Marketplace Subsidies: What Would a Health Plan Cost Me?

1"The subsidies ended." Not for most people.

What ended was the enhanced version. From 2021 through 2025 there was no upper income limit, and nobody paid more than 8.5 percent of income for the benchmark plan. Those temporary rules expired at the end of 2025, and as of this review Congress has not renewed them.

The original credit remains, and it still reaches most people who buy their own coverage. If your household income is between 100 and 400 percent of the federal poverty line, $15,650 to $62,600 for one person or up to $128,600 for a family of four for 2026 coverage, you can still qualify. The real change is at the top of that range. A household even a dollar above 400 percent now receives nothing, where before it would have received some help.

For households near that line, contributions to a traditional IRA, a health savings account with a bronze plan, or a pre-tax retirement plan can lower the income the Marketplace counts, and can be worth far more than the contribution itself.

2How the credit is actually figured

The credit fills the gap between the price of one particular plan and the share of your income the law treats as affordable. It takes three steps. First, your household income is measured against the poverty line; 2026 coverage uses the 2025 guidelines, $15,650 for one person and $32,150 for four. Second, that percentage sets your expected contribution:

Third, that contribution is subtracted from the annual premium of the benchmark plan, the second-lowest-cost silver plan for your household where you live. The difference is your credit.

In practice: a single adult earning $30,000, about 192 percent of the poverty line, is expected to pay about 6.2 percent of income, roughly $155 a month. If the benchmark plan costs $500 a month, the credit is about $345. Estimate your Marketplace subsidy to see your own expected contribution.

3"I have to buy the silver plan." You don't.

The benchmark plan is only a measuring stick. Once your credit is set, it is a fixed dollar amount you can apply to any bronze, silver, gold or platinum plan sold through the Marketplace. Applied to a cheaper bronze plan it can cover most or all of the premium; applied to a gold plan, you pay more of the difference. Because benchmark premiums vary so much by area, the same credit can buy very different coverage in neighboring counties.

4"The lowest premium is the best deal." Not if your income is modest.

Households with income up to 250 percent of the poverty line can also get cost-sharing reductions, which lower deductibles, copayments and out-of-pocket maximums. They come only with a silver plan. Below 150 percent of the poverty line, a silver plan is adjusted to cover about 94 percent of average costs, against 70 percent for a standard silver plan. For someone in that range who expects to see a doctor or fill prescriptions, a silver plan can cost far less over a year than a bronze plan with a lower premium, a difference a premium comparison alone will never show. American Indians and Alaska Natives can get additional cost-sharing protections at any metal level.

5"At my age, coverage will cost a fortune." That is where the credit works hardest.

Early retirees and people in their late 50s and early 60s often assume buying their own coverage is out of reach. Marketplace plans cannot turn you down or charge you more because of your health, but they can charge older adults up to three times what they charge young adults, so the sticker prices are high.

The credit is built to absorb much of that. Because it is measured against the benchmark premium for you, at your age, an older person's credit is usually larger than a younger person's at the same income. Two people earning the same amount can pay about the same share of their income for the benchmark plan even though one plan's sticker price is double the other's.

The catch is the 400 percent line. Above it there is no credit at all, and an older household pays the full, age-rated premium. That is why the income planning described above matters most to people between their mid-50s and Medicare.

6"My job offers insurance, so I can't get help." It depends on the price.

You can always buy a Marketplace plan, but you generally cannot get a credit if your employer offers coverage that counts as affordable and meets a minimum value standard. Family members of an employee are judged on the cost of family coverage, not the employee's own premium, so a spouse or child may qualify for a credit even when the worker does not. Ask your employer for the cost of each coverage tier before you decide.

The other things that rule out a credit are eligibility for Medicare, Medicaid, CHIP or most other public coverage, filing separately when married (with limited exceptions for survivors of domestic abuse or abandonment), not being lawfully present, or being someone else's dependent. Below 100 percent of the poverty line, people in states that expanded Medicaid are expected to have Medicaid instead; in states that did not, some adults fall into a gap with too much income for Medicaid and too little for a credit. See Medicare and Medicaid for the Medicaid routes.

7"If I guess my income wrong, it sorts itself out." At a price.

Most people take the credit in advance, paid to the insurer each month, based on the income they expect. At tax time, Form 8962 compares those payments with the credit your actual income allows. If your income came in lower, you get the difference back. If it came in higher, you repay the excess, and starting with tax year 2026 there is no cap on how much you may have to repay.

The protection is to report changes within 30 days: a raise, a new job, a lost job, a marriage, a divorce or a new baby. A new job with an affordable employer offer can end your eligibility for the credit from the month that coverage is available, even if you keep the Marketplace plan.

8What the Marketplace counts as income

The Marketplace uses modified adjusted gross income for your tax household: you, your spouse if you file jointly, and everyone you claim as a dependent. Start with the adjusted gross income on your return and add back untaxed foreign income, nontaxable Social Security benefits and tax-exempt interest. A dependent's income counts only if the dependent must file a return. Child support received, gifts and SSI do not count, and alimony counts only under divorce agreements made before 2019. Self-employed people and anyone with variable pay should estimate carefully and update the figure as the year unfolds. For early retirees living on savings, withdrawals from a traditional IRA or 401(k) count as income, while qualified Roth withdrawals and money from ordinary savings generally do not.

9When you can sign up

Open enrollment begins November 1 each year for coverage the following year; check HealthCare.gov or your state Marketplace for the closing date, which differs among states. Outside it you need a special enrollment period, usually opened by a life event such as losing other coverage, moving, marrying or having a baby, and generally lasting 60 days; see special enrollment periods. Children in families with income too high for Medicaid may qualify for CHIP instead.

11What only the Marketplace can show you

The benchmark premium is set where you live, so only HealthCare.gov or your state Marketplace can show your actual credit and the plans it buys. This guide does not decide whether an employer offer is affordable, whether you qualify for Medicaid or CHIP in your state, or whether Congress changes the rules for future years.