Health Issues

If you’ve looked at your 2026 Marketplace health insurance options and you’re feeling sticker shock because you’re seeing significantly larger premiums, don’t panic just yet. Here’s what you need to know as open enrollment for 2026 health coverage gets underway.

Here are five steps you can take to better understand changes in Marketplace insurance costs and take action during open enrollment.

That means you can take some time now to review details like deductibles, out-of-pocket maximums, covered drug lists, and provider networks, to get an idea of what your coverage options are for 2026. Your current plan might not be available for 2026, or there might be new plans available in your area, depending on where you live. And even in areas where plans continue to be offered by the same insurers that offered them in 2025, there could be changes in the coverage specifics.

Here’s how household income (MAGI) is calculated under the ACA.

Unless Congress extends the subsidy enhancements, enrollees will no longer be eligible for premium subsidies in 2026 if their 2026 household income is more than 400% of the 2025 FPL. If you’re in the continental United States, here’s what 400% of FPL amounts to in annual income, for 2026 coverage:

• Household of one: $62,600
• Household of two: $84,600
• Household of three: $106,600
• Household of four: $128,600
• Household of five: $150,600
• Household of six: $172,600

This is why – unless Congress extends the subsidy enhancements – you’ll see no subsidy at all in the Marketplace if your projected household income is above those amounts. (If you’re in Massachusetts, New Jersey, or New Mexico, you may still see some subsidies, as those states have state-funded subsidies that extend to enrollees with incomes above 400% of FPL.)

Consider a 60-year-old living in Atlanta, earning $63,000. (Here’s how ACA-specific modified adjusted gross income, or MAGI, is calculated.) At that income level, they’re just a little above 400% of FPL, ^{which means they won’t qualify for any subsidy at all in 2026 if Congress doesn’t extend the subsidy enhancements. In that case, the lowest-cost plan available to this person will cost $1,079/month in premiums in 2026, which amounts to more than 20% of their household income.}

But that lowest-cost option is a Bronze plan, and all Bronze Marketplace plans will allow enrollees to contribute to a health savings account (HSA) in 2026. So if this person enrolls in that Bronze plan, opens an HSA, and contributes just $1,000 to the HSA in 2026, that would bring their household income down to $62,000, which is just a little under 400% of FPL.

That would allow them to avoid the “subsidy cliff,” and would make them eligible for a significant subsidy. Their after-subsidy premium for that lowest-cost plan will drop to just $262/month – simply because they enrolled in an HSA-eligible plan, opted to contribute $1,000 to an HSA, and thus reduced their MAGI by $1,000.

That $1,000 HSA contribution (which is still their own money, and available at any time to pay for medical expenses on a pre-tax basis) ^{results in them qualifying for a subsidy of $817/month, which covers the majority of the cost of their coverage.}

This is just one example, and the specifics will vary depending on where you live, how old you are, how much you earn, and how much you’re able to contribute to an HSA. The maximum allowable HSA contribution for 2026 is $4,400 if you have self-only coverage, and $8,750 if your HSA-eligible health plan also covers at least one additional family member.

We recommend that you speak with a tax advisor if you’re considering this strategy, as there are tax ramifications when you make adjustments to your income. You should be aware of all of them before making any financial decisions.

It’s particularly important to project your income as accurately as possible for 2026, and keep the Marketplace updated if you realize mid-year that your income projection wasn’t correct. This is because 2026 will be the first year when there’s no cap on how much excess advance premium tax credit (APTC) has to be repaid to the IRS.

If you underestimate your income and then end up earning more than you projected, there will be no limit on how much excess APTC you have to repay to the IRS when you file your taxes in early 2027.

You have until at least December 15 (or later in some states) to pick a Marketplace plan that will take effect on January 1, 2026. So if you’re experiencing sticker shock when you see the prices that are currently displayed for 2026 coverage, you have a couple of options:

You can select a plan now, based on the prices that reflect the expiration of the subsidy enhancements.

If you do this, stay tuned for updates about the subsidy enhancements. If Congress later extends the subsidy enhancements or extends a modified version of them during open enrollment, you’ll have the option to pick a different plan if that’s your preference. The last plan you pick will take effect January 1, as long as you make the plan selection by December 15 (or the deadline in your state).

