ACA marketplace premiums rose an average of 26% in 2026, the sharpest single-year jump since the Affordable Care Act launched. The main driver: the enhanced premium tax credits that had been lowering costs for 22 million Americans since 2021 expired at the start of 2026, and they were not renewed. For millions of people, that expiration effectively doubled what they pay each month. But the increase is not uniform across states, and millions of people still qualify for meaningful subsidies. What you owe depends heavily on where you live, your household income, and your household size.
This breakdown covers the state-by-state data, what drove the increases, who is still protected by subsidies, and how to check your eligibility.
Why ACA Premiums Spiked So Much in 2026
Two separate forces pushed premiums higher at the same time.
The first is the expiration of the enhanced premium tax credits (PTCs) created under the American Rescue Plan in 2021 and extended through the Inflation Reduction Act in 2022. Those enhancements temporarily expanded subsidy eligibility to households earning above 400% of the federal poverty level (FPL) and reduced what every income bracket paid. Starting January 1, 2026, the enhanced credits expired and the original ACA subsidy structure returned. According to KFF, the average subsidized enrollee went from paying roughly $74 per month to well over $150 per month.
The second driver is underlying healthcare cost growth. Insurers cited rising prices for specialty drugs, increased utilization of high-cost treatments, and general labor and inflation pressures. Even if the enhanced credits had been renewed, many states would have seen meaningful rate increases in 2026.
The combination produced a record premium environment. The Peterson-KFF Health System Tracker found that benchmark silver plan premiums (the second-lowest-cost silver plan, which determines subsidy calculations) rose 21.7% nationally. States using Healthcare.gov saw an average 30% increase; states running their own marketplaces saw a smaller 17% average increase.
The "Subsidy Cliff" Is Back
One of the most disruptive changes in 2026 is the return of the subsidy cliff. Before the 2021 enhancements, ACA subsidies cut off sharply at 400% FPL. A household earning $1 above that line received no subsidy at all. The enhanced credits removed that cliff for four years. In 2026, the cliff is back.
That means anyone earning more than 400% FPL in 2026 pays the full unsubsidized premium, which is significantly higher than it was even a year ago. The Urban Institute estimates that close to 5 million people will drop ACA coverage in 2026, mostly because they now fall above the cliff or because their subsidized costs have become unaffordable.
For people who remain below 400% FPL, subsidies still exist under the original ACA formula. The question is whether those subsidies are large enough to offset both the rate increase and the loss of the enhanced credits.
ACA Subsidy Income Limits for 2026
The 2026 marketplace uses 2025 federal poverty level (FPL) figures to determine subsidy eligibility. In 48 states and DC (Alaska and Hawaii use higher thresholds), the income limits are:
2026 ACA Subsidy Eligibility by Household Size
| Household Size | 100% FPL (Medicaid floor) | 138% FPL (Medicaid upper limit) | 400% FPL (Subsidy cliff) |
|---|
| 1 | $15,650 | $21,597 | $62,600 |
| 2 | $21,150 | $29,187 | $84,600 |
| 3 | $26,650 | $36,777 | $106,600 |
| 4 | $32,150 | $44,367 | $128,600 |
| 5 | $37,650 | $51,957 | $150,600 |
| 6 | $43,150 | $59,547 | $172,600 |
| 7 | $48,650 | $67,137 | $194,600 |
| 8 | $54,150 | $74,727 | $216,600 |
| Each additional | +$5,500 | +$7,590 | +$22,000 |
2026 ACA Subsidy Income Thresholds, based on 2025 FPL guidelines via healthcare.gov and aspe.hhs.gov
If your household income falls between 100% and 138% FPL and you live in a Medicaid expansion state, you likely qualify for Medicaid rather than marketplace coverage. If you are between 138% and 400% FPL, you qualify for ACA premium tax credits. The smaller that credit is relative to the premium, the more you pay out of pocket.
State by State Premium Increases in 2026
The national 26% average masks enormous variation. Southern and Mountain West states using Healthcare.gov saw the steepest increases. States running their own marketplaces (California, New York, Massachusetts, Colorado, and others) generally kept increases lower because they had more regulatory flexibility and, in some cases, their own state subsidy programs that cushioned the blow.
