In this article

• Which carriers have announced they’re leaving the Marketplace?
• Will any carriers exit the market before the end of 2026?
• Why are carriers pulling out of the Marketplace?
• Declining Marketplace enrollment drives carrier decisions
• Marketplace participation is ultimately a business decision
• Current withdrawals reflect a familiar cycle
• What should consumers expect next?

At least seven health insurers have announced plans to leave the ACA Marketplace after 2026, affecting more than 650,000 enrollees across multiple states. The exits are raising new questions about the stability of the individual market and whether additional insurers could follow.

Although insurer participation in the ACA Marketplace has fluctuated for years, the latest withdrawals come at a time of growing uncertainty driven by higher premiums, declining enrollment, and federal rule changes that could further reshape the market in 2027.

Declining Marketplace enrollment drives carrier decisions

Marketplace enrollment declined in 2026, after five years of steady growth¹⁷ – and according to a Wakely analysis, effectuated enrollment is projected to be 17% to 26% lower in 2026 than it was in 2025.¹⁸

Although we don’t yet have official nationwide 2026 effectuated enrollment data from Centers for Medicare & Medicaid Services (CMS), NOTUS (News of the United States) has obtained internal CMS documents and reported that 21% of HealthCare.gov enrollees were disenrolled in the early months of 2026 for failure to pay premiums. Across state-run Marketplaces, the drop-off was much smaller, at about 8%, due in part to the supplemental subsidies offered by some state-run Marketplaces.

But nationwide, about 17% of the people who selected a plan during the open enrollment period for 2026 (or whose coverage was automatically renewed) have already lost their coverage for failure to pay premiums.¹⁹

And some state-run Marketplaces are showing significant declines in effectuated enrollment in early 2026. For example, Georgia’s effectuated Marketplace enrollment dropped from nearly 1.5 million in early 2025²⁰ to 950,000 by April 2026.²¹ In Washington state (which does offer state-funded subsidies), effectuated enrollment as of February 2026 was down more than 15% from where it had been a year earlier.²²

Overall, CMS projects that average effectuated Marketplace enrollment will be about 18.9 million people in 2026,²³ although it could potentially drop to as low as 16.5 million. In comparison, average effectuated Marketplace enrollment was 22.3 million people in 2025.²⁴

A major reason for the enrollment decline is the expiration of enhanced federal subsidies at the end of 2025. Many Marketplace consumers saw premiums rise sharply when those subsidy enhancements expired. Even though millions of people switched to plans with higher out-of-pocket costs or dropped their coverage altogether, average net premiums in the Marketplace still rose by 58% in 2026.

That sharp increase in net premiums is the primary reason so many people failed to pay their premiums in the early part of 2026.¹⁹ That matters because healthier consumers are generally more likely to drop coverage when premiums increase, while people with ongoing medical needs are more likely to keep their insurance.²⁵

As healthier people leave the market, insurers are left covering a smaller but less healthy risk pool. That increases average medical costs per enrollee and puts upward pressure on premiums.

The Trump administration’s rule changes for 2027 could intensify those pressures even further. Federal regulators have projected that the new rules could lead to as many as 2 million additional people leaving the Marketplace.¹⁶

CMS has also acknowledged that healthier enrollees may be more likely to lose or discontinue coverage under the new rules, potentially contributing to additional premium increases (although CMS notes that these premium increases may be offset by more eligibility verification for special enrollment periods and lower exchange user fees).¹⁶

Marketplace participation is ultimately a business decision

For insurers, participation in the Marketplace is fundamentally a financial calculation.

Insurers continuously evaluate whether Marketplace coverage is profitable and whether the market appears stable enough to justify continued participation. When enrollment declines, risk pools worsen, and policy uncertainty increases, some insurers decide the business risk is no longer worthwhile.

There can also be state-specific policy factors involved. New Mexico, for example, requires Medicaid managed care insurers to also offer statewide Marketplace coverage.²⁶ But in most states, Marketplace participation decisions are largely driven by insurers’ assessment of profitability and overall market stability.

Current withdrawals reflect a familiar cycle

Insurer participation in the Marketplaces has been cyclical over time, generally increasing when the individual market was healthier and larger, and decreasing when it was sicker and smaller. We can see a clear illustration of this when we look at how Aetna’s Marketplace participation has shifted in response to changing market conditions.

At the end of 2016, Aetna exited the Marketplace in 11 of the 15 states where it offered coverage.²⁷ The company then fully exited the ACA exchanges after 2017.²⁸

But Aetna later returned to the Marketplace in 2022 and expanded into additional states in 2023.²⁹ However, the company once again fully exited the Marketplace after 2025.³⁰

That pattern mirrors broader Marketplace trends over the past decade.

Insurer participation declined significantly in 2017 and 2018 amid repeated congressional repeal efforts and policy uncertainty surrounding the ACA.³¹

Participation later rebounded during the Biden administration, when enhanced subsidies and other policy changes (including a low-income special enrollment period, fixing the “family glitch,” and Marketplace access for DACA recipients) made Marketplace coverage more affordable and accessible, resulting in far more people with Marketplace coverage.³²

But the number of insurers participating in the Marketplace declined again for 2026, after several of the Biden-era changes were eliminated. This was the first overall decline in insurer participation since 2018.³³

Still, today’s Marketplace participation levels remain significantly stronger than they were during the market instability of 2017 and 2018.

In 2018, more than a quarter of Marketplace enrollees only had access to plans from a single insurer.³⁴ By contrast, despite the recent decline in participation, only 1% of HealthCare.gov enrollees in 2026 had access to just one insurer’s plans.³⁵

1. “Cigna Healthcare’s 2026 Footprint” Cigna. Accessed April 30, 2026
2. “Cigna to quit health insurance exchanges” Modern Healthcare. April 30, 2026
3. “Individual & Family Marketplace plans” Baylor Scott & White Health Plan. Accessed April 16, 2026
4. “Baylor Scott & White Health Plan will no longer carry Medicaid and marketplace insurance plans” WFAA, Apr. 15, 2026
5. “Non-Renewal of Health Insurance Marketplace and Off-Exchange Plans” CareSource. May 15, 2026. West Virginia SERFF tracking number CASO-134960434, and Ohio SERFF filing number CASO-134960415
6. “Two Major Insurers Are Leaving Indiana’s Health Marketplace in 2027. What Every Hoosier Needs to Know” Nefouse Benefits Consultants. Accessed May 7, 2026
7. “Ohio SERFF tracking number CASO-134960415” (See withdrawal notification in the SERFF filing). Ohio SERFF. Accessed June 11, 2026
8. ”SERFF tracking number CASO-134960415″ (See Part III Actuarial Memorandum) West Virginia SERFF. Accessed June 11, 2026
9. “Ohio SERFF tracking number CASO-134960415” (See FAQ page in the SERFF filing). Ohio SERFF. Accessed June 11, 2026
10. “PacificSource to exit ACA market, pull out of Montana entirely” Becker’s Payer Issues. May 22, 2026
11. “Providence to end most of its health insurance business” OPB. May 20, 2026
12. “Enrollment Data” Oregon Department of Financial Regulation. Accessed May 25, 2026
13. ”Requested Rate Increases Effective 2027” Connecticut Insurance Department. Accessed June 9, 2026
14. ”Mending Health Notifies Maine Bureau of Insurance that it Will Cease Offering Health Insurance Plans” Maine Bureau of Insurance. June 8, 2026. And “Mending to no longer serve as health insurance carrier amid its national direct primary care push” Becker’s Payer Issues. June 9, 2026. Source for enrollment total in Oklahoma is an email conversation with Jeff Yuan, co-founder of Mending.
15. “A ‘Perfect Storm’ Is Brewing for Health Insurers” Colorado Association of Health Plans. July 15, 2025
16. “Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program” Centers for Medicare & Medicaid Services. May 15, 2026
17. “Open Enrollment Marketplace Plan Selections, 2014-2026” KFF.org. Accessed May 7, 2026
18. “Who Paid, and Who Stayed? Early 2026 Enrollment Trends in the Individual Market” Wakely. Accessed May 7, 2026
19. “One in Five HealthCare.gov Enrollees Dropped Insurance Coverage This Year” NOTUS. May 12, 2026
20. “Effectuated Enrollment: Early 2025 Snapshot and Full Year 2024 Average” Centers for Medicare & Medicaid Services. July 24, 2025
21. “Georgia’s ACA enrollment plunges, raising concerns for rural hospitals” The Current GA. April 20, 2026
22. “Washington: Effectuated ACA enrollment down 11 – 16% so far; over 46,000 have already lost coverage” ACA Signups. May 6, 2026
23. “Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program” Centers for Medicare & Medicaid Services. May 15, 2026
24. “What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles” KFF.org. May 19, 2026
25. “Cigna Reports Q1 Gains, Announces ACA Marketplace Exit” Health Care Un-Covered” May 4, 2026
26. “State of New Mexico Health Care Authority (HCA) Medicaid Managed Care Services Agreement” New Mexico Human Services Department. Accessed May 8, 2026
27. “Why Are Insurers Leaving the ACA Marketplace and what does it mean for Obamacare?” Health Care Recruiters International. Oct. 25, 2016
28. “Aetna fully exits Obamacare exchanges with pull-out in two states” Reuters. May 10, 2017
29. “Aetna expanding to ACA exchanges in four new states” Health Care Finance. Sep. 13, 2022
30. “Aetna Members With ACA Plans Will Need New Coverage in 2026; CVS to Exit ACA Marketplace” OncoVenture. May 1, 2025
31. “Timeline of ACA repeal and replace efforts” BallotPedia. Accessed May 8, 2026
32. “Inflation Reduction Act Health Insurance Subsidies: What is Their Impact and What Would Happen if They Expire?” KFF.org. July 26, 2024
33. “Number of Insurers Participating in the Individual Health Insurance Marketplaces” KFF.org. Accessed May 7, 2026
34. “For 3rd Year in a Row, More Insurers are Entering the ACA Marketplaces, Creating More Options for Consumers” KFF.org. Nov. 23, 2020
35. “Plan Year 2026 Marketplace Plans and Prices Fact Sheet” Centers for Medicare & Medicaid Services. Oct. 30, 2025

In this article

• Key findings at a glance
• Marketplace coverage ‘downgrades’ were widespread as consumers searched for ‘cheap health insurance’
• How much will Marketplace enrollment drop in 2026?
• A spike in searches about going without coverage

As net health insurance premiums in the Marketplace have jumped by an average of nearly 60% nationally¹ due to the expiration of federal subsidy enhancements, many consumers have been reassessing what coverage they can afford – or whether they can afford coverage at all.

One of the clearest signals of that growing anxiety isn’t coming just from enrollment data or policy analysis. It’s showing up in what people are searching for online, particularly when it comes to the cost of health insurance.

A healthinsurance.org analysis of more than five years of Google Trends data shows a sharp spike in affordability-related searches in 2025, followed by continued growth in early 2026. Searches related to the cost of health insurance, lower-cost coverage options, subsidies, and even the consequences of going without insurance surged as consumers grapple with rising costs.

Taken together, these trends suggest a meaningful shift in how consumers are approaching health coverage in today’s higher-cost environment.

Key findings at a glance

Google Trends data reflects relative search interest over time, offering a real-time view into what consumers are actively Googling. Between 2024 and 2025, search interest for:

• “cost of health insurance” increased about 54%
• “bronze health plan” increased about 75%
• “catastrophic health insurance” increased about 71%
• “cheap health insurance” and “low cost health insurance” surged 48% to multi-year highs
• “Do you get penalized for not having health insurance?” increased 65%.

These queries did not fade when open enrollment ended in January 2026. Between January and March, when many consumers faced their first premium payments of the year, search interest accelerated. Compared to previous winters, for example, search interest in “cheap health insurance” sharply increased over 160%.

See the findings below.

Why consumers’ interest in health insurance costs surged

During the open enrollment period for 2026 Marketplace health coverage, some clear trends emerged in conjunction with the expiration of federal premium subsidy enhancements: Fewer people enrolled, and more people selected Bronze plans, which have lower premiums but higher out-of-pocket costs. And even with those changes, average net (after-subsidy) premiums grew by 58%, going from $113/month in 2025¹ to $178/month in 2026.²

So it’s not surprising that there has also been a significant increase in online search interest around health insurance costs and lower-premium coverage options in 2025 and 2026.

