Ohio marketplace health plans got more expensive for 2026, and fewer people qualify for help paying for them. The average Silver benchmark plan premium in Ohio rose to about $625 a month for 2026, up from around $497 in 2025, a weighted average rate increase of roughly 19.8% before any subsidy is applied. On top of that, the enhanced premium tax credits that had made coverage cheaper since 2021 expired at the end of 2025. Premium tax credits still exist for 2026, but they are smaller for most households, and the old income cutoff is back: households earning more than 400% of the federal poverty level no longer qualify for any subsidy at all. Ohio enrollment in the marketplace dropped from roughly 595,000 people in 2025 to about 463,000 for 2026, a decline directly tied to these subsidy changes.
Ohio does not run its own health insurance exchange. Residents shop for and enroll in ACA marketplace plans through HealthCare.gov, the federal marketplace platform. This matters because it means Ohio follows federal enrollment deadlines, federal subsidy rules, and federal plan standards rather than a state-run system with its own separate calendar or portal.
How the Ohio Marketplace Works
Because Ohio uses the federal marketplace, every step of shopping, comparing plans, and enrolling happens at HealthCare.gov rather than a state-branded site. For 2026 coverage, 11 insurance companies are offering plans on Ohio's exchange, down from 13 in 2025 after two carriers exited the state market. Plan availability varies by county, so the specific insurers and plan options a household sees depend on where in Ohio they live.
Plans are still organized into the same four metal tiers used nationwide:
| Metal Tier | Typical Coverage Share | Typical Monthly Premium (before subsidy) |
|---|
| Bronze | Insurer pays about 60% of costs | Lowest premium, highest deductible |
| Silver | Insurer pays about 70% of costs | Moderate premium, benchmark tier for subsidies |
| Gold | Insurer pays about 80% of costs | Higher premium, lower out-of-pocket costs |
| Platinum | Insurer pays about 90% of costs | Highest premium, lowest out-of-pocket costs |
Silver plans matter most for cost calculations because the second-lowest-cost Silver plan in each area is used as the "benchmark plan" that determines the size of a household's premium tax credit. Silver plans are also the only tier eligible for cost-sharing reductions, which lower deductibles and copays for qualifying lower-income households.
What Changed for 2026 Costs
Two separate things happened at once for the 2026 plan year, and it helps to understand them as distinct.
Underlying premiums went up. Insurers filed significantly higher rates for 2026, driven by rising medical costs, prescription drug prices, and insurer losses from prior years. Ohio's weighted average rate increase came in near 19.8% before subsidies, one of the larger jumps the state has seen in recent years.
Subsidies got smaller and the income cap returned. The enhanced premium tax credits created in 2021 and extended through 2025 expired on December 31, 2025. Congress considered several bills to extend them again in late 2025, but none passed the Senate before the deadline. As a result, 2026 marketplace subsidies reverted to the original ACA formula: premium tax credits are calculated on a sliding scale for households between 100% and 400% of the federal poverty level, and anyone above 400% FPL loses subsidy eligibility entirely, regardless of how high their premium is relative to income.
These two changes compound each other. A household that previously paid very little for coverage because of the enhanced credits may now face both a higher sticker price and a smaller credit, which is why Ohio's marketplace enrollment fell by roughly 21% heading into 2026.
2026 Income Limits for Premium Tax Credits
Premium tax credit eligibility for 2026 coverage is based on the 2025 federal poverty guidelines. The table below shows the income range where households generally qualify for a subsidy, from 100% to 400% of the federal poverty level, for the 48 contiguous states.
| Household Size | 100% FPL (annual) | 400% FPL (annual, subsidy cutoff) |
|---|
| 1 | $15,650 | $62,600 |
| 2 | $21,150 | $84,600 |
| 3 | $26,650 | $106,600 |
| 4 | $32,150 | $128,600 |
| 5 | $37,650 | $150,600 |
| 6 | $43,150 | $172,600 |
Add approximately $5,500 for each additional household member above 8. Households under 100% FPL generally do not qualify for marketplace subsidies in Ohio because they are expected to qualify for Medicaid instead, since Ohio expanded Medicaid eligibility.
Within the 100% to 400% FPL range, the amount of the premium tax credit depends on income as a percentage of the poverty level. Lower-income households within that range still receive a meaningful credit for 2026, but the credit is calculated using the standard, non-enhanced formula, meaning the expected household contribution toward the benchmark Silver plan is higher than it was in 2025.
Ohio Medicaid Expansion Still Available
Ohio expanded Medicaid under the ACA in 2014, and that expansion remains in place for 2026. This is an important alternative for lower-income Ohioans who fall below the marketplace subsidy floor.
