Rising Insurance Costs are Blocking Mental Health Treatment in North Carolina

Mental health treatment in North Carolina is becoming out of reach for thousands of residents as skyrocketing insurance premiums and steep deductibles force people to abandon therapy and other behavioral health services. A wave of policy changes and expiring federal subsidies has created a mounting crisis that hits hardest for those already impacted by depression, anxiety and co-occurring disorders.

North Carolina residents have a wide range of treatment options when it comes to managing mental health concerns and drug dependencies. Inpatient residential facilities and outpatient clinics stand ready to assist anyone who walks through their doors. But accessing services in The Tar Heel State may become more challenging as insurance options dwindle and prices soar.

High Costs Driving People Away From Therapy

The North Carolina Department of Insurance reported that average ACA rates in the state increased by more than 28% heading into 2026. At the same time, 200,000+ fewer North Carolinians enrolled in Affordable Care Act coverage this year, according to the Centers for Medicare and Medicaid Services.

For folks who’ve kept their coverage to pay for treatment, high deductibles threaten to make consistent therapy unaffordable. Bobby Newell, a licensed clinical social worker at Mindful Collaboration in Durham, noted that some clients carry deductibles ranging from $3,400 to $10,000. This means a person attending weekly therapy sessions could spend an entire year paying out of pocket before insurance kicks in.

The result: clients are stopping treatment not because they want to, but because they simply cannot afford to continue.

Linking Mental Health to Addiction

Disrupted access to behavioral health care doesn’t just affect people managing stress or life transitions. For individuals living with co-occurring disorders and combos of mental health conditions alongside substance use disorders, losing consistent care can have serious consequences.

Dual diagnosis treatment in North Carolina depends on ongoing, integrated support. When insurance gaps interrupt that care, the risk of relapse and psychiatric destabilization increases. Newell observed that previous clients stopped coming in at the start of the year because they couldn’t afford health insurance at all. Worse, this pattern has grown more common as private mental health practices struggle to serve as many people as they once did.

Newell pointed to a broader structural shift. Community mental health systems in the state have become increasingly privatized since 2000. This leaves fewer safety-net options for lower-income individuals and makes it harder for private group practices to extend subsidized care at scale. 

Insurance Coverage Matters

Just 761,457 North Carolinians enrolled in ACA coverage for 2026. It’s a sharp drop from the prior year driven by increased premium costs and the expiration of enhanced federal subsidies. Premium increases for marketplace plans range from roughly 7% to more than 36% depending on the insurer, representing the largest hike in five years.

An estimated 157,000 North Carolina residents who were enrolled in ACA coverage are at risk of losing it entirely in 2026 because they can no longer afford it, according to a letter Gov. Josh Stein sent to federal lawmakers.

For those losing coverage, the consequences extend well beyond skipped doctor visits. Behavioral health treatment centers, including residential treatment centers and outpatient programs, depend on insurance reimbursement to remain accessible. As coverage shrinks, so does the pool of people who can realistically seek care.

Treatment Approaches

For those still able to access care, evidence-based therapies remain the cornerstone of effective mental health and addiction treatment. Dialectical behavior therapy, which Newell uses in her practice, teaches emotion regulation skills particularly valuable for people who experience intense emotional responses or whose lack of emotional awareness may lead to addictions. 

Other widely used approaches in behavioral treatment centers include cognitive behavioral therapy (CBT), medication-assisted treatment (MAT) to relieve opioid and alcohol use disorders while stabilizing mood, and holistic care options like yoga

Finding Mental & Behavioral Care

For North Carolinians navigating this landscape, community health centers and local health departments may offer services regardless of insurance status. Free programs exist, and short-term insurance plans can assist uninsured residents, though these carry significant coverage limitations and fewer consumer protections.

Furthermore, most treatment centers often have financial counselors who can assist with insurance navigation, Medicaid eligibility checks, and sliding-scale arrangements.

Author

Nikki Wisher, BA

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Nikki Wisher is an Atlanta-based content writer who specializes in health and wellness. After earning her BA in English, she has been writing in the health and wellness space for over a decade, with credits ranging from addiction recovery to fitness to aesthetics and skin care. This includes her inclusive running blog forallrunners.com.

Editor

Peter Lee, PhD

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Peter W.Y. Lee is a writer and historian of American history during the Cold War. His primary focus is the relationship between youth and popular culture and its impact on U.S. society during the twentieth century. He has published widely on how the public has used popular culture as a mechanism to address political and social shifts throughout time