Sky-High Insurance Bills Push North Carolinians Off The Therapy Couch

For a growing number of North Carolinians, mental health care is turning into a luxury line item. Climbing premiums and eye-watering deductibles are driving people out of therapy and other treatment, local clinicians say, as 2026 insurance bills land and out-of-pocket costs spike.

Clinics feel the strain

In Durham, licensed clinical social worker Bobby Newell says she is already seeing clients vanish from the schedule, not because they are doing better, but because they can no longer afford to stay. Their insurance became too expensive, or their deductibles shot into the thousands.

Newell’s practice, Mindful Collaboration, has tried to plug the gaps. The clinic has opened more sliding-scale spots, expanded group therapy options and carved out intern-led appointments that cost just $5 to $10, Newell told Spectrum News. It is a creative workaround, but not a cure for the underlying cost problem. “Insurance has gotten incredibly expensive and unaffordable for a lot of folks,” she said.

Enrollment fell steeply

According to the Centers for Medicare & Medicaid Services, 761,457 North Carolinians selected Marketplace plans for 2026. Comparing federal enrollment snapshots, that figure is down from an estimated 975,110 the year before, a drop of roughly 213,000 people, according to reporting by Becker's.

Why costs jumped

Policy watchers largely point to two culprits: the end of enhanced premium tax credits at the close of 2025 and insurers’ own rate filings. A follow-up survey from KFF found that about half of returning Marketplace enrollees say their costs are “a lot higher” this year.

The hit is especially sharp in North Carolina. The North Carolina Department of Insurance approved average ACA premium increases of about 28.6 percent for 2026. That leaves many families facing significantly larger monthly payments along with higher out-of-pocket exposure when they actually use care.

State response and immediate options

Gov. Josh Stein signed Executive Order No. 33 in February, a move his office says is aimed at strengthening the behavioral health workforce, improving the state’s crisis response system and updating the involuntary commitment process. Providers say those steps could help over time. Right now, though, many local practices are in triage mode, trying to stretch staff and dollars to meet a rising wave of need.

Newell told Spectrum News she worries that untreated anxiety, depression and other issues will not just disappear; they could spill into schools, workplaces and the broader community as people go without care.

If you or someone you know is in crisis, you can call 988 for help or contact a local mental health provider to explore available options.

What to watch next

Advocates and clinicians are warning that the current shortfall in affordable coverage will not fix itself. They say it will likely take policy changes, new funding and stronger workforce support to keep the state’s treatment gap from widening.

In the meantime, sliding-scale programs, group sessions and low-cost intern clinics remain a crucial stopgap. For patients who can grab one of those limited slots, it can be the difference between staying in therapy and walking away, not because they want to, but because their budget leaves them little choice.