If you've been shopping for health insurance on the ACA Marketplace, 2026 brings some significant changes you need to know about. The enhanced premium subsidies that made coverage more affordable for millions of Americans expired at the end of 2025, and that means higher premiums for most people. Whether you're renewing your coverage or shopping for the first time, understanding what's changed—and what it means for your wallet—can help you make smarter decisions during open enrollment.
The good news? Marketplace coverage is still available, and if your income falls within certain limits, you'll still qualify for financial help. But the landscape has shifted, and knowing where you stand can save you from sticker shock when you log into HealthCare.gov.
What Happened to Enhanced Premium Tax Credits?
Here's the short version: enhanced premium tax credits, which were introduced through the American Rescue Plan Act in 2021 and extended through 2025, made ACA Marketplace coverage significantly more affordable. These enhanced subsidies limited premium payments to no more than 8.5% of your household income, and they removed the income cap entirely—meaning even people earning above 400% of the federal poverty level could get help paying for coverage.
That all changed on December 31, 2025. Now, for 2026 coverage, we're back to the original ACA subsidy structure. If you're between 100% and 400% of the federal poverty level, you still qualify for subsidies—but they're smaller. And if you earn more than 400% FPL (about $62,600 for an individual or $128,600 for a family of four), you're back on the subsidy cliff, paying full price with no financial assistance.
The numbers are sobering. Nationwide, enrollees' premium payments are expected to jump by an average of 114%—that's about $1,016 more per year. For some people, especially older adults and those with incomes just above the subsidy threshold, the increases are even steeper. A 60-year-old couple earning around $85,000 could see their annual premium hit $22,600 in 2026, which is roughly a quarter of their income.
Understanding the Subsidy Cliff and What It Means for You
The subsidy cliff is one of the most frustrating aspects of the ACA, and it's back in full force for 2026. Here's how it works: if your household income is at or below 400% of the federal poverty level, you qualify for premium tax credits that help lower your monthly payments. But if you earn even one dollar over that threshold, you lose all subsidies and pay the full premium.
This creates a bizarre situation where earning slightly more income can actually leave you worse off financially. For example, a single person earning $62,500 might qualify for thousands in premium subsidies, but a colleague earning $62,700 could pay full price—sometimes $500 or more per month with no help at all.
There's another wrinkle: if you estimate your income when you enroll and it turns out you actually earned more than 400% FPL by the end of the year, you'll have to pay back the entire premium tax credit when you file your taxes. In previous years with enhanced subsidies, there were limits on how much you'd have to repay. Now those protections are gone, and you could owe thousands of dollars at tax time.
About 1.6 million Americans who had subsidized coverage in 2025 will fall off the subsidy cliff in 2026. Experts predict that 4.2 million people could lose health insurance altogether because they can no longer afford coverage without the enhanced credits.
Navigating Metal Tiers and Carrier Options
The good news is that the basic structure of Marketplace plans hasn't changed. You'll still choose from four metal tier categories: Bronze, Silver, Gold, and Platinum. These tiers reflect how you and your insurance company split the costs of your care.
Bronze plans typically have the lowest monthly premiums but the highest out-of-pocket costs when you need care. They cover about 60% of your healthcare costs on average, leaving you responsible for the other 40%. Silver plans split costs closer to 70-30, Gold plans around 80-20, and Platinum plans cover about 90% of costs with the highest monthly premiums.
One important change for 2026: out-of-pocket maximums have increased to $10,600 for individuals and $21,200 for families. That's the most you'd pay for covered services in a year, but it's a significant jump from previous years. If you anticipate needing regular medical care, paying more for a Gold or Platinum plan might save you money in the long run compared to a Bronze plan with high deductibles.
During the 2025 open enrollment period, nearly 7.3 million people selected Bronze plans, making them one of the most popular choices. But here's something counterintuitive: in some states, Silver plans may actually cost more than Gold plans in 2026 due to something called silver loading. It's worth comparing all your options carefully rather than assuming a higher metal tier always means higher premiums.
How to Get Started with 2026 Enrollment
Open enrollment for 2026 coverage started on November 1, 2025, and runs through January 15, 2026, in most states. If you want coverage to begin on January 1, you need to enroll by December 15 in most states. Some states running their own exchanges have different deadlines, so check your state's marketplace if you don't use HealthCare.gov.
Your first step is to estimate your household income as accurately as possible. This matters more than ever in 2026 because of the subsidy cliff. If you're close to that 400% FPL threshold, even small changes in income can make a huge difference in your premium. Consider things like raises, bonuses, freelance income, and investment earnings when making your estimate.
Once you're on HealthCare.gov or your state's marketplace, you'll see which plans are available in your area and what subsidies you qualify for. Compare plans carefully—look at not just the monthly premium, but also deductibles, copays, out-of-pocket maximums, and whether your doctors and preferred hospitals are in-network. The lowest-premium plan isn't always the best deal if it comes with sky-high deductibles or doesn't cover the providers you need.
If the premium sticker shock is too much, you have options. You might qualify for a catastrophic plan if you're under 30 or have a hardship exemption—these have very low premiums but extremely high deductibles. You could also explore whether you're eligible for Medicaid or CHIP in your state, as income limits for those programs vary. And if your income is volatile or you're self-employed, you might be able to structure your finances to stay under the subsidy cliff.
The 2026 ACA Marketplace isn't the same as last year, and the changes aren't small. But with careful planning and a clear understanding of how subsidies work, you can still find coverage that protects your health without breaking your budget. Don't wait until the last minute—log in, compare your options, and make sure you're covered before the deadline.
