The 250% federal poverty level (FPL) threshold is the hard income cutoff for cost-sharing reductions (CSRs) in 2026. If your household income falls at or below this line and you enroll in a Silver plan through the Health Insurance Marketplace, you qualify for lower deductibles, copays, and out-of-pocket maximums. Cross that line and CSR benefits disappear entirely, regardless of whether you still receive a premium tax credit.
For a single person in the continental United States, 250% FPL in 2026 equals $39,125. For a family of four, the threshold is $80,375. These figures are based on the 2025 federal poverty guidelines, which the Marketplace uses to determine eligibility for all 2026 coverage.
What Is the 250% FPL CSR Threshold?
Cost-sharing reductions are a separate benefit from premium tax credits. While premium subsidies help you pay your monthly insurance bill, CSRs reduce what you pay when you actually use healthcare: deductibles, copayments, and the annual out-of-pocket maximum.
CSRs are only available to people who:
- Have household income between 100% and 250% of the FPL (or 138% to 250% FPL in states that expanded Medicaid)
- Enroll in a Silver-tier plan through the Health Insurance Marketplace
The 250% FPL line is where CSR eligibility ends. Households with income above 250% FPL may still receive premium tax credits (up to 400% FPL in 2026), but they receive no cost-sharing help.
2026 Income Limits at 250% FPL by Household Size
The table below shows the exact dollar amounts at 250% FPL for coverage year 2026. These are based on 2025 poverty guidelines, which the Marketplace uses throughout 2026.
| Household Size | 100% FPL | 150% FPL | 200% FPL | 250% FPL |
|---|
| 1 person | $15,650 | $23,475 | $31,300 | $39,125 |
| 2 people | $21,150 | $31,725 | $42,300 | $52,875 |
| 3 people | $26,650 | $39,975 | $53,300 | $66,625 |
| 4 people | $32,150 | $48,225 | $64,300 | $80,375 |
| 5 people | $37,650 | $56,475 | $75,300 | $94,125 |
| 6 people | $43,150 | $64,725 | $86,300 | $107,875 |
For each additional person beyond 6, add $5,500 to each column. Alaska and Hawaii have higher FPL amounts. These figures apply to the 48 contiguous states and Washington, D.C.
Your income for CSR purposes is Modified Adjusted Gross Income (MAGI), which includes wages, self-employment income, Social Security benefits, and most other income sources. It does not include SSI payments.
CSR Benefits by Income Band
Not all CSR enrollees get the same level of help. The Marketplace divides CSR-eligible Silver plans into three "Silver variants" based on how far below 250% FPL your income falls. The lower your income, the more valuable the cost-sharing reduction.
| Income as % of FPL | Actuarial Value | Out-of-Pocket Max (Individual) | Out-of-Pocket Max (Family) |
|---|
| 100% to 150% FPL | 94% | ~$3,500 | ~$7,000 |
| 150% to 200% FPL | 87% | ~$3,500 | ~$7,000 |
| 200% to 250% FPL | 73% | ~$9,600 | ~$19,200 |
| Above 250% FPL (no CSR) | 70% | $10,600 | $21,200 |
Actuarial value represents the percentage of covered healthcare costs the plan pays on average. A 94% AV plan covers more than a typical Platinum plan. A 73% AV plan provides modest improvement over a standard Silver plan.
The 200% to 250% FPL band is sometimes called the "weak CSR" tier because the actuarial value improvement is small: 73% vs. 70% for a standard Silver plan. However, the out-of-pocket cap reduction is meaningful. A standard 2026 Silver plan caps out-of-pocket costs at $10,600 per individual. With CSR at 200% to 250% FPL, that cap drops to approximately $9,600, and family caps drop from $21,200 to roughly $19,200.
Households in the 100% to 200% FPL range get far stronger CSR benefits. At 150% to 200% FPL, the out-of-pocket maximum falls to approximately $3,500 per individual, meaning healthcare costs are much more predictable and limited even with significant medical needs.
Why 250% FPL Is a Hard Cutoff
The 250% FPL boundary matters because CSR eligibility is binary at this threshold. At $39,124 of income (one dollar below the single-person cutoff), a 2026 Silver plan enrollee receives CSR benefits. At $39,126, they receive none.
This has a practical implication for year-end income planning. If your income is close to 250% FPL, a small increase from freelance work, a bonus, or a taxable retirement withdrawal can push you over the line and eliminate CSR entirely for the year. The reverse is also true: reducing reportable income through HSA contributions, traditional IRA contributions, or other pre-tax deductions can bring you back below the threshold.
Unlike premium tax credits, which adjust gradually as income changes, CSR is all-or-nothing at the 250% boundary. You either receive the enhanced Silver plan benefits or you do not.
CSRs Only Work With Silver Plans
This is the most important rule to understand about CSRs: you must enroll in a Silver plan to receive them. If you qualify for CSR but choose a Bronze, Gold, or Platinum plan, the cost-sharing reduction does not apply.
This sometimes creates a counterintuitive situation. A Gold plan typically has a higher premium but lower cost-sharing than a standard Silver plan. However, a CSR-enhanced Silver plan at 100% to 150% FPL has a 94% actuarial value, which is higher than a Gold plan (80% AV) and comparable to Platinum (90% AV). For lower-income households, the CSR Silver plan can be the best value available at any price point.
