ACA subsidies: What they are and who qualifies

What are ACA plan subsidies?

ACA plan subsidies are reductions in health insurance costs for those who qualify. There are two types of subsidies to help low- and moderate-income people afford health insurance in the ACA marketplace:

One subsidy helps reduce premiums.
The other subsidy helps reduce out-of-pocket expenses, such as deductibles and copayments.

You can only get these subsidies if you buy health insurance policies sold through the insurance marketplace. You can find links to your state's ACA marketplace at Healthcare.gov. Some states run their own marketplaces, while the federal government runs many others. Healthcare.gov will transport you to the correct marketplace.

Private insurance companies offer marketplace policies, but they must meet ACA standards. These plans:

Can’t reject you
Can’t charge more because of pre-existing health conditions
Must cover 10 essential health benefits, including hospitalizations, outpatient care, mental health, and prescription drugs
Must have out-of-pocket spending limits for individual and family plans

You usually have several health plan options in the marketplace. ACA plans come in four tiers:

Bronze plans tend to have the lowest premiums but the highest deductibles and out-of-pocket costs.
Silver plans usually have slightly higher premiums but lower deductibles than Bronze plans.
Gold and Platinum plans generally have the highest premiums but the lowest out-of-pocket costs.

Find out more about ACA plan metal tiers.

Eligibility for both types of subsidies is based on your income. The premium subsidy is technically a tax credit that you receive in advance to help you pay your premiums. The subsidy goes directly to the insurance company, and you pay the difference.

If your income ends up being higher than expected by the end of the year, you may need to pay back some of the subsidy when you file your income tax return the following spring. If your income turns out to be lower than you expected when you applied for the policy, you may receive a refund.

Who is eligible for ACA premium subsidies?

You are eligible for an ACA premium subsidy if your income falls between 100% and 400% of the federal poverty level. The enhanced subsidies implemented during the pandemic that removed the 400% income limit expired at the end of 2025, so households above that threshold no longer qualify for federal premium tax credits.

For coverage in 2026, the income limits follow the 2025 federal poverty guidelines.

Family size	Federal poverty level (100%)	Federal poverty level (400%)
Individuals	$15,650	$62,600
Family of 2	$21,150	$84,600
Family of 3	$26,650	$106,600
Family of 4	$32,150	$128,600
Family of 5	$37,650	$150,600
Family of 6	$43,150	$172,600
Family of 7	$48,650	$194,600
Family of 8	$54,150	$216,600

For each additional household member beyond eight, add $5,500 to the 100% poverty guideline and multiply the result by four to calculate the 400% threshold. Alaska and Hawaii have different income limits.

You need to estimate your income for the year when you buy a marketplace policy to figure out the subsidy’s size. The subsidy calculation is complicated, but it’s designed so that people pay approximately 2% to 10% of their income in premiums for a Silver-level plan on the ACA marketplace. The lower your income, the larger your subsidy. The government pays the subsidy, and you pay the remaining cost.

The Kaiser Family Foundation has a calculator that can help estimate your subsidy. The ACA marketplace websites have calculators to show exactly how much you'd have to pay for the policies available in your area after the subsidy.

What happened when the enhanced ACA subsidies expired?

When the enhanced ACA premium tax credits expired on Dec. 31, 2025, many people became ineligible, raising costs in 2026. The original premium tax credit program remains in place, but eligibility and subsidy amounts have returned to the rules that applied before the enhancements.

The American Rescue Plan Act expanded premium tax credits in 2021, and the Inflation Reduction Act extended those enhancements through 2025. The enhanced rules increased assistance for eligible households and removed the income cap that previously excluded households earning more than 400% of the federal poverty level.

KFF's May 2026 analysis found that average monthly premium payments after tax credits rose 58%, from $113 in 2025 to $178 in 2026. The analysis also found that the average marketplace deductible increased 37%, from $2,759 to $3,786 per person. The deductible increase reflects, in part, consumers switching to lower-premium plans with higher deductibles.

How much do you save with ACA premium subsidies?

ACA premium subsidies lower your monthly health insurance bill, but your savings depend on your household income, family size, and location. For 2026, the expiration of enhanced premium tax credits means many Marketplace enrollees will pay more for coverage than in 2025.

To estimate your 2026 savings, use the KFF Health Insurance Marketplace Calculator. Enter your state, ZIP code, household income, family size and ages to see estimated premiums and subsidies for available plans.

The subsidy calculation is based on the price of the second-lowest-cost Silver plan in your area, but you can use the subsidy to buy any plan on the marketplace. The size of the subsidy remains the same, even though the premiums for other plans are different.

Karen Pollitz, a senior fellow at the Kaiser Family Foundation, says gauging your next year’s income can be difficult.

"When they apply, people should make the best estimate they can justify and then if circumstances change during the year, they can and should return to the marketplace to adjust their premium subsidy -- claiming more if income has dropped or rolling back subsidies if income has increased,” Pollitz says.

Who is eligible for ACA cost-sharing subsidies?

People with household incomes between 100% and 250% of the federal poverty level (FPL) may qualify for ACA cost-sharing reductions. These subsidies lower deductibles, copayments, coinsurance, and out-of-pocket maximums. You must enroll in a Silver Marketplace plan to receive these savings.

For 2026 coverage, 250% of the FPL is:

For an individual: $39,125
For a family of four: $80,375

When you apply for a Marketplace plan, you will find out whether you qualify for additional cost-sharing reductions.

How much do you save with ACA cost-sharing subsidies?

How much you will save with ACA cost-sharing subsidies depends on your income. ACA cost-sharing subsidies lower the annual out-of-pocket maximum to $3,500 for individuals and $7,000 for families with incomes up to 200% of the federal poverty level (FPL).

For 2026 coverage, cost-sharing reductions lower the annual out-of-pocket maximum for eligible Silver plan enrollees as follows:

At 100% to 200% of FPL: $3,500 individual, $7000 family
At 200% to 250% of FPL: $8,450 individual, $16,900 family

How to find plans with health insurance subsidies

To find health insurance plans with ACA subsidies, apply through the Health Insurance Marketplace. Enter your household size, estimated income, and other required information to see which plans are available in your area, whether you qualify for premium tax credits, and how much you would pay after the savings are applied.

You can only shop for policies on the state marketplace at certain times. In most states, you can buy coverage or switch to a different policy during open enrollment every year, which runs from Nov. 1 to Dec. 15 for coverage to begin on Jan. 1. Plans purchased after December 15th through January 15th will begin February 1st.(Some states that run their own marketplaces have extended deadlines.)

You can also shop for policies on the state marketplace at other times if you qualify for a special enrollment period. You may become eligible for a special enrollment period if you: