ACA Health Insurance: Eligibility, Subsidies, How to Apply

What Is ACA Health Insurance?

The Affordable Care Act (ACA) created the Health Insurance Marketplace, a system where individuals and families can shop for health insurance plans with federal subsidies. Most people know the program as Obamacare. The Centers for Medicare & Medicaid Services (CMS) runs the federal marketplace at HealthCare.gov, while 21 states operate their own exchanges.

About 22.8 million Americans enrolled in marketplace plans for 2026 coverage, according to CMS enrollment data. That number has more than doubled since 2020, driven by expanded premium tax credits that lowered costs for millions of households.

The marketplace offers four tiers of plans: Bronze, Silver, Gold, and Platinum. Bronze plans have the lowest monthly premiums but highest out-of-pocket costs. Platinum plans have the highest premiums but cover the most when you need care. All marketplace plans must cover 10 essential health benefits, including doctor visits, hospital stays, prescription drugs, maternity care, and mental health services.

Subsidies come in two forms. Premium tax credits lower your monthly premium. Cost-sharing reductions lower your deductibles and copays on Silver plans. Both are based on your household income relative to the federal poverty level (FPL). Many people qualify for plans that cost less than $50 per month after credits, according to CMS plan pricing data.

Some states use their own names and websites for the marketplace. California runs Covered California. New York uses NY State of Health. Texas and 29 other states use the federal HealthCare.gov platform. No matter which platform your state uses, the federal subsidy rules are the same. Check your state benefits page for local details.

Who Qualifies for ACA Subsidies?

You qualify for premium tax credits if your household income falls between 100% and 400% of the federal poverty level. For a single person in 2026, that means earning between $15,960 and $63,840 per year. For a family of four, the range is $33,000 to $132,000 per year.

2026 Federal Poverty Level by Household Size

Source: HHS Federal Poverty Level Guidelines via HealthCare.gov, effective 2026.

These are the standard subsidy ranges. Under the Inflation Reduction Act (IRA), people with income above 400% FPL can also receive credits if their benchmark plan premium would exceed 8.5% of their household income. Congress authorized these expanded credits through 2025, and their extension for 2026 depends on new legislation.

Cost-Sharing Reductions

If your income falls below 250% FPL and you pick a Silver plan, you also get cost-sharing reductions (CSRs). These lower your deductibles, copays, and maximum out-of-pocket costs. The savings are largest for households below 150% FPL, where Silver plans work almost like Platinum coverage. For a single person, 250% FPL equals $39,900 in 2026.

Who Cannot Get Marketplace Subsidies

Not everyone can use the marketplace. You are not eligible for premium tax credits if:

• You qualify for Medicaid in your state (income below 138% FPL in expansion states)
• You are enrolled in Medicare or are age 65 or older
• Your employer offers affordable coverage (costs less than 9.12% of household income for self-only coverage)
• You are incarcerated
• You are not lawfully present in the United States (with some exceptions)

In the 10 states that have not expanded Medicaid, some adults fall into a "coverage gap." They earn too much for traditional Medicaid but less than 100% FPL, which is the floor for marketplace subsidies. Texas, Florida, Georgia, and Mississippi are among the states with this gap. If you are in this situation, check your state benefits page for local programs that may help.

Citizenship and Immigration

U.S. citizens, U.S. nationals, and lawfully present immigrants can buy marketplace plans and receive subsidies. Lawfully present immigrants with income below 100% FPL can qualify for marketplace subsidies even in expansion states, unlike citizens who would be directed to Medicaid. This exception closes the coverage gap for immigrant households.

Undocumented immigrants cannot enroll in marketplace plans. They may qualify for emergency Medicaid for urgent medical conditions.

You can use our free screener to check if you qualify for ACA subsidies and other programs in about five minutes.

How Much Can You Save?

Your savings depend on your income, age, household size, and where you live. The premium tax credit is calculated as the difference between the cost of the second-lowest-cost Silver plan (the "benchmark" plan) in your area and a percentage of your income.

How Premium Tax Credits Work

The ACA sets a maximum percentage of income you should pay for the benchmark Silver plan. People at 100% to 150% FPL pay 0% to about 4% of their income. People near 400% FPL pay up to 8.5% of their income. The government pays the rest as a tax credit applied directly to your monthly premium.

For 2026, CMS reports that the average marketplace premium after tax credits is about $50 per month for the lowest-cost plan available to eligible enrollees, based on CMS plan pricing data. Many households with income between 100% and 150% FPL qualify for $0-premium plans.

Example Savings

A single 40-year-old in Texas earning $25,000 per year (about 157% FPL) would pay roughly 2% to 4% of their income toward the benchmark Silver plan, or about $42 to $83 per month. The tax credit covers the rest of the premium, which could be $400 or more per month depending on the area.

A family of four in California earning $60,000 per year (about 182% FPL) would pay a similarly small share of income. They would also qualify for cost-sharing reductions on Silver plans, lowering their deductibles and copays.

Cost-Sharing Reduction Details

If you choose a Silver plan and your income is below 250% FPL, your plan's out-of-pocket costs drop. The reductions work in tiers:

• 100% to 150% FPL: Actuarial value increases to 94%. Very low deductibles and copays.
• 150% to 200% FPL: Actuarial value increases to 87%.
• 200% to 250% FPL: Actuarial value increases to 73%.

A standard Silver plan covers about 70% of medical costs. With CSRs at the lowest income tier, that jumps to 94%, meaning the plan covers almost all of your costs. You must select a Silver plan to receive these reductions. Bronze, Gold, and Platinum plans do not include CSRs.

