Do I qualify for a health insurance subsidy? 2026 income limits explained

If you are trying to figure out whether you qualify for help paying for a marketplace plan, the whole thing comes down to one number: where your household income falls on the federal poverty level scale. That single comparison decides whether you land in Medicaid, in the subsidy range, or above the line paying full price. Everything else — which plan, how much you save, whether you get the extra cost-sharing help — flows from it.

The frustrating part is that "the federal poverty level" sounds like one fixed number, and it isn't. It changes with your household size, it's measured against your estimated income for the year ahead, and the income it uses isn't quite the number on your pay stub. So let me walk through exactly where the lines are in 2026, what counts as income, the one thing that can disqualify you even if your income fits, and what to do if you are sitting close to the edge.

The one rule that decides everything

Marketplace financial help has two separate pieces, and they kick in at different income levels.

The first is the premium tax credit. It lowers your monthly premium, and under current law it runs from 100% to 400% of the federal poverty level. At the bottom of that band you pay a small share of your income toward the benchmark plan; as your income rises, your expected share rises too, and your credit shrinks. The premium tax credit applies to any metal tier you choose — Bronze, Silver, Gold, or Platinum.

The second is cost-sharing reductions. These are extra discounts that lower your deductible, your copays, and your out-of-pocket maximum — the money you spend when you actually use care, not just the premium. They're available below 250% of poverty, and here is the catch that trips everyone up: they only attach to a Silver plan. Pick Bronze to shave a little off the monthly bill and you throw the entire benefit away. For someone under that line, that's almost always the wrong move. We explain the tiers and exactly how much they cut in cost-sharing reductions, explained.

And then there are the two outer edges. Below roughly 138% of poverty in a state that expanded Medicaid, you generally land in Medicaid instead of the marketplace — and that's a good thing, because Medicaid almost always costs less and covers more than a subsidized plan. Above 400% of poverty, you fall off the cliff: no premium tax credit at all, full sticker price.

The cliff is back — and why the date matters

From 2021 through 2025, a temporary law removed that 400% ceiling and made the credits bigger across the board. Those enhanced credits expired on January 1, 2026. When they did, the rules reverted to the original Affordable Care Act schedule, the share of income people owe toward the benchmark plan went back up, and the hard 400% cutoff returned (IRS Rev. Proc. 2025-25; KFF).

So in 2026, the moment your income crosses 400% of poverty, your credit drops to zero. Not smaller — zero. For a single person that line is about $62,600. Earn $62,000 and you may get a meaningful credit. Earn $63,000 and, under current law, you pay the entire premium yourself. For an older enrollee that gap can be thousands of dollars a month over a few hundred dollars of income.

The actual 2026 dollar lines, by household size

Here's where it gets concrete. The federal poverty level for 2026 coverage uses the 2025 HHS poverty guidelines: $15,650 for one person, plus $5,500 for each additional person, in the 48 contiguous states and DC. (Alaska and Hawaii use higher guidelines, so the dollar figures there are larger — the percentages are the same.)

Run those guidelines through the percentages that matter, and the lines look like this:

A few ways to read this table:

• If your income is at or below the 138% column and you're in a Medicaid expansion state, you'll most likely be routed to Medicaid when you apply. Take it.
• If you're between the 100% and 250% columns, you're in premium-tax-credit territory and in the cost-sharing-reduction range — so a Silver plan gives you both. This is the sweet spot where a Silver plan can behave like a Gold or Platinum one.
• If you're between 250% and 400%, you still get a premium tax credit, but no cost-sharing reductions, so the metal tier you pick comes down to how much care you use.
• If you're above the 400% column, under current law you get no credit and pay full price.

For more household sizes (5, 6, 7+) and the exact figures, our 2026 subsidy income chart lays out every line, and the FPL calculator will tell you your own percentage from your income and household size.

What actually counts as "income"

This is where people most often get the wrong answer, because the marketplace doesn't use your gross pay and it doesn't use last year's tax return. It uses modified adjusted gross income (MAGI), estimated for the entire coverage year.

In plain terms, MAGI starts with your adjusted gross income — your total income minus certain deductions like the self-employed health insurance deduction, deductible IRA or HSA contributions, and student loan interest — and then adds back a few things:

• tax-exempt interest,
• the portion of Social Security benefits that isn't taxed, and
• any foreign earned income you excluded.

It's a household number. For most people that means you plus your spouse if you file jointly, plus any dependents who are required to file. And it's an estimate looking forward, not a record looking back — you're telling the marketplace what you expect to earn across all of 2026. We break down the exact line items in our MAGI explainer.

Two practical consequences fall out of this:

First, the deductions matter. Because HSA and traditional IRA contributions come out before MAGI is calculated, they can lower the income the marketplace counts. That's an ordinary tax move most years, but in a cliff year it can be the difference between a subsidy and none — more on that below.

Second, your estimate has teeth. You get the credit in advance based on what you projected, then you reconcile it on your tax return. Guess low and earn more, and you pay some of it back. Cross 400% of poverty and there's no cap on that repayment — you can owe the entire advance credit. So estimate honestly, and if your income changes during the year, log into the marketplace and update it so your monthly credit adjusts in real time.

The thing that can disqualify you even if your income fits

You can land squarely in the 100%–400% range and still not qualify, for one common reason: an affordable job-based offer.

If you (or a family member) are offered health coverage through an employer that's considered affordable and meets minimum value, you generally can't get a premium tax credit — even if you'd rather buy your own plan on the marketplace, and even if the marketplace plan looks better to you.

"Affordable" has a specific meaning here. The offer counts as affordable if your share of the premium for self-only coverage is below a set percentage of household income — roughly 9% (the IRS sets the exact figure each year). "Minimum value" means the plan covers at least 60% of expected costs, which nearly all real employer plans do.