At 200% to 250% FPL, the Silver-vs-Gold comparison is less clear because the CSR enhancement is small. If a Gold plan is available at a similar premium, it may be worth comparing total expected costs rather than defaulting to Silver.
How to Apply for a CSR-Eligible Silver Plan in 2026
CSRs are applied automatically when you meet the income requirements and select a Silver plan. You do not need to apply for CSRs separately. The enrollment process is the same as standard Marketplace enrollment.
Step 1: Determine your enrollment window. The main Open Enrollment Period for 2026 coverage runs November 1 through December 15, 2025. Outside that window, you need a Special Enrollment Period (SEP). Qualifying events include losing job-based coverage, moving, getting married, having a baby, or losing Medicaid eligibility.
Step 2: Gather your income information. You will need to estimate your total 2026 household income before taxes. Include all income sources: wages, self-employment, alimony, Social Security, rental income, and investment income. Compare your estimate to the 250% FPL threshold for your household size.
Step 3: Create or log into your Marketplace account. Go to Healthcare.gov if your state uses the federal exchange, or your state's own exchange. States with their own exchanges include California (Covered California), New York (NY State of Health), Washington (Washington Healthplanfinder), and others.
Step 4: Complete your application. Enter your household size, projected income, and zip code. The Marketplace will calculate your eligibility for premium tax credits and CSR automatically.
Step 5: Compare Silver plans. Once the Marketplace shows your results, filter to Silver plans. If you qualify for CSR, the enhanced Silver variants will be the only Silver plans shown. Compare premiums, deductibles, and provider networks.
Step 6: Enroll and confirm. After selecting a plan, pay your first premium to activate coverage. CSR benefits take effect on your coverage start date.
You can also get help through a Marketplace navigator, certified application counselor, or licensed insurance agent, all of whom can assist at no cost to you.
Use the free Benefits Navigator eligibility screener at /screener to check whether you qualify for CSR, premium tax credits, Medicaid, or other programs based on your income and household size.
Income Changes Mid-Year
If your income changes after you enroll, report the change to the Marketplace promptly. Changes can affect your CSR eligibility for the remainder of the year.
If your income drops below 100% FPL during the year and you live in a state that expanded Medicaid, you may become eligible for Medicaid instead of Marketplace coverage. If you live in a state that has not expanded Medicaid, dropping below 100% FPL creates a coverage gap: you do not qualify for Medicaid, and you lose Marketplace subsidy eligibility.
If your income rises above 250% FPL mid-year, your CSR benefits do not automatically disappear. The enhanced Silver plan you enrolled in stays in place until the next plan year. However, if you fail to report a significant income increase, you may face repayment of excess premium tax credits when you file your federal tax return.
States That Have Expanded Medicaid
In the 40 states (plus D.C.) that expanded Medicaid under the ACA, adults with income between 100% and 138% FPL qualify for Medicaid rather than Marketplace coverage. This means the effective starting point for CSR eligibility in expansion states is 138% FPL, not 100% FPL.
In the 10 states that have not expanded Medicaid, adults with income below 100% FPL fall into a coverage gap. Adults between 100% and 250% FPL are eligible for both premium tax credits and CSRs on the Marketplace, making the 250% FPL threshold particularly important in these states.
Frequently Asked Questions
What is the 250% FPL income limit for a family of 4 in 2026?
For a family of four in the 48 contiguous states, 250% FPL equals $80,375 for 2026 coverage. This is based on the 2025 poverty guidelines, which the Marketplace uses for 2026 enrollment.
Do I have to enroll in a Silver plan to get CSR benefits?
Yes. Cost-sharing reductions are only available on Silver plans purchased through the Health Insurance Marketplace. If you choose a Bronze, Gold, or Platinum plan, you will not receive CSR benefits even if your income qualifies.
What happens if my income is just over 250% FPL?
You lose CSR eligibility entirely. However, you may still qualify for a premium tax credit on a Silver, Gold, Bronze, or Catastrophic plan if your income is below 400% FPL. In 2026, the enhanced premium subsidy cliff has returned, so households above 400% FPL generally do not qualify for premium tax credits.
Is the 250% FPL threshold the same in all states?
The dollar amount at 250% FPL varies by state. Alaska and Hawaii have their own higher FPL guidelines. For all other states and D.C., the same national guidelines apply.
Can I get both a premium tax credit and CSR at the same time?
Yes. If your income is between 100% and 250% FPL (or 138% and 250% FPL in Medicaid expansion states) and you enroll in a Silver plan, you can receive both benefits simultaneously. The premium tax credit lowers your monthly payment; CSR lowers your deductibles, copays, and out-of-pocket maximum.
What if I qualify for CSR but do not enroll in a Silver plan?
The CSR benefit is forfeited. It does not apply to other metal tiers. If you are eligible for CSR and choose a non-Silver plan, you receive no cost-sharing assistance for that plan year.
How does the Marketplace know my income to determine CSR eligibility?
You self-report your projected annual household income when you apply. The Marketplace verifies this against IRS data when available. If there is a discrepancy between your reported and actual income, you may be required to repay premium tax credits when filing your taxes, though CSR overpayments are handled differently.
Does the 250% FPL limit apply to both the premium tax credit and CSR?
No. Premium tax credits extend to 400% FPL in 2026. The 250% FPL cutoff applies only to CSR benefits. You can qualify for premium tax credits at incomes above 250% FPL, but you will not receive CSR above that threshold.
