Marketplace Subsidies: What Would a Health Plan Cost Me?

1The credit is a subtraction, not a discount

Work out the share of income the law treats as affordable, subtract it from the cost of a benchmark plan, and the remainder is your credit. That is the whole calculation. Because the credit is a fixed dollar amount once those two figures are set, it does not shrink when you choose a cheaper plan or grow when you choose a dearer one.

You may take it in advance, paid straight to the insurer each month so you pay only the balance, or claim it when you file. Taking it in advance means the amount rests on the income you estimated, and the difference is settled on your tax return, so a year that turns out better than expected can leave you repaying part of it.

2The benchmark is the second-lowest silver plan

The plan your credit is measured against is the second-lowest-cost silver plan available to your household in your area. You do not have to buy it. You may apply the same credit to a bronze plan and pay less each month, or to a gold plan and pay more.

This is why two neighbours with identical incomes can receive very different amounts. The credit follows local premiums, and the benchmark in one county may be far cheaper than the benchmark in the next. It is also why a credit can change from one year to the next when nothing about your household has.

3Where your income has to sit

Eligibility generally runs from 100% of the federal poverty level up to 400% of it. Below that band, in states that expanded Medicaid, you are generally expected to be covered by Medicaid instead. In states that did not expand it, some households fall into a coverage gap: too much income for that state's Medicaid, too little for a Marketplace credit.

The upper edge is a cliff rather than a slope. Temporary rules in force from 2021 through 2025 removed that cap and limited what anyone paid to 8.5% of income, and those rules expired at the end of 2025. For 2026 a household a dollar above 400% of the poverty level receives nothing, so a small change in income can mean a large change in cost.

4The share you are expected to pay

Within the eligible band, the percentage of income you are expected to contribute rises with income. For 2026 it begins at 2.10% for households at the bottom of the range and reaches 9.96% at the top. The Internal Revenue Service publishes that table each year and it is indexed, so the figures move.

The percentage applies to your household income for the year of coverage, which for most people means an estimate made in advance. Reporting a change in income or household during the year is what keeps the advance payments close to the final figure and avoids a surprise at filing.

5Silver plans carry a second discount

Cost-sharing reductions are a separate saving. They lower deductibles, copayments and coinsurance rather than premiums, they depend on income being below a certain level, and they apply only if you choose a silver plan. This is the one case where the plan you pick changes what you are eligible for.

The practical effect is that a silver plan can be worth more to a household in that range than a gold one, despite the lower metal tier. Comparing monthly premiums alone will miss it entirely.

6What closes the door, and when you may enroll

An offer of employer coverage that counts as affordable and meets a minimum standard generally makes you ineligible for the credit, as does eligibility for Medicare or Medicaid. Married couples generally have to file a joint return to claim it.

Open enrollment runs from 1 November to 15 January for coverage in the following year. Outside that window you need a special enrollment period, which a life event such as losing other coverage, moving, marrying or having a child can open.

7What our calculator works out

Our subsidy calculator applies the published contribution percentage to your household income and size, and shows the required contribution that a credit would be measured against. It uses the current federal poverty guidelines and the applicable percentage table for the coverage year.

8What this does not tell you

The calculator cannot know the premiums where you live. The benchmark plan is local, and the credit is the gap between that local figure and your required contribution, so the site can show you the contribution side and only HealthCare.gov or your state Marketplace can show you the other.

It does not decide whether an employer offer counts as affordable, whether you would instead qualify for Medicaid or CHIP in your state, or whether you fall in the coverage gap. Those turn on state rules and on the details of the offer.