The cost of health insurance is causing consumer anxiety

In early 2026, search interest in “cost of health insurance” was more than double what it had been at the same time in 2025, and search interest in “health care subsidy” had nearly tripled. This makes sense given the expiration of federal premium subsidy enhancements at the end of 2025, and the anxiety this may have caused for consumers.³

If all Marketplace enrollees had renewed their 2025 plans for 2026, average net premiums were projected to increase by 114%.⁴ This caused significant sticker shock when people got their renewal notices last fall. Instead of renewing, many consumers opted to downgrade to a plan with a lower premium or drop their coverage altogether, resulting in net premiums “only” increasing by 58%.

The unfortunate reality is that most 2026 Marketplace enrollees were faced with higher premiums, higher out-of-pocket costs, or both. As a result, a recent KFF survey found that more than half of returning Marketplace enrollees are reducing their spending on food or basic household items so that they can afford their health insurance premiums and out-of-pocket costs.⁵

Marketplace coverage ‘downgrades’ were widespread as consumers searched for ‘cheap health insurance’

There has also been a spike in search interest related to Bronze and Catastrophic health plans, as well as “cheap” and “low-cost” health insurance. This is all indicative of the pressure that consumers are feeling when it comes to the monthly premiums they’re paying, and their efforts to find lower-cost coverage options.

Unfortunately, lower-cost options generally mean higher out-of-pocket costs. And that’s a best-case scenario that assumes a person continues to have ACA-compliant coverage. A person who switches from a Silver Marketplace plan to a Bronze or Catastrophic Marketplace plan will have higher out-of-pocket costs, but they’ll still have the ACA’s consumer protections, including coverage for pre-existing conditions and essential health benefits.

But we know that 1.2 million fewer people enrolled in Marketplace plans for 2026.⁶ Some of those people might have moved to other ACA-compliant coverage, such as an employer’s health plan. But some are likely uninsured altogether in 2026, while others might have opted for non-ACA-compliant insurance or even “coverage” that isn’t actually insurance, such as health care sharing ministry plans or Farm Bureau plans.⁷

Bronze plans became much more popular with Marketplace enrollees in 2026, growing from about 30% of enrollments in 2025 to about 40% of enrollments in 2026.⁸

At the same time, Silver plan selections dropped significantly, going from 56% of enrollments in 2025 to 43% in 2026.⁹

And while Gold plan selections increased slightly, from 13% of enrollments in 2025 to 17% in 2026,¹⁰ it’s worth noting that in many cases this was still a coverage downgrade, if the person previously had a Silver plan with strong cost-sharing reductions.¹¹

This is because for those with income that doesn’t exceed 200% of the federal poverty level, a Silver plan provides much more robust benefits than a Gold plan. But in many states, Gold plans have lower premiums than Silver plans.¹²

This helps to explain why some enrollees switched from Silver plans to Gold plans (or Bronze plans) in an effort to reduce premiums, despite giving up cost-sharing reductions to do so: Across all Marketplace enrollees, 51% were receiving CSR benefits in 2025, and that dropped to 37% in 2026.¹³ CSR benefits are only available on Silver plans, so consumers who are CSR-eligible are forfeiting that benefit if they select a non-Silver plan.¹⁴

Searches for ‘catastrophic health insurance’

Despite the fact that the Trump administration took steps to expand access to Catastrophic plans in the fall of 2025, Catastrophic plans accounted for just 0.3% of all Marketplace plan selections in 2026, up only slightly from about 0.2% in 2025.¹⁵ Catastrophic plans aren’t available at all in 14 states, are only offered by some (but not all) Marketplace insurers in most other states, and can never be purchased with premium tax credits.¹⁶ So while they’re fully ACA-compliant, they still make up just a tiny sliver of Marketplace enrollment.

But it’s also worth pointing out that while “Catastrophic health insurance” has a specific definition under the ACA, consumers were using this term to describe cheap “bare bones” coverage long before the ACA. Search interest in “catastrophic health insurance” grew considerably in 2025 and 2026, and although some people using this search phrase might be looking for ACA-compliant coverage, others might be looking for lower-cost plans that aren’t ACA-compliant.

Increasing interest in high-deductible health plans

Search interest related to high-deductible health plans has been steadily climbing in recent years, reaching new highs in 2025 and early 2026. As is the case with “catastrophic health insurance,” the term “high-deductible health plan” (HDHP) has a specific definition.¹⁷ These plans are regulated by the IRS, and enrollees are allowed to make pre-tax contributions to a health savings account. But consumers who are doing online searches may or may not know that, and might simply be looking for lower-cost coverage.

In 2026, for the first time, all Bronze and Catastrophic Marketplace plans are considered HDHPs, meaning enrollees in these plans can make HSA contributions. For enrollees who are willing and able to do so, this could have significant tax advantages, and could explain why some people opted to switch to these plans, despite the higher out-of-pocket costs.

But having access to an HSA doesn’t necessarily mean that a person will utilize that option. Opening an HSA and making contributions to it are optional. And while the majority of people enrolled in employer-sponsored HDHPs receive HSA contributions from their employer,¹⁸ most people with HDHPs purchased in the individual market have to make their own HSA contributions.

How much will Marketplace enrollment drop in 2026?

Although Marketplace plan selections during open enrollment dropped by about 1.2 million people in 2026 compared with the year before, that doesn’t account for people who might not have paid their initial premiums to effectuate their coverage. Nor does it account for people whose coverage was terminated at the end of a grace period due to non-payment of premiums.

A Wakely analysis that covered about 80% of the individual market found that 86% of the people who selected a plan during the open enrollment period for 2026 (including those whose coverage was auto-renewed) paid their January premium. The other 14% includes some people whose coverage didn’t get effectuated, and others who were in a grace period and may or may not have paid their past-due premiums by the end of that grace period.

But overall, the Wakely analysis projects that “average enrollment in the individual market could shrink 17% to 26% in 2026 compared to 2025 average enrollment.”¹⁹

A KFF analysis of returning Marketplace enrollees found that nearly one in five reported being unsure they’ll be able to continue to pay their monthly premiums throughout 2026.⁵ So it’s not surprising that online search interest in whether there’s a penalty for going without health insurance increased so much in 2025 and early 2026. Some people have already given up their coverage (plan selections during open enrollment dropped by about 1.2 million people compared with 2025), and others are unsure whether they’ll be able to maintain their coverage throughout 2026.⁵

Although the Wakely analysis gives some good clues about early effectuated enrollment, it will likely be at least mid-2026 before we have official nationwide numbers from CMS in terms of how many people had effectuated Marketplace coverage as of February 2026. The effectuated enrollment number is always lower than the number of plan selections made during open enrollment.

But the first effectuated enrollment report won’t reflect the number of policies that lapsed at the end of March when their three-month grace period ended. Nor will it reflect people who were able to make their initial premium payments but weren’t able to continue to make those payments later in the year.²⁰

So as insurers start to prepare rates and plans for next year, it remains to be seen how many people will have individual-market coverage as we head into 2027.

A spike in searches about going without coverage

Consumer search interest in whether there’s a penalty for not having health insurance grew significantly in 2025 and the early part of 2026. This corresponds with a drop in Marketplace enrollment: 24.3 million people selected Marketplace plans for 2025,²¹ and that dropped to 23.1 million for 2026.²² So it makes sense that more people might want to learn more about the ramifications of going without health insurance.

Note: There hasn’t been a federal penalty for being uninsured since 2018, but DC and four states do impose a penalty.

What to do if you’re struggling with health insurance costs

If health insurance feels unaffordable in 2026, you’re certainly not alone. Read more about what to do if you’re feeling premium sticker shock, and what you can do if you can’t afford health insurance and aren’t eligible for Medicaid.

Consumer search trends signal growing cost pressure in health insurance

1. “2025 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column AB) Centers for Medicare & Medicaid Services. Accessed Apr. 7, 2026
2. “2026 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column AG) Centers for Medicare & Medicaid Services. Accessed Apr. 7, 2026
3. “Worried About Health Insurance Costs? There May Be Cheaper Options — But With Trade-Offs” KFF Health News. Dec. 18, 2025
4. “ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire” KFF.org. Sep. 30, 2026
5. “Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees” KFF.org. Mar. 19, 2026
6. “2025 Marketplace Open Enrollment Period Public Use Files” and “2026 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column H) Centers for Medicare & Medicaid Services. Accessed Apr. 7, 2026
7. “Private Health Coverage: Information on Farm Bureau Health Plans, Health Care Sharing Ministries, and Fixed Indemnity Plans” Government Accountability Office. July 26, 2023
8. “2025 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column BR) and “2026 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column BW) Centers for Medicare & Medicaid Services. Accessed Apr. 7, 2026
9. “2025 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column BS) and “2026 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column BX) Centers for Medicare & Medicaid Services. Accessed Apr. 7, 2026
10. “2025 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column BT) and “2026 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column BY) Centers for Medicare & Medicaid Services. Accessed Apr. 7, 2026
11. “Final 2026 Open Enrollment Report: Metal Levels (Part 5B)” ACA Signups. Apr. 6, 2026
12. “ACA marketplace 2026: The silver loading mitigation” Xpostfactoid. Nov. 7, 2025
13. “2025 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column AE) and “2026 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column AJ) Centers for Medicare & Medicaid Services. Accessed Apr. 7, 2026
14. “Cost sharing reduction (CSR)” HealthCare.gov. Accessed Apr. 7, 2026
15. “2025 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column BQ) and “2026 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column BV) Centers for Medicare & Medicaid Services. Accessed Apr. 7, 2026
16. “Policy Changes Bring Renewed Focus on High-Deductible Health Plans” KFF.org. Jan. 5, 2026
17. “Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans” Internal Revenue Service. Accessed Apr. 7, 2026
18. “Employer Health Benefits, 2025 Annual Survey” KFF.org. Oct. 22, 2025
19. “Who Paid, and Who Stayed? Early 2026 Enrollment Trends in the Individual Market” Wakely. Accessed Apr. 15, 2026
20. “ACA Marketplace Enrollment is Down in 2026—But All of the Data Isn’t in Yet” KFF.org. Feb. 5, 2026
21. “2025 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column H) Centers for Medicare & Medicaid Services. Accessed Apr. 7, 2026
22. “2026 Marketplace Open Enrollment Period Public Use Files” (State level PUFs, Column H) Centers for Medicare & Medicaid Services. Accessed Apr. 7, 2026

In this article

• Why you might not qualify for Medicaid
• Scenario 1: You earn too much to qualify for a subsidy
• Scenario 2: You qualify for subsidies, but coverage still seems unaffordable
• Scenario 3: You’re in the coverage gap
• Scenario 4: You cannot afford ACA-compliant health insurance
• How to get help finding coverage

For people who buy their own health insurance, premiums rose significantly in 2026 after Congress failed to extend federal subsidy enhancements that expired at the end of 2025. Stories of consumers facing unaffordable health insurance premiums are widespread.¹ You’re not alone if you feel like you can’t afford health insurance.

Why you might not qualify for Medicaid

We’ll discuss private health insurance in a moment, but if health coverage feels unaffordable and you’re also not eligible for Medicaid, you might have wondered why you can’t enroll in Medicaid. There are a few reasons this might be the case:

• You might be in a state that hasn’t expanded Medicaid under the ACA (more about that below).
• Your income might be above the eligibility cut off for Medicaid.
• You might be a recent (within the last five years) immigrant.²
• Your kids might be Medicaid/CHIP-eligible but you might not be, because the income limits are higher for kids. ³

Now let’s take a look at a few scenarios to explain why you might be facing unaffordable health insurance premiums, and what you might be able to do about it.

Scenario 1: You earn too much to qualify for a subsidy

The “subsidy cliff” returned in 2026, due to the expiration of the federal subsidy enhancements. This means that federal premium subsidies (premium tax credits) are no longer available to Marketplace enrollees with household income above 400% of the federal poverty level (FPL), regardless of how expensive their coverage options are. (Note that state-funded subsidies do extend above 400% of FPL in Connecticut, New Jersey, and New Mexico.)

What can you do to qualify for subsidies?

If you lost your subsidy altogether at the end of 2025, it’s likely because your household ACA-specific Modified Adjusted Gross Income (MAGI) is over 400% of FPL. (For 2026 coverage in the continental United States, that means you earn more than $62,600 for a single person, or more than $128,600 for a family of four).⁴

Eligibility for a federal Marketplace premium tax credit requires that a household’s Modified Adjusted Gross Income (MAGI) be at or below 400% of the Federal Poverty Level (FPL). Depending on how far above this threshold your projected income is, it may be possible to bring your MAGI within the required range. This is generally done in one of two ways:

• Adjusting projected income if you are working fewer hours, taking on fewer clients, or otherwise earning less.
• Reducing MAGI through allowable tax deductions, including contributions to pre‑tax retirement accounts or health savings accounts.

If your income is too high to qualify for subsidies, you’ll pay full price for whatever plan you select. Here are some tips for choosing the plan that best fits your needs and budget.

If you’re not subsidy-eligible and you prefer a Silver plan, you might consider an off-exchange plan. These are ACA-compliant individual-market policies, but in most states, full-price Silver plans are less expensive off-exchange than on-exchange.⁵ This is because the cost of cost-sharing reductions is added to the premiums for on-exchange Silver plans in most states.

Premium subsidies are not available for off-exchange plans. But if you’re not eligible for subsidies due to your income, you won’t be giving up anything by opting for an off-exchange plan. (“Off-exchange” refers to fully ACA-compliant individual-market plans, and does not include non-ACA-compliant plans. Those are addressed in more detail below.)

If you prefer a Bronze or Gold plan, the full-price premiums for those plans are generally the same on-exchange or off-exchange because there are no CSRs impacting the price on or off exchange. But depending on where you live, there may be insurers that offer coverage only on-exchange or only off-exchange. So if you’re not subsidy-eligible, a comprehensive comparison of both on-exchange and off-exchange plans will give you a full picture of what’s available in your area.

(Regardless of whether you’re shopping on-exchange or off-exchange, you can complete the process yourself or do it with help from a broker, which won’t cost you anything.)

Scenario 2: You qualify for subsidies, but coverage still seems unaffordable

You’re certainly not alone if you’re in this category. Most Marketplace enrollees are still eligible for subsidies in 2026,⁶ but after-subsidy premiums were projected to more than double in 2026, due to the expiration of the subsidy enhancements at the end of 2025.⁷

As noted above, enrollees with household income above 400% of FPL lost their subsidies altogether at the end of 2025, resulting in substantial premium increases. But even for those who still qualify for subsidies, the subsidies now cover a smaller share of enrollees’ total premiums. To continue to have Marketplace coverage in 2026, these enrollees must either pay higher premiums, downgrade their coverage, or both.

KFF surveyed Marketplace enrollees in November 2025, asking what they would do when confronted with net premiums that were more than doubling. More than half indicated that they would either select a plan with lower premiums but higher deductibles and co-pays, or drop their coverage altogether.⁸

If your coverage feels unaffordable even with subsidies, there are a couple of options to make it more affordable:

• Reduce MAGI. As long as your MAGI stays above the Medicaid eligibility threshold in your state (and doesn’t drop below 100% of FPL), a lower MAGI will result in a larger subsidy. You can use a subsidy calculator to see how changes in your MAGI will affect the size of your subsidy.
• Downgrade to a plan with a lower premium. Several state-run Marketplaces have published data on 2026 plan selections, and there was a clear trend towards higher enrollment in Bronze plans (which have higher out-of-pocket costs but lower premiums than Silver or Gold plans).⁹ But at this point, most current enrollees won’t have an opportunity to change their coverage for the rest of the year, as open enrollment for 2026 has ended and most special enrollment periods limit current enrollees to a different plan at the same metal level as their current plan.¹⁰

Scenario 3: You’re in the coverage gap

The coverage gap is not new in 2026. It has always existed in nine states that haven’t expanded Medicaid as called for in the ACA: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming. Because those states have chosen not to expand Medicaid, many adult residents with income below the federal poverty level are not eligible for any financial assistance with their health coverage and are not eligible for Medicaid.

Learn more about the coverage gap.

What can you do to qualify for financial assistance?

If you’re an adult in one of those nine states and your income is below the federal poverty level, you’re not eligible for Marketplace subsidies.¹¹ You may find that you’re not eligible for Medicaid either (unless you’re pregnant or the parent of a minor child, although Medicaid income rules for this vary by state).¹²

To become eligible for Marketplace subsidies, you would need an ACA-specific modified adjusted gross income (MAGI) of at least 100% of the prior year’s FPL.

For 2026 coverage, that’s $15,650 for a single adult, or $21,150 for a household of two.⁴

Note: If you’re in a coverage gap state and you enter an income below the FPL on the Marketplace plan comparison tool, it will tell you that you aren’t subsidy eligible, but it won’t tell you why. The reason is that your income is below the FPL.

Here’s how MAGI is calculated under the ACA. Note that it’s gross income, rather than take-home pay, and it’s different than the MAGI used for other purposes.

Be sure to include all income, and remember it’s household income, not just your own income.¹³

If you’re in the coverage gap and your income increases to at least the FPL, you’ll qualify for a special enrollment period to enroll in a Marketplace plan.

Medicaid eligibility varies by state, with the states that expanded Medicaid eligibility under the Affordable Care Act covering a much greater portion of the low-income adult population. If you’re affected by the coverage gap, you may find that you’d actually be eligible for Medicaid if you lived in one of your neighboring states.

Starting in 2027, Medicaid recipients in expansion states will face a work requirement (nationwide), which will require at least 80 hours per month of work or other community engagement.¹⁴

Scenario 4: You cannot afford ACA-compliant health insurance

If you’ve tried all of the above strategies and can’t make an ACA-compliant health plan work with your budget, you may have already dropped your coverage or be planning to do so soon.

There are some additional coverage options you may consider, which might be better than going without any coverage at all. None of these alternatives is regulated by the ACA. Some aren’t considered insurance at all, and thus aren’t subject to a state’s insurance laws. Because these plans aren’t ACA-compliant, they don’t have to cover the essential health benefits, typically exclude pre-existing conditions, and generally have annual and lifetime benefit caps. But depending on your circumstances and budget, they may pay for some health care costs that you would otherwise pay entirely out-of-pocket if you had no coverage at all. It’s important to review the plan details thoroughly before making a decision.

Non-ACA-compliant insurance options

These include short-term health insurance, fixed-indemnity plans, and various types of supplemental coverage such as accident insurance and critical illness insurance. Short-term health insurance availability varies by state: In some states there are no plans available, while in others there are plans available with total durations of up to three years, including renewals. None of these plans are considered comprehensive coverage under the ACA.

Non-ACA-compliant options that aren’t considered insurance

There are a variety of “coverage options” that aren’t actually insurance, although consumers aren’t always aware of that. These include, for example, direct primary care memberships, Farm Bureau plans available in certain states, and health care sharing ministry plans.

The specific benefits vary from one plan to another. But since these types of coverage are not considered insurance, consumers who have problems with them cannot turn to the state insurance department for assistance.

Free and low-cost health care

Depending on your financial situation, you may qualify for free or low-cost care at a federally qualified health center.¹⁵ (Here’s a tool that can help you find one near you.)

Almost all hospital emergency departments are required to assess and stabilize patients regardless of their ability to pay.¹⁶ But the hospital can still bill you for the care you receive in the emergency department.¹⁷

How to get help finding coverage

There are people online, on the phone, and in your community who can help you with the process of getting health coverage. You don’t have to pay anything for their assistance, as premiums are the same whether you have assistance or take a DIY approach. Here’s an overview of the help that’s available to you:

• Agents and brokers can help with on-exchange or off-exchange plans. They receive a commission from the insurance carrier if they enroll you in a plan, but it doesn’t affect the price you pay.
• Navigators and Certified Application Counselors (CACs) can help with on-exchange plans as well as Medicaid
• The Marketplace call center can answer questions and help with enrollment. If you’re in a state that uses HealthCare.gov, the number is 1-800-318-2596. If you’re in a state that runs its own exchange (20 states plus DC), there will be a state-run call center.
• The “find local help” tool on HealthCare.gov will let you see agents, brokers, Navigators, and CACs in your area. State-run Marketplaces have similar tools.
• An Enhanced Direct Enrollment (EDE) entity can walk you through the enrollment process for an on-exchange or off-exchange plan. See a current list of approved EDE entities.
• Dial 211. If you aren’t sure where to turn, calling 211 will get you to a local or regional call center that can connect you to helpful health coverage resources.¹⁸

1. “Stories to cover as Americans seek affordable health insurance” Association of Health Care Journalists. Jan. 28, 2026
2. “Coverage for lawfully present immigrants” HealthCare.gov. Accessed Feb. 25, 2026
3. “Medicaid, Children’s Health Insurance Program, & Basic Health Program Eligibility Levels” Centers for Medicare & Medicaid Services. December 2023.
4. “2025 Poverty Guidelines” U.S. Department of Health & Human Services. Accessed Feb. 18, 2026
5. “Explaining Cost-Sharing Reductions and Silver Loading in ACA Marketplaces” KFF.org. June 26, 2025
6. “Plan Year 2026 Marketplace Plans and Prices Fact Sheet” CMS Newsroom. Oct. 30, 2025
7. “ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire” KFF.org. Sep. 30, 2025
8. “2025 KFF Marketplace Enrollees Survey” KFF.org. Dec. 4, 2025
9. “The other shoe to drop: How many enrollees were forced to “buy down” to a worse plan with higher out of pocket costs?” ACA Signups. Feb. 5, 2026
10. “Special Enrollment Period Reference Chart” Center on Budget and Policy Priorities. And “Title 45 § 155.420 Special enrollment periods” Code of Federal Regulations. Accessed Feb. 20, 2026
11. “Subsidized coverage” HealthCare.gov. Accessed Feb. 18, 2026
12. “Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level” KFF.org. Accessed Feb. 18, 2026
13. “Count income & household size” HealthCare.gov. Accessed Feb. 18, 2026
14. “A Summary of Federal Medicaid Work Requirements” Center for Health Care Strategies. Accessed Feb. 18, 2026
15. “Federally Qualified Health Center (FQHC)” HealthCare.gov. Accessed Feb. 19, 2026
16. “You have rights in an emergency room under EMTALA” Centers for Medicare & Medicaid Services. Accessed Feb. 19, 2026
17. “Overview of the Emergency Medical Treatment and Active Labor Act (EMTALA) and Emergency Abortion Services” Congress.gov. Accessed Feb. 19, 2026
18. “Dial 211 for Essential Community Services” Federal Communications Commission. Accessed Feb. 25, 2026

In this article

• What’s happening with Marketplace health plan enrollments?
• Why might consumers be downgrading to Bronze plans?
• Which states saw a decrease in Bronze plan selections?
• What does a shift to Bronze plans mean for consumers?
• Options for Bronze plan buyers facing higher out-of-pocket costs

As consumers face decreased access to Marketplace health insurance subsidies for 2026 plans – and higher net premiums for consumers who continue to be subsidy-eligible – one clear buying trend has emerged: a migration of buyers to Bronze-level health plans.

During the open enrollment period for 2026 coverage, nearly 40% of all Marketplace enrollees selected a Bronze plan,¹ up from about 30% the year before.²

And while about 43% of enrollees selected Silver plans for 2026,³ that was down from about 56% the year before.⁴ In other words, a significant number of enrollees have downgraded their coverage for 2026, in addition to the people who simply dropped their coverage altogether.

Options for Bronze plan buyers facing higher out-of-pocket costs

If you’re enrolled in a Bronze plan and worried about higher out-of-pocket costs, there are several tips to keep in mind:

• Comparison shop for your care whenever possible. Although your health plan might have a wide range of in-network hospitals, medical offices, and pharmacies, that doesn’t mean your out-of-pocket costs will be the same at all of them. If you need a prescription, you can check with various in-network pharmacies (including mail-order options) to see if there are price differences. The same is true for other medical care, and there are transparency tools that can help you determine what your costs will be.²³
• Discuss your financial situation with your medical providers. You may find that they can offer a payment plan that fits within your budget.
• If at all possible, consider opening and funding an HSA. All Bronze plans are HSA-eligible as of 2026. The money you contribute to an HSA is pre-tax. And if you need to use it to pay your deductible or other medical expenses, it will continue to be tax-free when you make the withdrawal. If you don’t end up needing to use the money in your HSA, it will remain in the account in future years until if and when you need it.
• If your income isn’t more than 200% of the federal poverty level, you might be eligible for reduced out-of-pocket costs if you use a federally qualified health center (FQHC) that’s in your plan’s provider network. Depending on your income, these clinics can reduce the amount that you’d otherwise have to pay out-of-pocket under the terms of your health plan.²⁴
• Consider supplemental coverage, such as a critical illness policy or an accident insurance policy, that could reimburse some of your out-of-pocket costs if you were to face unexpected medical costs for a covered illness or injury.
• Some people with high-deductible health insurance choose to enroll in a local doctor’s direct primary care (DPC) membership program, to have unlimited access to various primary care services. And as of 2026, having a DPC membership no longer prohibits a person from making HSA contributions if they also have an HSA-eligible health plan, as long as the DPC membership meets certain parameters.²⁵

1. “2026 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column BW divided by Column H). Centers for Medicare & Medicaid Services. Mar. 27, 2026
2. “2025 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column BR divided by Column H). Centers for Medicare & Medicaid Services. May 12, 2025
3. “2026 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column BX divided by Column H). Centers for Medicare & Medicaid Services. Mar. 27, 2026
4. “2025 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column BS divided by Column H). Centers for Medicare & Medicaid Services. May 12, 2025
5. “ACA Sign-Ups Are Down by Over a Million People, But It’s Still an Incomplete Picture” KFF.org. Jan. 29, 2026
6. “2026 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column H). Centers for Medicare & Medicaid Services. Mar. 27, 2026
7. “Marketplace Enrollment, 2014-2025” KFF.org. Accessed Mar. 3, 2026
8. “2026 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column BW divided by Column H). Centers for Medicare & Medicaid Services. Mar. 27, 2026. And ”2025 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column BR divided by Column H). Centers for Medicare & Medicaid Services. May 12, 2025
9. “Deductibles in ACA Marketplace Plans, 2014-2026” KFF.org. Nov. 6, 2025
10. “ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire” KFF.org. Sep. 30, 2025
11. “2026 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column AG). Centers for Medicare & Medicaid Services. Mar. 27, 2026. And ”2025 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column AB). Centers for Medicare & Medicaid Services. May 12, 2025
12. “2025 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column BT divided by Column H). Centers for Medicare & Medicaid Services. May 12, 2025
13. “2026 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column BY divided by Column H). Centers for Medicare & Medicaid Services. Mar. 27, 2026.

    This migration to Gold plans (and reduction in Silver and Bronze plan selections) happened because Washington adopted premium alignment for 2026, requiring insurers to add a 43% load to the premiums for Silver plans. This is because most Silver plans actually have benefits that are similar to those of Platinum plans, as a result of cost-sharing reductions (CSR).[efn_note]“Final Cascade Care Savings amounts for plan year 2026” Washington Health Benefit Exchange. Sept. 30, 2025

14. “2026 Open enrollment Preview Report” Washington Health Benefit Exchange. Jan. 16, 2026
15. “New Mexico Open Enrollment 2025 Level of Coverage Summary” BeWellnm. Accessed Mar. 3, 2026
16. “New Mexico Open Enrollment 2026 Level of Coverage Summary” BeWellnm. Accessed Mar. 3, 2026
17. “2026 Marketplace Open Enrollment Period Public Use Files” (state-level public use files, Column BW divided by Column H). Centers for Medicare & Medicaid Services. Mar. 27, 2026.
18. “Health Insurance Marketplace Affordability Program” New Mexico Health Care Authority. Accessed Mar. 3, 2026
19. “New Mexico HB4, Fiscal Impact Report” New Mexico Legislature. Feb. 5, 2026
20. “More Americans are picking higher-deductible Obamacare plans, possibly risking their health” Politico. Feb. 4, 2026
21. “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability” Centers for Medicare & Medicaid Services; Department of Health and Human Services. June 25, 2025
22. “Out-of-pocket maximum/limit” HealthCare.gov. Accessed Mar. 6, 2026
23. “Hospital Price Transparency” and “Health Plan Price Transparency” Centers for Medicare & Medicaid Services. Accessed Mar. 3, 2026
24. “Chapter 9: Sliding Fee Discount Program” HRSA Health Center Program. Accessed Mar. 3, 2026
25. “H.R.1” (Section 71308(a)) Congress.gov. Enacted July 4, 2025

In this article

• Can early retirees get health insurance through the ACA Marketplace?
• How can early retirees find out if they’re eligible for Marketplace subsidies?
• Can early retirees get Medicaid if they’re in an expansion state?
• Is COBRA or state continuation a good option for early retirees?
• Early retirement health insurance through a spouse’s coverage

If you’re retiring before age 65 and your employer doesn’t offer retiree health benefits, you’ll need a plan for your health coverage until you become eligible for Medicare at 65. Let’s take a look at your early retirement health insurance options and what you need to know about each one.

Early retirement health insurance through a spouse’s coverage

If you’re retiring early but your spouse is still working, you may both have access to your spouse’s employer-sponsored health plan. There is no federal law requiring group health plans to offer coverage to spouses, but almost all of them do.¹⁷

If your spouse is enrolled in their employer’s plan and you’re enrolled in your own employer’s plan, your loss of coverage will trigger a special enrollment period that will allow you to be added to your spouse’s plan (assuming the plan is offered to employees’ spouses).

If you and your spouse are both covered under your plan, the loss of coverage when you retire will trigger a special enrollment period that will allow both of you to enroll in your spouse’s plan (assuming your spouse is an eligible employee and the plan allows employees’ spouses to enroll).¹⁸

1. “Guidance Regarding Age Curves and State Reporting” Centers for Medicare & Medicaid Services. Dec. 16, 2016
2. “Premium Tax Credit (PTC) Overview” Internal Revenue Service. Accessed Feb. 11, 2026
3. “APTC and CSR Basics” Centers for Medicare & Medicaid Services. Oct. 2025
4. “2025 Poverty Guidelines“ U.S. Department of Health & Human Services. Accessed Feb. 11, 2026
5. “Count income & household size” HealthCare.gov. Accessed Feb. 11, 2026
6. “Starting Your Retirement Benefits Early” Social Security Administration. Accessed Feb. 11, 2026
7. “See Plans & Prices” (zip code 36525) HealthCare.gov. Accessed Feb. 11, 2026
8. “Topic no. 451, Individual retirement arrangements (IRAs)” Internal Revenue Service. Accessed Feb. 11, 2026
9. ”Status of State Medicaid Expansion Decisions” KFF.org. Feb. 9, 2026
10. “Eligibility Policy” Medicaid.gov. Accessed Feb. 11, 2026
11. “Seniors & Medicare and Medicaid Enrollees” Medicaid.gov. Accessed Feb. 11, 2026
12. “Income Definitions for Marketplace and Medicaid Coverage” Center on Budget and Policy Priorities. Aug. 2025
13. “H.R. 1” (Section 71119) Congress.gov. Enacted July 4, 2025
14. “Estate Recovery” Medicaid.gov. Accessed Feb. 11, 2026
15. “FAQs on COBRA Continuation Health Coverage for Workers” U.S. Department of Labor. Accessed Feb. 11, 2026
16. “What are the COBRA Laws State-by-State?” COBRA Help. Accessed Feb. 11, 2026
17. “Employer Health Benefits, 2025 Annual Survey” (Page 52) KFF.org. Oct. 22, 2025
18. “Title 29 § 2590.701-6 Special enrollment periods” Code of Federal Regulations. Accessed Feb. 11, 2026

In this article

• Many older Marketplace buyers face drastic premium hikes
• ‘Subsidy cliff’ affects households with incomes above 400% of federal poverty level
• American Rescue Plan & Inflation Reduction Act temporarily eliminated ‘subsidy cliff’
• Why it’s called a ‘cliff’
• Areas with higher average premiums will be hit hardest by the ‘cliff’

It’s happened. Congress has not extended enhanced Marketplace subsidies that have made coverage more affordable since 2021¹ – and hundreds of thousands of Marketplace enrollees with household incomes over 400% of the federal poverty level are now experiencing the return of the so-called “subsidy cliff,”² due to the loss of their premium subsidies.

The impact of this “subsidy cliff” is causing dramatic increases in health insurance premium expenditures. Particularly hard hit are enrollees in their 50s and 60s, who – without subsidies – could well face premiums that consume half or more of their income.

(Premiums are age-based; without subsidies, a person who is 52 will pay about twice as much as a person who is 21, and a person who is 64 will pay three times as much as a person who is 21).³

Here’s what Marketplace buyers are facing in 2026 with the return of the “subsidy cliff”:

Many older Marketplace buyers face drastic premium hikes

With the “subsidy cliff” returning to the health insurance Marketplace in 2026, a 63-year-old couple in Charleston, West Virginia, earning $85,000/year, will pay more than 15 times as much for the lowest-cost Gold plan, compared with what they paid in 2025.

In 2025, they would have paid about $300/month for the lowest-cost Gold plan, and they even had access to a zero-premium Bronze plan.⁴

But because Congress didn’t extend the subsidy enhancements that had been keeping coverage more affordable since 2021, this hypothetical couple has lost their subsidy altogether.

• To buy the lowest-cost Gold plan in 2025, they would have paid $300/month. But in 2026, their premium is $4,562/month for the lowest-cost Gold plan.
• The lowest-cost Bronze plan in 2025 had no premium at all for this couple’s demographics, as their subsidy covered the full cost. But in 2026, the lowest-cost Gold plan has a premium of $3,648/month.⁵

If they decided keep the Gold plan, they’ll be spending two-thirds of their household income on health insurance.

And even the lowest premium Bronze plan – which they could get with no premium at all in 2025 – will cost more than half of their household income in 2026.

‘Subsidy cliff’ affects households with incomes above 400% of federal poverty level

That’s because $85,000 for a household of two is 402% of the 2025 federal poverty level (FPL).⁶ And the ACA has a so-called “cliff” where Marketplace subsidy eligibility ends abruptly if an enrollee’s household income is more than 400% of the previous year’s FPL. That’s how it worked from 2014 through 2020, when subsidies weren’t available to these enrollees, regardless of how expensive their coverage was.⁷

The subsidy eligibility income limit was temporarily lifted from 2021 through 2025, due to the American Rescue Plan (ARP) and Inflation Reduction Act (IRA). But it returned  in 2026 because the ARP/IRA subsidy enhancements were not extended by Congress.¹

To illustrate the “subsidy cliff” in more detail, let’s look at the ten states where average full-price Marketplace premiums were projected to be highest for plan year 2026.⁸ The following table illustrates the effect of lost or decreased subsidies, including their effect on three different buyer age bands:

American Rescue Plan and Inflation Reduction Act temporarily eliminated ‘subsidy cliff’

Section 9661 of the ARP capped Marketplace health insurance premiums (for the benchmark Silver plan) at no more than 8.5% of household income.⁹ The 8.5% cap applied to people with household incomes of 400% of the federal poverty level or higher. For people with lower incomes, the percentage of income that had to be paid for the benchmark premium was reduced across the board. These subsidy enhancements were initially applicable for 2021 and 2022, but the Inflation Reduction Act extended them through 2025.

If your household income was more than 400% of FPL and the benchmark plan’s premium was no more than 8.5% of your income, you wouldn’t qualify for a premium subsidy (meaning, the ARP/IRA didn’t change anything about your situation). This was more likely to be the case for younger enrollees in areas of the country where health insurance is less costly than average.

But if the full-price cost of the benchmark plan was more than 8.5% of your income, you were eligible for a premium subsidy between 2021 and 2025.  (This assumes you met the rest of the eligibility requirements, meaning that you were lawfully present in the U.S. and not eligible for Medicaid, premium-free Medicare Part A, or employer-sponsored coverage that was considered affordable and provided minimum value).

So for some people, especially older enrollees in areas of the country where health insurance is particularly costly, even those with income well above 400% of FPL were receiving a premium subsidy between 2021 and 2025. But people who earn more than 400% of FPL no longer qualify for a subsidy in 2026 – no matter how expensive their health insurance is.

Why it’s called a ‘cliff’

Due to the “subsidy cliff,” a few hundred dollars in extra annual income could translate to the loss of thousands of dollars per month in subsidies, if it pushes you over the 400% FPL threshold. And as we illustrated above, some enrollees will find that even the most inexpensive health plan now has premiums that amount to more than half their annual income. For most households, that’s simply unaffordable.

It’s called a cliff because there’s a sharp and sudden spike in health insurance premiums when subsidies end abruptly at 400% of FPL. From 2021 through 2025, subsidies were instead phased out slowly as income increased. But that is no longer the case in 2026 as subsidies are once again only available to enrollees with household income up to 400% of FPL.

Let’s take another look at the 63-year-old West Virginia couple described above, but let’s assume their income in 2026 is $84,500, instead of $85,000. That puts them just over 399% of the 2025 FPL, meaning they will still qualify for a premium subsidy in 2026.

In that case, their after-subsidy premiums for the benchmark Silver plan will be capped at a little less than 10% of their household income. That means the benchmark plan will cost them a little more than $700/month in 2026. They’ll be able to apply their subsidy to any metal-level plan, meaning they’ll be able to get the lowest-cost Bronze or Gold plan for even lower premiums.

But if their income goes above $84,600 (400% of the 2025 FPL),⁶ they will lose their subsidy altogether.

Areas with higher average premiums are hit hardest by the ‘cliff’

We used West Virginia as the example here because individual/family health insurance premiums in West Virginia are much higher than the national average.¹⁰

So let’s also consider Idaho, where 2025 premiums were much lower than the national average.¹⁰ We’ll assume we have the same 63-year-old couple, earning $85,000, but now they live in Boise instead of Charleston, WV.¹¹

• In 2025, the lowest-cost Bronze plan cost them less than $2/month after subsidies. In 2026, that plan will cost them $1,527/month as the “subsidy cliff” returns.
• In 2025, the lowest-cost Gold plan cost $712/month. That jumped to $2,354/month in 2026, with the return of the “subsidy cliff.”

While these amounts aren’t as extreme as the West Virginia example (because full-price health insurance premiums are lower in Idaho), this couple will still have to pay more than a fifth of their household income for the lowest-cost plan, now that the “subsidy cliff” has returned.

1. “ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire” KFF.org. Sep. 30, 2025
2. “2025 Marketplace Open Enrollment Period Public Use Files” Centers for Medicare & Medicaid Services. Accessed Oct. 8, 2025
3. “State Specific Age Curve Variations” Centers for Medicare & Medicaid Services. Accessed Oct. 17, 2025
4. “See Plans & Prices” (zip code 25301) HealthCare.gov. Accessed Oct. 7, 2025
5. “See Plans & Prices” (zip code 25301) HealthCare.gov. Accessed Jan. 27, 2026
6. “2025 Poverty Guidelines” U.S. Department of Health & Human Services. Accessed Oct. 6, 2025
7. “Questions and answers on the Premium Tax Credit” Internal Revenue Service. Accessed Oct. 7, 2025
8. “2026 Rate Change Project” ACA Signups. Oct. 3, 2025
9. “Text of the American Rescue Plan” (Section 6991). Congress.gov. Accessed Oct. 7, 2025
10. ”Effectuated Enrollment: Early 2025 Snapshot and Full Year 2024 Average” CMS.gov, July 24, 2025
11. “Estimate Your Premiums For 2026 (and 2025)” Your Health Idaho. Accessed Oct. 7, 2025

In this article

• What has happened to Marketplace health insurance subsidies in 2026?
• How did ARP’s subsidy enhancements affect eligibility for Marketplace premiums?
• How were the subsidies enhanced – and what has happened when those enhancements expired?
• Who is feeling the change the most?
• ACA subsidy rules have reverted
• Temporary subsidy enhancements under the ARP and IRA
• Subsidies disappeared for people with household incomes over 400% FPL
• For everyone else, subsidies are smaller than they would have been if the enhancements had been extended

ACA subsidy rules have reverted

With the subsidy enhancements expired, the rules have reverted to the subsidy rules set by the ACA. Here’s how the reinstated ACA premium subsidy rules work: ⁹

• Subsidies are available if household income is at least 100% of the federal poverty level (FPL), or more than 138% FPL in states that had expanded Medicaid eligibility under the ACA. However,
• Subsidies are not available if household income is more than 400% FPL, regardless of the percentage of income a household would have to spend to buy coverage. This results in a “subsidy cliff” at 400% FPL.

For subsidy-eligible enrollees, the subsidy amount was designed so that an the enrollee would have to pay a certain percentage of their household income for the benchmark plan (second-lowest-cost Silver plan). That percentage varied with household income and ranged between roughly 2% and 9.5% of household income. (This is called the “applicable percentage” and the range was indexed each year by the IRS.)¹⁰

Temporary subsidy enhancements under the ARP and IRA

Now let’s take a look at how the ARP temporarily changed these rules, and how the IRA extended those changes through 2025:

• Elimination of the subsidy cliff. The 400% FPL cap on subsidy eligibility was temporarily eliminated, so we haven’t had a subsidy cliff for the last five years. Instead, people with household income over 400% FPL were eligible for subsidies if the cost of the benchmark plan was more than 8.5% of their household income. (This assumes they met other subsidy eligibility requirements, including not having access to Medicaid, premium-free Medicare Part A, or an employer’s plan that’s considered affordable and provides minimum value.) Because subsidy eligibility is based on keeping the cost of the benchmark plan at no more than 8.5% of household income, the subsidy amounts phase out as income increases. 8.5% of $500,000 is a much larger amount than 8.5% of $100,000. So the higher a person’s income gets, the more they’re expected to pay on their own, and the smaller their subsidy gets. Eventually, if income is high enough, the subsidy drops to $0. But this is a gradual phasing out, rather than a sharp cliff where subsidy amounts suddenly drop to $0
• Bigger subsidies for everyone who’s subsidy-eligible. For subsidy-eligible enrollees, the percentage of household income that the enrollee had to pay for the benchmark Silver plan was reduced across the board. Instead of ranging from roughly 2% to 9.5% of household income, it ranged from 0% to 8.5% of household income.¹¹ And again, that applied to households with income above 400% FPL.
• No change to lower-income eligibility. The bottom income threshold for premium subsidy eligibility did not change.

So the ARP subsidy enhancements, extended by the IRA, had two major effects:

• They allowed Marketplace enrollees with household income above 400% FPL to potentially qualify for premium subsidies.
• They reduced the percentage of income that people receiving the premium tax credit pay for the benchmark plan at all income levels.

For example, under the original ACA rules, a person earning 150% FPL would pay 4% of their income for the benchmark plan,¹⁰ and their subsidy would cover the rest. But under ARP rules, a person earning 150% FPL paid0% of their income for the benchmark plan. Their subsidy covered the entire cost of the premium.¹²

For 2026 coverage, the 2025 FPL numbers will be compared with Marketplace applicants’ projected 2026 household income.

Since the ARP subsidy enhancements were not extended, the applicable percentages for 2026 range from 2.1% to 9.96%¹³ (up from 0% to 8.5% in 2025). And subsidies are not  available at all for those with household income above 400% of FPL.

Subsidies disappeared for people with household incomes over 400% FPL

The return of the subsidy cliff is particularly significant for older enrollees, since ACA-compliant individual and small-group premiums are based on age. (In almost all states, unsubsidized premiums for a 53-year-old are roughly twice as much as those for a 21-year-old, and a 64-year-old’s unsubsidized premium will be three times as much as a 21-year-old.)¹⁴, ¹⁵, ¹⁶ Subsidies are larger for older people, because they have to offset the larger age-based premiums. But with subsidies disappearing altogether for those with income above 400% FPL, the full-price premiums will be particularly expensive for older enrollees.

It will also be particularly significant in areas where health insurance is more expensive than average since the full premium will have to be paid by enrollees if their household income is over 400% FPL. The national average pre-subsidy Marketplace premium in 2025 was about $619/month,¹⁷ but as we’ll discuss in a moment, some states have much higher averages. And pre-subsidy premiums are increasingly significantly for 2026.¹⁸

To illustrate this, let’s look ten of the states where average full-price Marketplace premiums were projected to be highest for plan year 2026.¹⁹ (Note that although New Mexico was projected to have the eighth-highest full-price premiums in 2026,¹⁹ we’re not including them in our analysis because the state allocated funding to offset the decline in federal subsidies, even for enrollees above 400% of FPL.)²⁰

We’ll consider  three applicants in each state, ages 45, 55, and 64,- earning about 403% of the 2025 FPL, which is used to determine subsidy eligibility for 2026. This amounts to roughly $63,000 in annual income in the continental U.S., and just under $79,000 in Alaska.²¹ But because they’ve lost their subsidies altogether in 2026, their net premiums have increased substantially, as shown in the table below:

Because the ARP subsidy enhancements were allowed to sunset at the end of 2025, these individuals are not  eligible for any premium subsidies in 2026 (assuming their 2026 household income is more than 400% of the 2025 FPL). As a result, the amount they have to pay in premiums for the lowest-cost Marketplace plan has increased by hundreds of dollars per month – in some cases, by more than a thousand dollars per month.

Although this is just an illustration, these enrollees are not hypothetical. Across all Marketplace enrollees nationwide, the 55-64 age group has the highest total enrollment, with nearly 5.5 million enrollees in 2025.²²

And out of the 24.3 million people who selected Marketplace plans during the open enrollment period for 2025 coverage, more than 1.6 million reported incomes above 400% FPL.²³ The chart above illustrates the percentage of enrollees in each state whose income is over 400% FPL. In eight of the ten states we looked at, enrollees with income above 400% FPL account for at least 10% of Marketplace enrollment.

For everyone else, subsidies cover as much of the premium as they did in 2025

In addition to the return of the subsidy cliff for households earning more than 400% FPL, it’s important to understand that a return to the pre-ARP ACA subsidy rules has also resulted in subsidies being smaller than they would otherwise have been, for everyone who continues to be subsidy-eligible. This is because at all income levels, people have to pay a larger percentage of their income to purchase coverage.

In 2025, under the ARP subsidy rules, people paid between 0% and 8.5% of their household income for the benchmark (second-lowest-cost Silver) plan. With the subsidy enhancements expiring  at the end of 2025, this range is instead 2.1% to 9.96% of household income in 2026 (but with no assistance available if household income is above 400% of FPL).²⁴

So for example, consider a single person in the continental U.S. who earns 250% of FPL:

• In 2025, their income was $37,650, which is 250% of the 2024 FPL.²⁵ And in 2025, they had to pay 4% of that income for the benchmark silver plan.²⁶ That means their after-subsidy premium for the benchmark plan was $1,506 for the whole year, or about $126/month.
• In 2026, their income is $39,125, which is 250% of the 2025 FPL.²⁷ But because everyone has to pay a higher percentage of household income for the benchmark plan due to the expiration of the subsidy enhancements, they’ll have to pay 8.44% of their income for the benchmark plan.²⁴ That’s about $3,302 for the whole year, or about $275/month.

So this person went from paying $126/month for the benchmark plan in 2025 to paying $275/month for the benchmark plan in 2026, even though their income stayed at the same percentage of FPL.

Obviously, a person can use their premium subsidy to buy any metal-level plan that’s available to them, so they don’t have to buy the benchmark plan. Their actual after-subsidy cost will depend on the plan they select, and the available options differ greatly from one area to another.

But the reason subsidies won’t stretch to cover as much of the premium in 2026 is because Marketplace enrollees will be expected to pay a larger percentage of their household income to buy the benchmark plan. That means subsidies will be smaller than they would otherwise have been, and after-subsidy premiums will be higher than they would otherwise have been.

The Biden-Harris administration noted that the subsidy enhancements have resulted in not only record-high enrollment, but also an increase in the number of people who upgraded their Marketplace coverage from Bronze to a higher metal level.²⁸ This makes sense, since the larger subsidies allowed people to buy more expensive coverage without increasing their net premiums.

Without the ARP subsidy enhancements, the Congressional Budget Office projects that Marketplace enrollment will drop by about 4 million people.²⁹ And while millions of people will continue to have Marketplace coverage, it stands to reason the plan upgrades in response to the subsidy enhancements could reverse, with people opting to downgrade their coverage to keep the premiums affordable.²⁸

1. “2025 Marketplace Open Enrollment Period Public Use Files” Centers for Medicare & Medicaid Services. Accessed Oct. 7, 2025
2. “Another Year of Record ACA Marketplace Signups, Driven in Part by Medicaid Unwinding and Enhanced Subsidies” KFF.org. Jan. 24, 2024
3. “Historic 21.3 Million People Choose ACA Marketplace Coverage” Centers for Medicare & Medicaid Services. Jan. 24, 2024
4. “Effectuated Enrollment: Early 2025 Snapshot and Full Year 2024 Average” CMS.gov, July 24, 2025
5. “Marketplace 2025 Open Enrollment Fact Sheet” Centers for Medicare & Medicaid Services. Oct. 25, 2024
6. “American Rescue Plan Act of 2021” NCSL.org. Mar. 9, 2021; “American Rescue Plan and the Marketplace” Centers for Medicare & Medicaid Services. Mar. 12, 2021; “Summary: The Inflation Reduction Act of 2022” Senate Democrats. Accessed Oct. 22, 2025
7. “American Rescue Plan and the Marketplace” Centers for Medicare & Medicaid Services. Mar. 12, 2021
8. “2026 Rate Change Project” ACA Signups. Accessed Oct. 3, 2025
9. “Questions and Answers on the Premium Tax Credit” Internal Revenue Service. Accessed Dec. 5, 2024
10. “Text of the Affordable Care Act” (page 111). House.gov. Accessed Nov. 14, 2024
11. “Inflation Reduction Act Health Insurance Subsidies: What is Their Impact and What Would Happen if They Expire?” KFF.org. July 26, 2024
12. “Explaining Health Care Reform: Questions About Health Insurance Subsidies” KFF.org. Oct. 25, 2024
13. “Revenue Procedure 2025-25” Internal Revenue Service. Accessed July 30, 2025
14. “Title 45 § 147.102 Fair health insurance premiums” Code of Federal Regulations. Accessed Oct. 8, 2025
15. “Guidance Regarding Age Curves and State Reporting” (applicable 2018 or later).
16. “Market Rating Reforms” Centers for Medicare & Medicaid Services. Accessed Oct. 8, 2025
17. “Effectuated Enrollment: Early 2025 Snapshot and Full Year 2024 Average” Centers for Medicare & Medicaid Services. July 24, 2025
18. ”How much and why ACA Marketplace premiums are going up in 2026” KFF.org. Aug. 6, 2025
19. “2026 Rate Change Project” ACA Signups. Oct. 3, 2025
20. ”New Mexico Special Session HB2” New Mexico Legislature. Enacted Oct. 7, 2025
21. “HHS Poverty Guidelines for 2025” U.S. Department of Health & Human Services. Accessed Oct. 8, 2025. These enrollees were eligible for significant premium subsidies in 2025.[efn_note]Plan comparison tools for HealthCare.gov, Vermont Health Connect, Access Health CT, and CoverME (used zip code with the largest population in each state) Accessed Oct. 8, 2025
22. “2025 Marketplace Open Enrollment Period Public Use Files” (Demographics tab, Column J) CMS.gov, Accessed Oct. 9, 2025
23. “2024 Marketplace Open Enrollment Period Public Use Files” (FPL Tab, Columns L and M) CMS.gov, Accessed Oct. 9, 20254
24. “Revenue Procedure 2025-25” Internal Revenue Service. Accessed Oct. 9, 2025
25. “2024 Poverty Guidelines” U.S. Department of Health & Human Services. Accessed Oct. 9, 2025
26. “Revenue Procedure 2024-35” Internal Revenue Service. Accessed Oct. 9, 2025
27. “2025 Poverty Guidelines” U.S. Department of Health & Human Services. Accessed Oct. 9, 2025
28. “Expanded Financial Assistance Allows Families to Save Money and Upgrade Health Insurance” The White House. Nov. 8, 2024
29. “The Premium Tax Credit and Related Spending” Congressional Budget Office. July 2024

In this article

• Marketplace subsidy enhancements have expired
• Some states have made Marketplace coverage more affordable
• Low-income recent immigrants lost access to subsidies
• There’s no longer a cap on repayment of excess APTC
• Higher out-of-pocket caps are in effect
• Bronze and Catastrophic Marketplace plans are now HSA-eligible
• Having a direct primary care membership no longer prevents HSA eligibility
• Some individual-market health plans terminated at the end of 2025

With the start of the new year, eight significant changes affecting Marketplace health coverage are now in place. Here’s a look at the health policy developments that are already affecting ACA premiums, premium tax credits (referred to as subsidies in this article), and other coverage costs for individual-market plan buyers.

Marketplace subsidy enhancements have expired

As of January 1, 2026, the Marketplace subsidy enhancements put in place by the American Rescue Plan are no longer in effect. This could still change, as Congress is considering measures that would reinstate them, or implement a modified version of the subsidy enhancements, but nothing has been passed yet.¹ So for the time being, the subsidy rules have reverted to the way they were before 2021.

That means subsidies don’t cover as much of the premiums as they did for the past five years, and the “subsidy cliff” has returned, making people ineligible for subsidies if their household income (an ACA-specific version of MAGI) is more than 400% of the federal poverty level (FPL).

What you can do:

• If open enrollment is still ongoing in your state, you can still enroll or switch plans for the rest of 2026. There are several states where open enrollment continues until the end of January. After the end of open enrollment, you may find that you can still make a plan change if you have a qualifying life event that triggers a special enrollment period. Learn more about special enrollment periods.
• If your household income is a little above 400% of FPL, understand how contributions to a health savings account (HSA) or pre-tax retirement account will reduce your ACA-specific MAGI. (See below for information about how HSA access for Marketplace enrollees has been expanded for 2026.) Speak with a tax advisor.

Some states have made coverage more affordable

To address the expiration of the federal subsidy enhancements, several of the states that offer their own state-funded subsidies have modified or increased their subsidies for 2026.

If you’re in California, Colorado, Connecticut, Maryland, Massachusetts, or New Mexico, you may find that enhanced state subsidies will offset some or all of the reduction in your federal subsidy amount.

And due to a new premium alignment approach (in other words, state rules regarding how insurers add the cost of cost-sharing reductions to Silver plan premiums), many enrollees in Washington,² Illinois,³ and Arkansas⁴ might find that Bronze and Gold plans are more affordable than they were in prior years.⁵

What you can do:

• If you’re in a state that runs its own Marketplace (meaning it doesn’t use HealthCare.gov), you may find that the state is offering its own subsidies, on top of the federal subsidies. Don’t let open enrollment pass you by without checking to see what’s available in your state.
• Even in states that use HealthCare.gov, you might find that coverage is more affordable than you were expecting, due to a reinsurance program or premium alignment.

Low-income recent immigrants lost access to subsidies

As of January 1, ACA premium subsidies are no longer available to recent immigrants with income under the federal poverty level.

This stems from the “One Big Beautiful Bill Act” that was enacted last summer, and it’s a significant change from the rule that was previously in place from 2014 through 2025.

Before 2026, lawfully present low-income immigrants could qualify for Marketplace subsidies during the five-year waiting period before becoming eligible for Medicaid. But that’s no longer the case. These immigrants now face the same coverage gap that applies to low-income U.S. citizens in nine states that have not expanded Medicaid under the ACA.

What you can do:

• If you’re a lawfully present immigrant,⁶ you can still qualify for Marketplace subsidies as long as your 2026 income is at least 100% of the 2025 FPL. In the continental U.S., that amounts to $15,650 for a single person, and $32,150 for a household of four.⁷

There’s no longer a cap on repayment of excess APTC

If you have Marketplace coverage and an advance premium tax credit (APTC) subsidy is being applied to your premium (this is the case for most Marketplace enrollees nearly everyone), you have to reconcile that APTC when you file your tax return.⁸

If you end up earning less than you projected for the plan year (but not a Medicaid-eligible amount or less than the FPL), the IRS will increase your premium tax credit accordingly (either as a refund or a reduction of the amount of income tax you owe). But if you end up earning more than you projected for the plan year, you will have to repay the excess APTC that was paid on your behalf.

Through the 2025 plan year, there were caps on how much excess APTC had to be repaid, depending on your income. But that’s gone as of the 2026 plan year. Any APTC that’s paid out for the 2026 plan year will have to be fully reconciled when enrollees file their 2026 tax returns in 2027. Regardless of income, all enrollees receiving excess APTC will have to repay the full amount of excess APTC that was paid on their behalf. This will continue to be the case in future years as well.

What you can do:

• If APTC is being paid to your insurer, be sure you’ve projected your 2026 income as accurately as possible. Report any changes in your income or household size to the Marketplace, as these changes could affect your subsidy amount. You can log back into your Marketplace account at any point during the plan year to make updates to your income projection and household details,⁹ and the Marketplace will adjust your APTC amount in real time. This will help to ensure that you don’t have any unwelcome surprises next year at tax time.

Higher out-of-pocket caps are in effect

Each year, the federal government sets an upper limit for the maximum amount that health plans can require enrollees to pay out of pocket for covered, in-network care. This limit applies to all individual-market and employer-sponsored plans with effective dates of 2014 or later.¹⁰

In 2025, the limit was $9,200 for a single individual. But it rose significantly in 2026, to $10,600, partly due to a rule change that was finalized in 2025.

What you can do:

• Make sure you understand the out-of-pocket limit for your policy (which might be well below the maximum allowable cap), and have a plan for how you’ll cover that cost if you need extensive medical care.
• If your plan auto-renewed for 2026 and you’re in a state where open enrollment extends through the end of January, you still have time to comparison shop and switch plans if there’s another option that will better meet your needs. In the rest of the country, plan changes are only possible for the rest of 2026 if you qualify for a special enrollment period.

Bronze and Catastrophic Marketplace plans are now HSA-eligible

Starting with the 2026 plan year, all Bronze and Catastrophic plans purchased through the Marketplace are HSA-eligible. This is a significant change from past years, when only a small fraction of Bronze Marketplace plans were HSA-eligible, and no Catastrophic plans were.

What you can do:

• If you’re enrolled in a Bronze or Catastrophic Marketplace plan, be sure you understand how HSAs work, and consider whether you might want to establish an HSA and make contributions.
• If you have a Bronze Marketplace plan (or an HSA-eligible plan at any other metal level) and you contribute to an HSA, the contributions will reduce your ACA-specific modified adjusted gross income, which determines your access to Marketplace subsidies. (Note that while Catastrophic Marketplace plans are now HSA-eligible, subsidies can never be used with Catastrophic plans, regardless of income.)
• Customers with HSA-eligible coverage can open an HSA and make contributions for 2026 at any time between January 1, 2026 and April 15, 2027.

Having a direct primary care membership no longer prevents HSA eligibility

In another rule change that took effect in 2026, people with direct primary care (DPC) memberships – including Marketplace plan buyers – are no longer prohibited from contributing to an HSA (assuming they also have HSA-eligible high-deductible health plan (HDHP) coverage).¹¹

DPC memberships allow people to pay a monthly fee to a medical office, giving them access to unlimited primary care that the practice makes available. Learn more about direct primary care.

DPC memberships have long appealed to people whose health plans have high deductibles, as a way of accessing primary care without needing to meet their deductible. But longstanding IRS rules prohibited people with HDHPs from contributing to an HSA if they also had a DPC membership. That has changed as of 2026.¹²

What you can do:

• If you have a DPC membership or are considering one, you may find that you can contribute to an HSA in 2026, as long as you also have HSA-eligible health coverage in addition to your DPC membership. The DPC will need to meet certain requirements, including a fee of no more than $150/month for a single person, or $300/month for a family, and limits on what services can be covered.
• If you have funds in your HSA and also have a DPC membership, you can use your HSA funds to pay DPC fees. This is also new as of 2026.¹²

Some individual-market health plans terminated at the end of 2025

At the end of 2025, some individual-market plans, including all individual plans offered by Aetna in 17 states, terminated and were not eligible for renewal. If you were enrolled in one of these plans and you didn’t pick a replacement policy, you might have become uninsured as of January 1 (if you had off-exchange coverage), or you might have been automatically mapped to a new plan by the Marketplace.

What you can do:

• Your special enrollment period due to the loss of coverage will continue for 60 days after the end of 2025 (ie, until March 1, 2026), so you still have time to pick a replacement policy.
• If you were automatically enrolled into a replacement plan by the Marketplace and you use your special enrollment period to pick a new plan during your special enrollment period, it won’t take effect until the first of the month after you enroll. Any 2026 out-of-pocket costs you incur on the plan that was chosen for you will not transfer to the new plan you select, so keep this in mind when deciding if you want to switch plans.

1. “This GOP senator says reviving Obamacare subsidies would be ‘putting America first’” Politico. Jan. 12, 2026
2. ”Exchange Board certifies 2026 health and dental plans” Washington Healthplanfinder. Sep. 12, 2025
3. ”2026 Marketplace Changes” Get Covered Illinois. Accessed Jan. 28, 2026
4. ”Health insurance for many Arkansans will be affordable in 2026 after all — if you shop around” Arkansas Times. Dec. 3, 2026
5. “Tale of two states: Effects of strict silver loading or the lack thereof in the 2026 ACA marketplace” Xpostfactoid. Dec. 21, 2025
6. “Immigration status to qualify for the Marketplace” HealthCare.gov. Accessed Jan. 9, 2026
7. “2025 Poverty Guidelines” U.S. Department of Health & Human Services. Accessed Jan. 9, 2026
8. “Reconciling your advance payments of the Premium Tax Credit” Internal Revenue Service. Accessed Jan. 12, 2026
9. “Reporting income & household changes after you’re enrolled” HealthCare.gov. Accessed Jan. 9, 2026
10. “Affordable Care Act Implementation FAQs – Set 18” Centers for Medicare & Medicaid Services. Accessed Jan. 12, 2026
11. “H.R.1 – One Big Beautiful Bill Act” (Section 71308(a)) Congress.gov. Enacted July 4, 2025
12. “Treasury, IRS provide guidance on new tax benefits for health savings account participants under the One, Big, Beautiful Bill” Internal Revenue Service. Dec. 9, 2025

In this article

• Who’s experiencing Marketplace sticker shock?
• Review the available plans. (Those won’t change.)
• Understand your income as a percentage of the federal poverty level
• Understand how HSA contributions can affect your MAGI
• Update your Marketplace account
• Remember the Dec. 15 deadline (in most states) and stay tuned for updates

The Marketplace subsidy enhancements introduced by the American Rescue Plan expired at the end of 2025, after Congress failed to extend them. This has resulted in significantly higher after-subsidy health insurance premiums for most Marketplace enrollees. (Congress is still considering this issue as of January 2026, so the subsidy structure could potentially change.)¹

If you’re feeling sticker shock because your premiums increased significantly, here’s a look at your options now as we head into 2026.

1. Review the available plans. (Those won’t change.)

The 2026 plan year is already underway, and the individual market plans for 2026 were finalized months ago. So although after-subsidy premiums could still change if Congress takes action to reinstate the subsidy enhancements or a modified version of them,⁶ the coverage details of the available plans will not change.

So if you haven’t picked a plan yet, or if your coverage auto-renewed and you haven’t comparison shopped to see what your options are, you still have time to select a plan for the rest of 2026 (unless you’re in Idaho, where enrollment now requires a special enrollment period). Make sure you understand details like deductibles, out-of-pocket maximums, covered drug lists, and provider networks, to get an idea of what your coverage options are for the rest of 2026.

2. Understand your income as a percentage of the federal poverty level (FPL)

Your eligibility for 2026 Marketplace premium subsidies is based on how your projected 2026 household income compares to the 2025 federal poverty level. (Note that these numbers are higher in Alaska and Hawaii.)⁷

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

Because Congress has not extended the subsidy enhancements, enrollees are no longer eligible for premium subsidies 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 you’re seeing no subsidy at all in the Marketplace if your projected household income is above those amounts. (If you’re in Connecticut, 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.)

3. Understand how HSA contributions can affect your MAGI

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,⁸ which means they won’t qualify for any subsidy at all in 2026 (unless Congress in some way reinstates the subsidy enhancements). Without a subsidy, the lowest-cost plan available to this person costs $1,079/month in premiums in 2026,⁹ which amounts to more than 20% of their household income.

But that lowest-cost option is a Bronze plan, and all Bronze Marketplace plans 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 will allow them to avoid the “subsidy cliff,” and will 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)¹⁰ 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.¹¹

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.

4. Update your Marketplace account

Now is a good time to make sure your Marketplace account is up to date. If there have been any changes in your household or your income since the last time you updated your Marketplace account, be sure to report those changes to the Marketplace.

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 is 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.

5. Remember the Jan. 15 deadline (in most states) and stay tuned for updates

Unless you live in Idaho, you have until at least January 15 (or later in some states) to pick a Marketplace plan that will take effect on February 1, 2026.

With that deadline upon us, now’s the time to pick a plan if you haven’t already done so. However, 2026 subsidy amounts may still change, even now that the plan year is underway, as Congress continues to consider the issue of subsidy enhancements.

The House has passed a bill to reinstate and extend them for three years, although the Senate is working on legislation that would include modifications to the subsidy enhancements. We don’t know whether the two chambers will reach an agreement, and if so, what the details would involve.⁶

Regardless of whether you picked a plan back in November, or you’re picking one now, it’s important to stay tuned to see if anything changes. If Congress reinstates the subsidy enhancements or a modified version of them, they may open a special enrollment period that would allow consumers to enroll or pick a different plan. So consumers should continue to pay close attention to the news around this issue and any communications they might get from the Marketplace.

One other important point to keep in mind: If you already have coverage that took effect in January and you’re considering a different plan that will have a February 1 effective date, your 2026 out-of-pocket costs will reset to zero under the new plan. So if you’re incurring any out-of-pocket costs in January, you’ll want to keep that in mind when deciding whether you want to select a different plan to cover you for the rest of 2026.

1. “House Passes Extension Of Obamacare Health Insurance Subsidies” HuffPost. Jan. 8, 2026
2. “Effectuated Enrollment: Early 2025 Snapshot and Full Year 2024 Average” Centers for Medicare & Medicaid Services. July 24, 2025
3. “ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire” KFF.org. Sep. 30, 2025
4. “IMPORTANT: *Official* avg. 2026 premium hikes will likely be lower than KFF’s 114% estimate for three critical reasons…” ACA Signups. Jan. 2, 2026
5. “ACA Insurers Are Raising Premiums by an Estimated 26%, but Most Enrollees Could See Sharper Increases in What They Pay” KFF.org. Oct. 28, 2025
6. “House passes bill to extend enhanced ACA subsidies 3 years” HuffPost. Jan. 8, 2026
7. “2025 Poverty Guidelines” U.S. Department of Health & Human Services. Accessed Oct. 30, 2025
8. “2025 Poverty Guidelines” U.S. Department of Health & Human Services. Accessed Oct. 29, 2025
9. “Estimate your premiums for 2026” (zip code 30033) Georgia Access. Accessed Oct. 29, 2025
10. “Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans” Internal Revenue Service. Accessed Oct. 30, 2025
11. “Revenue Procedure 2025-19” Internal Revenue Service. Accessed Oct. 29, 2025

Over the years, the headlines surrounding the possibility of the ACA (aka Obamacare) being overturned have often focused on people with pre-existing conditions who buy their own health insurance. (This is certainly a valid concern, as those individuals would undoubtedly be worse off without the ACA.)

But the impact of the ACA goes well beyond securing access to health coverage for people with pre-existing conditions. Who are these Americans whose lives are better off – thanks to the ACA? See if you can find yourself – or your loved ones – in this list:

1. In 2025, nearly 22 million Americans (93% of all Marketplace/exchange enrollees) are receiving premium subsidies, making their coverage affordable.⁴ The average full-price premium was about $619/month in 2025, but the average subsidy amount (about $550/month) covered the majority of the average premium. (Note that Congress allowed a subsidy enhancement program to expire at the end of 2025. Although this issue was still under consideration in Congress as of early 2026,⁵ fewer people are subsidy-eligible in 2026, and subsidies are smaller than they would have been if the subsidy enhancements had been extended.)
2. More than 12.5 million people who are receiving cost-sharing reductions that make medical care more affordable and accessible.⁴
3. People who are (or want to be) self-employed and wouldn’t have been able to qualify for and/or afford a privately purchased health insurance plan without the ACA’s guaranteed-issue provisions and premium subsidies.⁶
4. People with pre-existing conditions who gain access to an employer-sponsored plan after being uninsured for more than 63 days. HIPAA guaranteed that people in this situation (meaning they didn’t have continuous prior coverage) could enroll in the employer-sponsored plan, but HIPAA allowed the plans to impose waiting periods for pre-existing conditions.⁷ The ACA eliminated those waiting periods.⁸
5. People who lose access to employer-sponsored coverage and no longer have to rely on COBRA (or mini-COBRA/state continuation) for health coverage. COBRA is still an option, but the ACA’s consumer protections in the individual market ensured that self-purchased coverage is also an option. Depending on income, the ACA’s expansion of Medicaid is also an option in most states.
6. People who gain access to an employer-sponsored health plan and have a waiting period of no more than 90 days before their coverage takes effect. Pre-ACA, employers could determine their own waiting periods, which were sometimes longer than three months.⁹
7. Full-time (30+ hours/week) workers at large businesses who are offered health insurance with unlimited annual benefits instead of “mini-med” plans, thanks to the ACA’s employer mandate. (Employers can choose not to comply, but they face a penalty in that case.)¹⁰
8. 

   People with serious conditions often exhausted their coverage under pre-ACA plan because of annual or lifetime benefits caps.

   People with serious medical conditions who would otherwise have exhausted their coverage in the private market, including employer-sponsored plans.¹¹ Pre-ACA, annual and lifetime benefit caps were used by the majority of private health insurance policies,¹² with benefit caps that were often in the range of $1 million to $5 million.¹³ And it could be shockingly easy to hit those maximums if you had a premature baby or a serious medical condition.¹⁴

