Carolina.
State averages hide enormous county-level spread. Whichever of Alabama or North Carolina you are in, your ZIP is what sets your premium.