ACA Benchmark Premium Changes by State (2026)
| State | Benchmark Premium Increase | Notes |
|---|
| Arkansas | +67% | Highest in the nation; pricing adjustment for cost-sharing reductions |
| New Mexico | +53% | Second highest; large unsubsidized population |
| New Hampshire | +50% | Major insurer repricing |
| Arizona | +49% | Dominant insurer withdrew; market repriced |
| Washington | +41% | State-based marketplace; among highest state exchange increases |
| Tennessee | +38% | Limited insurer competition |
| Mississippi | +36% | Rural market challenges |
| Texas | +32% | Largest unsubsidized population in the country |
| Georgia | +31% | Expanded enrollment post-Pathways program |
| Florida | +30% | National average for Healthcare.gov states |
| North Carolina | +28% | Near national average |
| Ohio | +25% | Mixed insurer competition |
| Michigan | +22% | Medicaid expansion state; moderate increase |
| Pennsylvania | +19% | State-based marketplace; below Healthcare.gov average |
| Illinois | +18% | Moderate increase |
| Colorado | +16% | ConnectforHealthCO; state subsidies soften impact |
| Virginia | +15% | Competitive market |
| New York | +14% | NY State of Health; state-funded backstop |
| California | +13% | Covered California; state supplement for some enrollees |
| Massachusetts | +10% | Connector-managed; lowest large-state increase |
| Alaska | -3% | Only state with a benchmark premium decrease |
Benchmark premium changes are for the second-lowest-cost silver plan. Source: KFF and Becker's Payer Issues. Data reflects 2026 rate filings.
A few things stand out in this table. Arkansas's 67% increase is an outlier driven partly by how the state priced cost-sharing reduction adjustments, a technical factor layered on top of the subsidy expiration. New Mexico, New Hampshire, and Arizona follow, each exceeding 49%. Alaska is the one state where premiums actually fell, benefiting from specific market dynamics.
States with their own marketplaces generally did better. Covered California (California's marketplace) held its increase to 13%. New York State of Health came in at 14%. Massachusetts held to 10%. These states have more tools (including state-funded reinsurance programs and direct insurer negotiations) than states relying on the federal platform.
Who Is Hardest Hit
The enrollees facing the largest cost increases fall into two groups.
Group 1: People above 400% FPL. These households now owe the full unsubsidized premium. For a 45-year-old in a high-increase state like Arkansas or Arizona, that could mean going from under $200 per month (with enhanced credits) to $600 or more. Many are simply dropping coverage.
Group 2: People between 300% and 400% FPL. They still get subsidies, but under the original ACA formula, those subsidies are smaller than what they received under the enhanced structure. Their out-of-pocket costs rose significantly even though they technically remain subsidy-eligible.
People below 250% FPL fare somewhat better. The original ACA formula was designed to protect lower-income enrollees first, and for households in that range the standard credits still cover a meaningful share of the premium. Cost-sharing reduction plans (silver plans with CSR) also remain available for households below 250% FPL and can substantially lower deductibles and copays.
States That Added Their Own Subsidies
Several states responded to the enhanced credit expiration by creating or expanding state-funded premium assistance. This is why state-based marketplace states saw smaller increases on average.
- California: Covered California supplements federal subsidies for enrollees between 200% and 400% FPL. Some enrollees saw little change in their net premium.
- New York: The state's Essential Plan covers many enrollees who would otherwise fall into the subsidy gap.
- Massachusetts: The Connector's ConnectorCare program provides state-funded cost sharing for low and moderate-income residents.
- Colorado: State reinsurance and ConnectforHealthCO negotiations held rate growth to 16%.
- New Jersey: State subsidy program fills part of the gap for households up to 600% FPL.
If you live in one of these states, the headline increase in unsubsidized rates may not reflect what you actually pay. Running your numbers through the marketplace calculator, or using a free screener tool, is the only accurate way to know your net cost.
How to Apply for ACA Coverage in 2026
If you lost coverage because premiums became unaffordable, or if you dropped your plan without checking your actual subsidy amount, you may still have options.
The standard open enrollment period for ACA coverage runs from November 1 through January 15 (or later in some states). Outside of that window, you need a qualifying life event to enroll: things like losing other coverage, getting married, having a child, or moving to a new state.