9. Coal miners with black lung disease, and their survivors. The ACA made benefits under the Black Lung Benefits Act of 1972 available to more people.¹⁵
10. Medicare beneficiaries who use Part D prescription drug coverage and who would have ended up in the so-called Part D donut hole. The ACA closed the donut hole as of 2019,¹⁶ and the Inflation Reduction Act eliminated it altogether as of 2025.¹⁷
11. Medicare beneficiaries who receive free preventive care.¹⁸¹⁹
12. American taxpayers and Medicare beneficiaries who benefit from ACA cost controls that have extended the solvency of the Medicare Hospital Insurance trust fund and improved Medicare’s long-term financial outlook.²⁰²¹
13. Lower-income seniors who can remain in their homes as they age, thanks to the ACA’s expansion of Medicaid funding for in-home long-term care services and supports.²²²³
14. Nursing home residents – and people with loved ones living in nursing homes – who benefit from an effort to implement federal funding for background checks on employees who interact with patients.²⁴
15. The 12 million low-income Americans who are elderly and/or disabled, covered simultaneously by both Medicare and Medicaid,²⁵ and who benefit from the improvements the ACA made for the dual-eligible population.²⁶²³
16. College students who are no longer offered health plans with low annual and lifetime benefit caps.²⁷
17. Women (and their partners) who have access to contraception at no cost – including birth control methods such as IUDs (intrauterine devices), implants, and tubal ligations that are highly effective but would have prohibitively high out-of-pocket costs if they weren’t covered by insurance.²⁸
18. Pregnant women who have access to routine prenatal care without cost sharing.²⁹
19. Expectant parents – male and female – who cannot be denied enrollment in a health plan in the individual market. (Pre-ACA, expectant parents’ applications were rejected in nearly every state.)³⁰
20. People who buy their own health insurance and would like to have a child. Pre-ACA, individual health insurance rarely covered maternity care.³¹
21. Breastfeeding mothers who have access to breast pumps and breastfeeding counseling as part of their insurance benefits. The ACA also guarantees that breastfeeding mothers who work for large employers have access to adequate breaks and a private, non-bathroom area for pumping milk.³²
22. Anyone who is better off in a world where people in need of mental health care can access it – because their health insurance covers it and they aren’t rejected because of a preexisting mental health condition when they apply for a new health plan.³³ (Note that mental health coverage has to be provided on all individual and small-group plans with effective dates of 2014 or later. It does not have to be provided on large group health plans, but if it is, the coverage must be provided on the same terms as coverage for medical/surgical care.)³⁴
23. People with substance abuse disorders who can obtain treatment that would be unaffordable to them without health insurance coverage.³⁵
24. The nearly 21 million people who have gained access to Medicaid thanks to the ACA’s expansion of eligibility to low-income adults.³⁶
25. Low-income families and individuals who no longer have to meet asset tests to qualify for Medicaid or CHIP, with eligibility now based on the ACA’s modified adjusted gross income instead. (Some populations, including the elderly and disabled, are still subject to asset tests for Medicaid eligibility.)³⁷
26. People in some rural areas of the country where hospitals have been able to remain open thanks to Medicaid expansion.³⁸
27. Young adults age 25 and under who are able to remain on their parents’ health insurance as they work to start their careers.
28. Young adults who were in foster care until age 18, and who are allowed to continue their Medicaid coverage until age 26, regardless of income.³⁹
29. Early retirees who can enroll in comprehensive individual-market health insurance for their pre-Medicare years, regardless of their medical history.⁴⁰ The ACA’s expansion of Medicaid (available in 40 states and DC) also makes Medicaid available to early retirees whose income is low.
30. 

    ACA’s Marketplace plans must cover a list of vaccinations for children from birth to age 18.

    Children who have access to free vaccines and well-child care.⁴¹⁴²

31. Adults who have access to a wide range of preventive health services at no cost.⁴¹⁴³
32. Families whose health plan covers their kids’ dental care. (Some plans include pediatric dental, but it can also be obtained as a stand-alone policy.)⁴⁴
33. People in New York,⁴⁵ Oregon,⁴⁶ Washington, DC,⁴⁷ and Minnesota⁴⁸ who earn a little too much for Medicaid but are eligible for coverage under Basic Health Programs. (New York’s program has been temporarily further extended, but will return to being a Basic Health Program in mid-2026.⁴⁵ Washington DC’s Basic Health Program is new for 2026.)⁴⁷
34. People who find themselves needing to appeal their health plan’s decision on a prior authorization request or claim. The ACA ensures access to both an internal appeal and, if that’s unsuccessful, an external review by a third party.⁴⁹
35. Medicare Advantage enrollees whose health plan is required to spend at least 85% of revenue on members’ medical claims and quality improvements.⁵⁰⁵¹
36. Individuals and employers whose insurers are required to spend at least 80% or 85% of premiums on members’ medical claims and quality improvements, as opposed to administrative costs. (Plans that don’t hit this target must send rebates to enrollees and employers.)⁵²
37. People age 65 and older, including recent immigrants, who are able to enroll in ACA-compliant health plans if they’re not eligible for premium-free Medicare. (Pre-ACA, individual-market insurers generally would not enroll people over age 64.)⁵³
38. Women, who no longer pay more for health insurance than men.⁵⁴
39. Older people (including those age 65+ who aren’t eligible for premium-free Medicare), whose premiums for individual or small-group coverage are no more than three times as much as the premiums for a 21-year-old.⁵⁵ (For individual-market coverage, the 3:1 ratio is calculated before Marketplace subsidies are applied. If the applicant is subsidy eligible, their subsidies will be larger to account for the fact that their premiums are larger than a 21-year-old’s.)⁵⁶
40. People who buy their own health insurance and no longer have to worry that the policy could be rescinded because they forgot to mention a health issue on the application.⁵⁷ (This was typically due to an omission in the medical history section, and those questions are no longer asked – thanks, also, to the ACA.)⁵⁸
41. Everyone who benefits from the more robust premium review processes that states have as a result of the ACA.⁵⁹⁶⁰ The rate review process ensures that state (or federal, in a few states) regulators review proposed annual premium increases to determine whether they’re actuarially sound.⁶¹
42. Everyone who benefits from the ACA’s risk adjustment program, which levels the playing field and helps to prevent plan designs that would be unappealing to individuals and groups with high-cost medical conditions.⁶²⁶³ (The risk adjustment program transfers money from plans with healthier enrollees to plans whose enrollees have higher claims, reducing the incentive for insurers to design plans that would appeal to healthier enrollees.)
43. People with individual and small-group coverage that includes all of the essential health benefits.⁶⁴ Pre-ACA – especially in the individual market – it was common for plans to not include coverage for all of the essential health benefits. In particular, coverage for maternity care and mental health/substance use care was often lacking.³¹
44. People who pay full price for individual health insurance in Alaska, Colorado, Delaware, Georgia, Idaho, Maine, Maryland, Minnesota, Montana, Nevada, New Hampshire, New Jersey, North Dakota, Oregon, Pennsylvania, Rhode Island, Virginia, and Wisconsin, who are paying lower premiums thanks to reinsurance programs that were implemented under Section 1332 of the ACA.⁶⁵
45. Native Americans and Alaska Natives, who can enroll year-round in plans sold through the exchanges, and who are eligible for plans with zero cost sharing if their income doesn’t exceed 300% of the poverty level.⁶⁶ (That’s $96,450 for a family of four enrolling in 2026 coverage in the continental United States; the dollar amount is higher in Alaska and Hawaii.)⁶⁷
46. Native Americans and Alaska Natives who receive care via Indian Health Services (IHS) because the ACA permanently reauthorized the Indian Health Care Improvement Act.⁶⁸ (So periodic reauthorization is no longer necessary.)⁶⁹
47. People who are protected from discrimination in healthcare based on race, national origin, sex, age, or disability, thanks to Section 1557 of the ACA. (The details of how these protections work are determined by HHS, so there have been some changes over time under different administrations. HHS initially issued rulemaking in 2016,⁷⁰ but it was rolled back in 2020.⁷¹ HHS finalized new rules in 2024 that strengthened anti-discrimination protections, including a prohibition on health care discrimination based on gender identity.⁷² But a federal court vacated the gender identity non-discrimination protections in 2025.⁷³)
48. People who can make more informed food choices thanks to a requirement that nutritional and calorie information be displayed on certain restaurant menus. This stems from Section 4205 of the ACA, and was implemented in 2018.⁷⁴⁷⁵
49. People who shop for coverage in the health insurance Marketplace (exchange) and find the star rating system for health plans to be helpful during the plan selection process.⁷⁶
50. People who could benefit from new biosimilar drugs becoming available. Section 7002 of the ACA created the pathway under which biosimilar drugs are approved by the FDA.⁷⁷⁷⁸

1. “The Supreme Court Throws Out the ACA Lawsuit, Not the ACA” The Commonwealth Fund. June 21, 2021
2. “Kennedy v. Braidwood: The Supreme Court Upheld ACA Preventive Services but That’s Not the End of the Story” KFF.org. June 27, 2025
3. “Reviewing Efforts to Replace the Affordable Care Act” The Regulatory Review. Feb. 18, 2025
4. “Effectuated Enrollment: Early 2025 Snapshot and Full Year 2024 Average” Centers for Medicare & Medicaid Services. July 24, 2025
5. ”House Passes Extension Of Obamacare Health Insurance Subsidies” HuffPost. Jan. 8, 2026
6. “Fact Sheet: How Enhanced Premium Tax Credits for Affordable Health Care Empower Self-Employed Americans” Center for American Progress. Oct. 28, 2024
7. “Health Insurance Market Reforms: Pre-Existing Condition Exclusions” KFF.org. Sep. 2012
8. “ACA Section 1201” Congress.gov. Accessed Nov. 11, 2025
9. “Implementing Health Reform: Waiting Periods For Employer-Sponsored Health Insurance” Health Affairs. Feb. 22, 2014
10. “Employer shared responsibility provisions” Internal Revenue Service. Accessed Nov. 11, 2025
11. “ACA Section 2711” Congress.gov. Accessed Nov. 11, 2025
12. “Under The Affordable Care Act, 105 Million Americans No Longer Face Lifetime Limits on Health Benefits” U.S. Department of Health & Human Services. Mar. 4, 2012
13. “Health insurance as assurance: The importance of keeping the ACA’s limits on enrollee health costs” Brookings. Jan. 17, 2017
14. “Couldn’t have done it without ACA” 1000 Days. Accessed Nov. 11, 2025
15. “The Black Lung Program, the Black Lung Disability Trust Fund, and the Excise Tax on Coal” Congressional Research Service. Feb. 7, 2023
16. “Closing the Medicare Part D Coverage Gap: Trends, Recent Changes, and What’s Ahead” KFF.org. Aug. 21, 2018
17. “CMS Releases 2025 Medicare Part D Bid Information and Announces Premium Stabilization Demonstration” Centers for Medicare & Medicaid Services. July 29, 2024
18. “Background: The Affordable Care Act’s New Rules on Preventive Care” Centers for Medicare & Medicaid Services. Updated Sep. 10, 2024
19. “ACA Section 4103, ACA Section 4104 (which amended SSA §1833) and ACA Section 4105” Congress.gov. Accessed Nov. 19, 2025
20. “Medicare Is Not ‘Bankrupt’” Center on Budget and Policy Priorities. Feb. 10, 2025
21. “Solvency extensions to the Medicare Hospital Insurance Trust Fund: what is driving them?” National Library of Medicine. Apr. 9, 2025
22. “ACA Section 2401” Congress.gov. Accessed Nov. 11, 2025
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24. “CMS National Background Check Program” Centers for Medicare & Medicaid Services. Accessed Nov. 11. 2025
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27. “Student Health Plan Enrollees to Gain New Protections Under Affordable Care Act” The Commonwealth Fund. Feb. 11, 2011
28. “Most insurance covers IUDs. Hers cost more than $14,000” News Medical. Jan. 31, 2025
29. “Women’s Preventive Services Guidelines” Health Resources and Services Administration. Accessed Nov. 11, 2025
30. “Pre-Existing Condition Prevalence for Individuals and Families” KFF.org. Oct. 4, 2019
31. “Analysis: Before ACA Benefits Rules, Care for Maternity, Mental Health, Substance Abuse Most Often Uncovered by Non-Group Health Plans” KFF.org. June 14, 2017
32. “Understanding Health Care Coverage for Breastfeeding” American College of Obstetricians & Gynecologists. Accessed Nov. 11, 2025
33. “Does the Affordable Care Act cover individuals with mental health problems?” U.S. Department of Health & Human Services. Accessed Nov. 11, 2025
34. “The Mental Health Parity and Addiction Equity Act (MHPAEA)” Centers for Medicare & Medicaid Services. Accessed Nov. 11, 2025
35. “Building on the ACA to Address Substance Use Disorders & Mental Illness” Community Catalyst. Mar. 24, 2022
36. “Medicaid Enrollment – New Adult Group” Medicaid.gov. Data as of March 2025. Accessed Jan. 8, 2026
37. “Eligibility Policy” Medicaid.gov. Accessed Nov. 11, 2025
38. “Medicaid Coverage Supports Rural Patients, Hospitals, and Communities” American Hospital Association. June 5, 2025
39. “Medicaid Coverage for Former Foster Youth Up to Age 26” Congress.gov. Accessed Nov. 12, 2025
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63. “The Patient Protection and Affordable Care Act’s (ACA’s) Risk Adjustment Program: Frequently Asked Questions” Congressional Research Service. Oct. 4, 2018
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72. “Nondiscrimination in Health Programs and Activities” U.S. Department of Health & Human Services. May 6, 2024
73. “Court Vacates ACA Section 1557 Gender-Identity Discrimination Rules” Thompson Teuters. Nov. 5, 2025
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