You can hold off on picking a plan for now, and stay tuned for updates regarding the federal subsidy enhancements.

If you decide to delay enrollment in the hopes that the subsidy enhancements will be extended by Congress, be sure to set a calendar reminder to enroll in a plan before December 15. If you don’t, your current Marketplace coverage will be auto-renewed. (If you’re currently uninsured, you’ll continue to be uninsured in January.) But actively selecting your own plan is generally a better option than relying on auto-renewal.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written hundreds of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

We had the first glimpse of how the congressional debate in Washington over the federal shutdown and extending the enhanced premium tax credits for people who purchase coverage on the ACA marketplaces may be impacting voters’ decisions in upcoming elections last night. Looking at the 2025 Voter Poll results from Virginia and New Jersey, the economy remains the top issue for voters (48% of voters in Virginia said it was the most important issue facing the state as did 32% of New Jersey voters), health care came in behind economic issues with about one in five voters saying it was their most important issue. And this group of voters went disproportionately for the Democratic candidates. For example, in Virginia, the Democratic candidate for Governor won 81% of voters who said health care was the most important issue facing the state. The only group that the Republican candidate did as well with was the 11% of voters who said immigration was their top issue. In New Jersey, Democratic gubernatorial candidate Mikie Sherrill won 92% of health care voters. Notably, both Democratic candidates for Governor also won a majority of voters who said the economy was their most important issue – a group that President Trump won handedly back in 2024. After Tuesday’s elections, it is becoming increasingly difficult to disentangle concerns about the economy and concerns about health care as costs become the most pressing health care issue for voters, as CEO Drew Altman and I have both argued in the past.

There are many caveats and cautions before predicting how this off-year election and the current debate and government shutdown will play out a year from now including the fact that these election results are limited to two states and elections are often more about specific candidates than actually about issues. In addition, if there is a deal on the ACA tax credits, it will no longer serve as a talking point for candidates. However, the results do underscore the advantage that Democratic candidates still have on health care issues. And as economic issues and health care concerns become even more intertwined, as seen in the debate over the ACA tax credits in Washington, voters may give the upper hand to Democratic candidates in the voting booth. The 2025 election results highlight the growing importance of addressing health care costs in both policy debates and electoral choices.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written hundreds of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

The FAQs below are intended to help you understand this Calculator. More detailed questions and answers about signing up for coverage are available on our Marketplace FAQ page.

I am having difficulty viewing or understanding my results. What should I do?

It could be that you are using an older version of Microsoft Edge or Firefox. Try updating to a newer version of your web browser. Not sure which browser version you are running? Check here for Microsoft Edge or here for Firefox. If you continue to have technical problems with the Calculator after updating your browser, please contact KFF.

Please note that we are not able to provide individual advice or assistance understanding your results.

Does the calculator provide definitive results for what I will pay?

No. The comparison calculator is based on 2025 premiums for plans sold in your area, as 2026 premiums are not available yet. There are several additional reasons why your calculator results may differ from your actual tax credit amount or premium payment. For example, the calculator relies completely on information as you enter it, whereas the Marketplace may calculate your Modified Adjusted Gross Income (MAGI) to be a different amount or may verify your income against previous year’s data. Additionally, some plans may include non-essential benefits, which would not be subsidized by premium tax credits. To find out if you are eligible for financial assistance under current law and to sign up, you must contact HealthCare.gov, your state’s Health Insurance Marketplace, or Medicaid program office. Results in both columns are illustrative. Values under the enhanced premium tax credits scenario use the 2025 federal poverty guidelines as the basis for tax credit calculations whereas in plan year 2025, the Exchanges used 2024 federal poverty guidelines to calculate the required contribution toward benchmark plan coverage.

How do health insurance premium tax credits work?

Premium tax credits are financial assistance from the Federal government to help you pay for health coverage or care. The amount of assistance you get is determined by your income and family size. For more information of how health insurance premium tax credits are calculated, visit this page.

What is included in household income? How do I know what to enter for my income?

For information on how to calculate your household income, see here.

What is Medicaid? How does it relate to financial help through the Health Insurance Marketplace?