One important update: since 2023, the so-called family glitch is fixed. A family member's eligibility is now judged on whether the family premium is affordable, not just the employee's self-only premium. So if your job's family coverage is too expensive, your spouse and kids may qualify for marketplace subsidies even though you, the employee, don't. That change opened the door for a lot of families who used to be stuck.

If your employer's offer is unaffordable (your self-only share is above the threshold) or doesn't meet minimum value, you can decline it and shop the marketplace with a subsidy. If you're weighing the two, our guide to employer vs. marketplace coverage and the employer-vs-marketplace comparison walk through how to compare them.

How to actually check — in about fifteen minutes

You don't have to do this math by hand. Here's the fastest honest path:

1. Estimate your 2026 household MAGI. Add up expected wages, self-employment income, and other taxable income for everyone in the household, then subtract the deductions above. If your income is lumpy or you're self-employed, estimate conservatively and plan to update it.
2. Find your FPL percentage. Run your income and household size through the FPL calculator, or read it straight off the table above. This tells you which band you're in.
3. Estimate the actual credit. Our subsidy estimator turns your income and household into an estimated monthly premium tax credit and net premium — the number that actually matters, not the sticker price.
4. Apply through the marketplace. When you formally apply at HealthCare.gov or your state exchange, the application screens everyone for Medicaid and CHIP automatically, checks any employer offer, and produces your real, binding credit. The tools get you 95% of the way there; the marketplace gives you the official number.

What to do if you're near the cliff

This is where a little planning is worth the most money. If your projected income is hovering just above 400% of poverty — say a single person expecting around $63,000 to $66,000 — you're staring at the difference between a real credit and nothing. A few honest moves can pull your counted income back under the line:

• Make a deductible HSA contribution. If you're enrolled in an HSA-eligible high-deductible plan, contributing to a health savings account lowers your MAGI dollar-for-dollar. For someone just over the line, a contribution you keep anyway can restore a credit worth far more than the contribution felt like.
• Make a traditional IRA contribution. Same effect — it reduces the income the marketplace counts and is money set aside for you.
• Time income you control. If you're self-employed or have flexibility over when income lands, smoothing it across years can keep a single big year from knocking you over the cliff.

The reverse is also worth saying plainly: if you're below the bottom of the range — under 100% of poverty in a state that didn't expand Medicaid — you can fall into the coverage gap, where you earn too little for a marketplace subsidy but your state's Medicaid is too narrow to cover you. In the non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming), adults near or below the poverty line sometimes find there's no affordable option at all, though CHIP still covers kids. It's an ugly gap, and it's worth knowing about before you assume you'll qualify.

A couple of worked examples

The Silver sweet spot. Devon is single, lives in Ohio, and expects to earn about $30,000 in 2026 — roughly 192% of poverty, between the 150% and 250% columns. Devon qualifies for a premium tax credit and for cost-sharing reductions. Because those reductions only attach to Silver, Devon picks a Silver plan instead of the cheapest Bronze. The premium is a bit higher, but the deductible drops by thousands and the out-of-pocket maximum falls too. After one urgent-care visit and a round of physical therapy, the "more expensive" Silver plan is the one that costs less for the year.

The cliff fix. Maya is single, 60, and expects about $64,000 — just over the $62,600 cliff for one person. Under current law she gets no credit and faces the full premium, which at her age can run well over $1,000 a month. She moves to an HSA-eligible plan and contributes enough to her HSA to bring her counted income just under $62,600. That single move restores a premium tax credit worth several thousand dollars a year, and the HSA money is hers to keep. Same $64,000 of earnings, an entirely different bill.

The family glitch fix in action. The Reyes family has employer coverage offered through one spouse's job, but the family premium would eat 16% of their income. Self-only coverage for the employee is affordable, so the employee stays on the job plan — but because the family premium is unaffordable, the spouse and kids can shop the marketplace with a subsidy. Before 2023 they'd have been locked out entirely.

Common mistakes

• Using last year's income, or just your paycheck. The marketplace wants your estimated MAGI for the whole coming year, household-wide. Self-employed and variable-income people get this wrong most often.
• Picking Bronze when you're under 250% of poverty. You give up cost-sharing reductions that only exist on Silver. The small premium savings rarely beats the much larger reduction in your deductible and out-of-pocket maximum.
• Forgetting the employer-offer test. People assume their income qualifies them, apply, take the credit, and then owe it back because they had an affordable offer they declined.
• Ignoring the cliff until tax time. Drifting from $61,000 to $63,000 over the year — a bonus, a side gig, an early retirement-account withdrawal — can erase your credit and trigger a full repayment. Update the marketplace when your income moves.
• Assuming the enhanced rules still apply. They expired at the end of 2025. The income at which you "max out" is lower and the 400% cliff is real again, under current law as of June 2026.

The honest part

We don't sell plans, so here's what a salesperson won't lead with. A subsidy is not automatically the best deal in the room. If your income is under your state's Medicaid line, Medicaid beats any subsidized marketplace plan on both cost and coverage — take it and don't pay for a plan you don't need. If you have an affordable employer offer, the marketplace usually isn't even an option, and the job plan is often the cheaper one anyway once you account for the lost subsidy. And if you're well above 400% of poverty, you're paying full price either way, so the question becomes which plan costs the least across a realistic year — not which one has a subsidy attached, because none of them will.

Qualifying for help is really just answering four questions in order: What's my estimated household MAGI for 2026? What percentage of the poverty level is that? Do I have an affordable job-based offer? And if I qualify, am I under 250% so a Silver plan pulls in cost-sharing reductions too? Run those four and you'll know not just whether you qualify, but exactly how much help you should expect — and whether buying through the marketplace is even the right move for you.