What Do Marketplace Plans Cover?

All marketplace plans must cover 10 essential health benefits required by federal law. You cannot be denied coverage for pre-existing conditions, and plans cannot charge you more because of your health history.

Essential Health Benefits

Every marketplace plan covers:

• Outpatient care (doctor visits, specialist appointments)
• Emergency services
• Hospitalization (surgery, overnight stays)
• Maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative services and devices
• Laboratory services
• Preventive and wellness services (annual checkups, vaccines, screenings at no cost)
• Pediatric services, including dental and vision for children

Preventive care is free on all marketplace plans with no copay or deductible. This includes annual physicals, immunizations, cancer screenings, and contraception.

How to Apply for ACA Health Insurance

You can apply during the annual Open Enrollment Period or during a Special Enrollment Period if you have a qualifying life event. For 2026 coverage, Open Enrollment ran from November 1, 2025, through January 15, 2026, on HealthCare.gov. Some state exchanges had different deadlines.

Step 1: Check your eligibility

Use our free eligibility screener or review the income limits above. The screener takes about five minutes and checks ACA subsidies along with 20 other programs.

Step 2: Gather your documents

You will need:

• Social Security numbers for everyone in your household
• Proof of income (pay stubs, W-2 forms, or tax return)
• Employer and income information for every household member
• Policy numbers for any current health insurance
• Immigration documents (if applicable)

Step 3: Submit your application

Online: Visit HealthCare.gov if your state uses the federal platform. In California, go to Covered California. In New York, go to NY State of Health. In Texas, use HealthCare.gov.

Phone: Call the federal marketplace at 1-800-318-2596 (TTY: 1-855-889-4325). Help is available in over 150 languages.

In person: Find local enrollment help through HealthCare.gov's find-help tool. Navigators and certified application counselors can walk you through the process at no cost.

Step 4: Compare plans and enroll

After submitting your application, the marketplace shows you plans available in your area along with your estimated tax credit. Compare premiums, deductibles, provider networks, and prescription drug coverage. If you qualify for cost-sharing reductions, select a Silver plan to get those savings.

Step 5: Pay your first premium

Your coverage does not start until you pay your first monthly premium. The marketplace or your insurance company will send you a bill. Coverage start dates depend on when you enroll.

Special Enrollment Periods

Outside of Open Enrollment, you can sign up if you experience a qualifying life event within the past 60 days. Qualifying events include:

• Losing other health coverage (job loss, aging off a parent's plan, losing Medicaid)
• Moving to a new state or zip code
• Getting married or divorced
• Having or adopting a child
• Changes in household income that affect subsidy eligibility

Report your life event on HealthCare.gov or your state exchange to start a Special Enrollment Period.

ACA and Other Programs

Many people who buy marketplace plans also qualify for other federal and state benefits. Here are some programs worth checking:

• Medicaid provides free or low-cost health coverage for people with income below 138% FPL in expansion states. If your income is below the Medicaid threshold, you may get better coverage through Medicaid than through a marketplace plan.
• SNAP (food stamps) helps with monthly grocery costs. Many households that qualify for ACA subsidies at the lower income range also qualify for SNAP.
• LIHEAP helps pay heating and cooling bills. If your income is low enough for ACA cost-sharing reductions, you likely qualify for energy assistance too.
• WIC provides food packages for pregnant women, new mothers, and children under five. The income limit is 185% FPL.
• TANF provides cash assistance to families with children in financial need.

Our free screener checks ACA subsidies and all of these programs at once.

Frequently Asked Questions

Can I get ACA insurance if my employer offers coverage?

You can always buy a marketplace plan, but you only qualify for premium tax credits if your employer's plan is considered "unaffordable." For 2026, employer coverage is unaffordable if the employee-only premium costs more than 9.12% of your household income. If your employer plan meets the affordability threshold, you will not receive subsidies on the marketplace.

What happens if my income changes during the year?

You should report income changes to the marketplace as soon as possible. If your income goes up, your tax credit may decrease and you could owe money at tax time. If your income goes down, you may qualify for a larger credit or even Medicaid. You reconcile your credits when you file your federal tax return.

Can I apply outside of Open Enrollment?

Only if you have a qualifying life event, such as losing other coverage, moving, getting married, or having a baby. These events trigger a 60-day Special Enrollment Period. Medicaid and CHIP enrollment is open year-round with no enrollment period.

What is the difference between ACA marketplace plans and Medicaid?

ACA marketplace plans are private insurance sold through the exchange, with costs reduced by tax credits. Medicaid is a government-run program that provides free or nearly free coverage to people with very low incomes. If your income is below 138% FPL in an expansion state, Medicaid is usually the better option because it has no premiums and minimal cost-sharing.

Do I have to file taxes to get the premium tax credit?

Yes. The premium tax credit is a federal tax credit, so you must file a federal income tax return to claim it. If you received advance payments of the credit during the year, you must reconcile those payments on your tax return using IRS Form 8962. Failing to file could mean you have to repay your credits and lose future subsidies.

What are the metal tiers (Bronze, Silver, Gold, Platinum)?

The tiers describe how costs are shared between you and your plan. Bronze plans cover about 60% of costs and have the lowest premiums. Silver plans cover 70% and qualify for cost-sharing reductions. Gold plans cover 80%. Platinum plans cover 90% but have the highest monthly premiums. All tiers cover the same essential health benefits.

Are pre-existing conditions covered?

Yes. Under the ACA, insurance companies cannot deny you coverage or charge you more because of pre-existing conditions. This applies to all marketplace plans in every state. Conditions like diabetes, cancer, asthma, and mental health disorders are fully covered.