Medicaid is a comprehensive, free health insurance program  for people with limited income.  This interactive takes into account whether your state has expanded Medicaid or not and will give you an estimate of whether your household income qualifies you and your family for Medicaid or the Children’s Health Insurance Program (CHIP), if applicable. Members of your family that are eligible for either Medicaid or CHIP are not eligible for premium tax credits in the Marketplace and would instead need to sign up for Medicaid or CHIP.

If I am eligible for Medicare, can I still sign up on the Marketplace?

No, you cannot sign up for new Marketplace coverage if you are eligible for Medicare.  Most people age 65 and older are eligible for Medicare, which is the health insurance program run by the federal government.  If you are eligible for Medicare, even if you do not choose to enroll in Medicare, you are not able to purchase Marketplace coverage.

When using the Health Insurance Marketplace Calculator, if some members of your household are eligible for Medicare and others are not, you should enter your full household size (including those who are eligible for Medicare) in Question #4. For the following question, please enter only those family members who are signing up for Marketplace coverage (do not enter adults who are eligible for Medicare in Question #5).

If you are over the age of 65 but not yet eligible for Medicare due to immigration status or your work history, you may be eligible for Marketplace coverage and premium tax credits. You can use the Health Insurance Marketplace Calculator by entering your age as 64.

What are my options if I have job-based health coverage?

In general, people who qualify for health insurance through their job are not able to get financial assistance through the Marketplaces.

However, if your employer’s coverage is either unaffordable or doesn’t meet the health care law’s “minimum value” requirement, then you may be eligible for financial help to purchase through the Marketplace. Family members (spouses and children) who are eligible for employer-sponsored coverage can still qualify for Marketplace premium tax credits if the employer-sponsored coverage for the family is considered unaffordable, even if the employee has access to affordable individual coverage. Starting in 2023, the so-called “family glitch” has been fixed to allow family members in these circumstances to enroll in subsidized coverage.

When using the Health Insurance Marketplace Calculator, you can answer “No” to Question #3 if your employer’s coverage is unaffordable or does not meet the minimum value requirement.

The amount health insurers charge for coverage on the ACA Marketplaces is rising 26%, on average, in 2026. In states that run their own Marketplaces, the average benchmark (second-lowest cost) silver premium, on which the tax credit calculation is based, is rising 17% next year. In states that use Healthcare.gov, these premiums are rising an average of 30%.

Most enrollees would face even sharper increases in what they pay if they ACA’s enhanced premium tax credits expire. This 26% is the increase in the amount insurers are charging, which in most cases is not what enrollees pay. 22 million out of 24 million marketplace enrollees currently receive a tax credit. The amount subsidized enrollees pay is not what insurers charge, but rather a sliding-scale share of their household income, based on a formula set by Congress. If Congress extends the enhanced tax credits, the amount subsidized enrollees pay each month will remain about the same, even though the amount insurers are charging is increasing sharply.

If the enhanced premium tax credits expire at the end of this year, KFF estimates that currently subsidized enrollees will see their monthly premium payments more than double, increasing by about 114%, on average. This reflects people with incomes below four times the poverty level receiving less financial assistance and those with incomes over four times poverty no longer being eligible for financial assistance at all and therefore being hit by a double whammy of lost tax credit and higher insurer premiums.

Even if the enhanced tax credits expire, many lower income enrollees will continue to be eligible for a bronze plan with zero or a very low premium payment after accounting for the smaller tax credit they will continue to receive. However, this could mean switching from a silver plan with a reduced deductible as low as under $100 to a bronze plan with a deductible of over $7,000.

The amount insurers charge for ACA Marketplace premiums is rising for several reasons, including but not limited to increasing hospital costs, the rising popularity of expensive GLP-1 drugs like Ozempic, and the threat of tariffs. These factors are similarly cited by insurers selling employer coverage. However, an additional factor driving up the amount insurers charge for ACA Marketplace premiums (that is not affecting employer premiums) is the expected expiration of the enhanced premium tax credit. In their 2026 filings to state regulators describing their requested premium increases, ACA Marketplace insurers said they would charge about 4 percentage points more, on average, than they otherwise would have because they expected healthier people to drop Marketplace coverage if enhanced premiums tax credit expire.

Because the ACA’s tax credit is tied to the cost of the second-lowest cost silver plan, when these benchmark premiums rise, so does the federal cost of offering tax credits.