ACA Marketplace Premium Estimator

Significantly higher than 2025. KFF projects average premium payments up 114% ($1,016/year) due to the expiration of enhanced Premium Tax Credits at end of 2025. Use Healthcare.gov's official Window Shopping tool with your ZIP code, age, and income for an exact 2026 quote.

100% to 400% of Federal Poverty Level (FPL) — and the 400% "subsidy cliff" is back for 2026 because enhanced PTCs expired. For a single person: $15,650 to $62,600. Family of 4: $32,150 to $128,600. Above 400% FPL = zero subsidy. Below 100% FPL = potentially Medicaid eligible (in expansion states).

The second-lowest-cost Silver plan in your area. The Premium Tax Credit subsidy is calculated against this plan, ensuring you can buy at least benchmark coverage for the maximum percentage of income required by ACA. You can use the subsidy on any plan, but if you pick something more expensive than benchmark, you pay the difference.

Federally: November 1 through January 15 each year. Some state-based Marketplaces (CA, NY, NJ, MA, etc.) extend through end of January. Outside Open Enrollment, you need a Qualifying Life Event (job loss, marriage, birth, move) to enroll via a Special Enrollment Period (typically 60 days).

Most people take it in advance — it lowers your monthly premium immediately. But if your income changes (raise, bonus, side income), you may have to repay excess advance credits at tax time. Estimate income carefully; update Healthcare.gov mid-year if it changes substantially. Underpayment can be claimed as additional credit on your tax return.

In Medicaid-expansion states (40 states + DC as of 2026): you're eligible for Medicaid at no cost. In non-expansion states (TX, FL, GA, AL, MS, SC, TN, WI, KS, WY): you're in the "coverage gap" — too poor for ACA subsidies, too rich for Medicaid in your state. Federal exchange flags this and offers options.

Depends on the plan's network. ACA plans use HMOs, PPOs, EPOs, and POS networks, with varying provider lists. Always check "Doctor Lookup" on Healthcare.gov before enrolling. PPO plans typically have larger networks but higher premiums; HMO plans cheaper but require referrals and in-network providers.

Short-term plans (limited duration, exempt from ACA rules — typically 4 months max), employer-sponsored coverage, COBRA continuation (expensive), Medicare (age 65+ or disability), Medicaid (low income), Tricare (military), VA (veterans), and direct primary care subscriptions. Healthcare sharing ministries are not insurance and don't guarantee payment.