Documents you will need to apply:
- Social Security numbers for all household members enrolling
- Employer information and income details (pay stubs or most recent tax return)
- Policy numbers for any current coverage
- Information about job-based coverage available to your household
- Immigration documents if applicable
How to apply, step by step:
- Go to healthcare.gov (or your state's marketplace if your state runs its own)
- Create or log into your account
- Complete the application with household, income, and coverage information
- Review your eligibility for premium tax credits and cost-sharing reductions
- Compare available plans (filter by metal tier, premium, and network)
- Select a plan and confirm enrollment before the deadline
- Pay your first premium to activate coverage
Common reasons applications get denied or subsidies are incorrectly calculated:
- Income entered does not match IRS records from prior year
- Household size is reported incorrectly (e.g., omitting a dependent)
- Employer coverage available to the household meets minimum value and affordability standards (disqualifies marketplace subsidies)
- Not a lawful US resident or citizen
- Already enrolled in Medicare or Medicaid
If you are unsure whether you qualify, CoveredUSA's free screener takes two minutes and shows you exactly which programs you are eligible for based on your household income and size. Check your eligibility now at CoveredUSA. It takes 2 minutes.
ACA vs. Medicaid: Which One Do You Qualify For?
With premiums up sharply, many people near the lower end of the income scale are better served by Medicaid than by an ACA marketplace plan. If your household income is below 138% FPL and you live in one of the 41 states (including DC) that have expanded Medicaid, you qualify for Medicaid at little or no cost. There is no premium, and out-of-pocket costs are minimal.
The table in the subsidy income limits section above shows the 138% FPL cutoffs by household size. A family of four earning under $44,367 in 2026 should check Medicaid eligibility first before applying through the marketplace. For ACA subsidy information, visit aca-income-limits.
If you are unsure which program fits your income, the screener at coveredusa.org checks both simultaneously.
Frequently Asked Questions
How much did ACA premiums go up in 2026?
On average, ACA marketplace premiums rose 26% in 2026 according to KFF. However, the increase enrollees actually pay depends on their income. People who received enhanced premium tax credits through 2025 may see their costs more than double because those credits expired. People with low incomes and standard subsidies saw smaller increases.
Why did ACA premiums increase so much in 2026?
Two factors drove the increase. First, enhanced premium tax credits created under the American Rescue Plan in 2021 and extended through 2022 expired on January 1, 2026. Second, underlying healthcare cost growth (including rising drug prices and utilization) pushed insurer rates higher. The two factors together produced the largest single-year increase since the ACA launched.
Which states had the highest ACA premium increases in 2026?
Arkansas saw the largest increase at 67%, followed by New Mexico (53%), New Hampshire (50%), and Arizona (49%). States in the South and Mountain West generally saw the steepest increases. Alaska was the only state where benchmark premiums declined.
Which states had the lowest ACA premium increases in 2026?
Alaska saw a 3% decrease. Among states with increases, Massachusetts (10%), California (13%), New York (14%), Virginia (15%), and Colorado (16%) had the smallest increases. These are mostly states that run their own marketplaces and have state-funded subsidy programs.
Does the subsidy cliff apply in 2026?
Yes. The enhanced credits that eliminated the subsidy cliff at 400% FPL expired on January 1, 2026. Households earning above 400% FPL no longer qualify for any federal premium tax credit. For a family of four, that threshold is $128,600 in annual income.
Can I still get ACA coverage if I missed open enrollment?
Yes, if you have a qualifying life event. Losing other health coverage, getting married, having or adopting a child, moving to a new coverage area, and several other events trigger a special enrollment period (SEP). You typically have 60 days from the qualifying event. If you lost coverage because you could no longer afford the premium, that loss itself qualifies you for a SEP.
What is the income limit to get ACA subsidies in 2026?
For 2026, ACA subsidies are available to households earning between 100% and 400% of the 2025 federal poverty level. For a single person, that is between $15,650 and $62,600. For a family of four, between $32,150 and $128,600. In Medicaid expansion states, the lower bound effectively starts at 138% FPL because households below that threshold qualify for Medicaid instead.
Should I check Medicaid before applying to the ACA marketplace?
Yes. If your household income is below 138% FPL and you live in a Medicaid expansion state, Medicaid will cost you less than any marketplace plan. The ACA marketplace application will screen for Medicaid eligibility automatically, but knowing which program you are likely to qualify for first saves time.