Adults ages 19 to 64 in Ohio generally qualify for Medicaid if household income is at or below 138% of the federal poverty level, which works out to approximately $21,600 a year for a single adult and roughly $7,600 more for each additional household member, based on current guidelines. Children qualify at higher income thresholds, generally up to around 206% FPL, and pregnant women qualify up to about 200% FPL under Ohio's Healthy Start and related programs.
Because Ohio expanded Medicaid, there is no coverage gap for low-income adults the way there is in the 10 states that have not expanded. Anyone earning below 138% FPL should apply through Ohio Medicaid rather than the marketplace, since Medicaid typically has little to no monthly premium. HealthCare.gov applications automatically check for Medicaid eligibility as part of the marketplace application process, so households do not need to apply twice. For state-specific Medicaid details, see our Ohio benefits guide.
Cost-Sharing Reductions for Silver Plans
Separate from premium tax credits, cost-sharing reductions lower out-of-pocket costs like deductibles and copays for households between 100% and 250% FPL, but only on Silver plan selections. These reductions were not affected by the expiration of enhanced premium tax credits and remain available for 2026. Households in this income range often get the best overall value by choosing a Silver plan specifically to unlock these reductions, even if a Bronze plan shows a lower premium.
Step-by-Step: How to Apply in Ohio
- Go to HealthCare.gov. Ohio does not have a separate state exchange, so all applications and enrollments happen on the federal site.
- Create or log in to your account. Returning users can update an existing application rather than starting over.
- Enter household and income information. This includes household size, expected 2026 income, and any current coverage.
- Review your eligibility results. The application will show whether you qualify for a premium tax credit, cost-sharing reductions, or Ohio Medicaid instead.
- Compare plans by metal tier and network. Check monthly premium after subsidy, deductible, and whether your doctors and prescriptions are covered.
- Enroll and set up payment. Choose a plan and confirm your first premium payment to activate coverage.
- Report income changes during the year. Because subsidies are reconciled on your tax return, updating the marketplace when your income changes helps avoid owing money back at tax time.
Open Enrollment Dates for 2026 Coverage
Open enrollment for 2026 Ohio marketplace coverage runs from November 1, 2025 through January 15, 2026. To have coverage start on January 1, 2026, enrollment needed to be completed by December 15, 2025. Enrolling between December 16, 2025 and January 15, 2026 generally starts coverage on February 1, 2026.
Outside the open enrollment window, Ohioans can still enroll if they qualify for a Special Enrollment Period, typically triggered by losing other coverage, having a baby, getting married, or moving to a new coverage area.
What If Your Income Is Above 400% FPL
With the return of the subsidy cliff, households earning more than 400% of the federal poverty level receive no premium tax credit for 2026, no matter how large their premium is relative to income. For these households, a few strategies can still help manage cost:
- Compare Bronze plans carefully. Full-price Bronze premiums are typically lower, though deductibles are higher, so this works best for households that expect to use little care.
- Check if a Health Savings Account-eligible plan fits your situation. HSA-eligible plans let you set aside pre-tax money for medical expenses, which can offset the lack of a subsidy.
- Revisit income assumptions. If your projected income is close to the 400% FPL line, small legitimate reductions, like maximizing retirement contributions, could bring you back under the cutoff and restore subsidy eligibility.
Frequently Asked Questions
Does Ohio have its own health insurance marketplace?
No. Ohio uses the federal marketplace at HealthCare.gov rather than running a state-based exchange. All plan shopping, applications, and enrollment for Ohio residents happen through the federal platform.
Are premium tax credits still available in Ohio for 2026?
Yes, but they are smaller than in 2025 for most households. The enhanced premium tax credits from 2021 through 2025 expired at the end of 2025, so 2026 credits use the original ACA formula. Households above 400% of the federal poverty level no longer qualify for any premium tax credit.
Why did Ohio marketplace premiums increase so much for 2026?
Insurers filed a weighted average rate increase of about 19.8% for 2026, driven by rising medical and prescription drug costs and prior-year insurer losses. This increase happened separately from, and on top of, the expiration of enhanced subsidies.
Has Ohio expanded Medicaid?
Yes. Ohio expanded Medicaid in 2014 and the expansion remains in effect for 2026. Adults ages 19 to 64 with income at or below approximately 138% of the federal poverty level generally qualify, with no coverage gap for low-income adults.
What happens if I do not enroll by January 15, 2026?
Missing the open enrollment deadline generally means waiting until the next open enrollment period unless you qualify for a Special Enrollment Period due to a life change like losing coverage, marriage, or the birth of a child.
Are cost-sharing reductions still available in 2026?
Yes. Cost-sharing reductions for households between 100% and 250% of the federal poverty level who choose a Silver plan were not affected by the expiration of enhanced premium tax credits and remain available for 2026.
