ACA Marketplace Health Insurance (2026)
Metal tiers, subsidies, enrollment windows, and how to actually pick a plan.
The ACA Marketplace — HealthCare.gov in 30 states and state-run exchanges in 20 states + DC — is where individuals and families buy ACA-compliant health coverage. For 2025, over 21 million people enrolled, an all-time record, driven by enhanced premium tax credits that kept premiums under $200/month for 80% of enrollees. 2026 rules depend on whether the enhanced subsidies (originally passed in the Inflation Reduction Act) are extended; we break out both scenarios below.
Metal tiers at a glance
| Tier | Plan pays (avg) | You pay (avg) | Premium | Deductible range |
|---|---|---|---|---|
| Bronze | 60% | 40% | Lowest | $5,500–$9,200 |
| Silver | 70% | 30% | Medium | $3,000–$5,500 |
| Silver + CSR (low income) | 73%–94% | 6%–27% | Same as Silver | $100–$3,000 |
| Gold | 80% | 20% | Higher | $1,000–$3,000 |
| Platinum | 90% | 10% | Highest | $0–$1,500 |
Subsidies in 2026
Premium Tax Credits (PTCs) cap what you pay for the benchmark Silver plan as a percentage of your income. 2026 caps (if enhanced subsidies extended):
- Up to 150% FPL: $0/month premium
- 150–200% FPL: 0%–2% of income
- 200–250% FPL: 2%–4% of income
- 250–300% FPL: 4%–6% of income
- 300–400% FPL: 6%–8.5% of income
- Above 400% FPL: capped at 8.5% of income (no "cliff")
If enhanced subsidies are not extended for 2026, the 400% FPL cliff returns: households above 400% FPL pay full unsubsidized premium.
How to pick a plan
- Estimate your 2026 income. Accuracy matters — underestimate and you owe at tax time; overestimate and you pay too much premium during the year.
- Check for Medicaid eligibility first. Under 138% FPL (in expansion states) means Medicaid, which is free or near-free.
- Estimate your healthcare usage. Few doctor visits? Bronze. Ongoing prescriptions or a chronic condition? Gold or Silver-CSR. Expecting high costs (surgery, pregnancy)? Gold or Platinum.
- Verify your doctors are in-network. Marketplace narrow networks are real; use the plan finder's provider search.
- Check the formulary. Your prescriptions may not be covered, or may be on a high-cost tier. Look up each medication before enrolling.
- Look at total annual cost, not just premium. (Premium × 12) + (likely out-of-pocket) is the number that matters.
ACA Marketplace questions
The Health Insurance Marketplace (also called the Exchange) is where individuals and families can buy ACA-compliant health plans. It operates via HealthCare.gov in 30 states, and via state-run exchanges in the other 20 plus DC. Plans are standardized by 'metal tier' (Bronze, Silver, Gold, Platinum) and must cover 10 Essential Health Benefits.
Most US citizens and legal residents are eligible. You don't need to have income to enroll, and you don't need to be unemployed. You're not eligible if you already have affordable employer coverage or qualify for Medicare. Medicaid-eligible individuals (income below 138% FPL in expansion states) should go through Medicaid instead, which is free or near-free.
Before subsidies: a benchmark Silver plan for a 40-year-old averages $510/month nationally for 2026. After subsidies: 80% of Marketplace enrollees pay under $200/month, and many pay $10 or less. The younger you are, the cheaper the unsubsidized premium; subsidies mostly target middle-income enrollees.
Bronze: plan pays 60% on average, you pay 40%. Lowest premium, highest out-of-pocket. Silver: 70/30 split. Gold: 80/20 split. Platinum: 90/10 split. Silver is the tier subsidies are pegged to — and with Cost-Sharing Reductions for low-income enrollees, a Silver plan can act like a Gold or Platinum for under $200/month.
Additional subsidies available to households earning 100%–250% of FPL who enroll in a Silver plan. CSR reduces deductibles, copays, coinsurance and out-of-pocket max. A CSR-enhanced Silver plan at 150% FPL can have a $100 deductible and $2,000 out-of-pocket max — effectively Platinum-level coverage at Silver prices. CSRs only work with Silver plans, not Bronze or Gold.
Federal Open Enrollment runs November 1 – January 15 each year. Plans purchased by December 15 start January 1; plans purchased December 16 – January 15 start February 1. Some state exchanges have slightly different dates — California's Covered California runs through January 31.
A 60-day window outside Open Enrollment triggered by a qualifying life event: marriage, divorce, birth/adoption, loss of other coverage (job loss, aging off parent's plan at 26, losing Medicaid), relocation, change in citizenship/residency, income change. You must apply within 60 days and provide documentation.
The federal individual mandate penalty was reduced to $0 in 2019, so there's no federal tax penalty. However, California, Massachusetts, New Jersey, Rhode Island, Vermont, and DC have state-level mandates that impose penalties ranging from $750 to the cost of a bronze plan. More importantly, being uninsured means paying full price for any medical care.
Same ACA rules, different administration. HealthCare.gov handles 30 states. The other 20 states + DC run their own exchanges (Covered California, NY State of Health, Washington Healthplanfinder, etc.). State exchanges often have extra state-level subsidies on top of federal ones, and may have extended open enrollment periods.
Yes, but you lose subsidies. Off-Marketplace plans from carriers like Blue Cross, Cigna, and Aetna are ACA-compliant but don't qualify for Premium Tax Credits. This only makes sense if your income exceeds subsidy limits or you want a plan not sold on the Marketplace.