For several years, low-income Americans earning under 150% of the federal poverty level could enroll in an ACA Marketplace plan any month of the year, with zero-dollar premiums guaranteed by enhanced premium tax credits. That option no longer exists. The income-based year-round Special Enrollment Period ended on August 25, 2025, after a federal rulemaking and the enactment of the One Big Beautiful Bill Act in July 2025. Starting January 1, 2026, anyone who enrolls through an income-based SEP not tied to a specific qualifying life event is also ineligible for premium tax credits under the new law. The practical result is this: if you earn under 150% FPL and are uninsured in mid-2026, the year-round door you may have used before is closed. Millions of people who relied on this pathway are now affected. Knowing what alternatives exist, which ones are year-round versus window-based, and what income thresholds control each option is essential before making any enrollment decision.
Three genuine alternatives exist in 2026 for people in the 100% to 150% FPL income band. Medicaid is the strongest option for anyone under 138% FPL in an expansion state: it is free, comprehensive, and available year-round through healthcare.gov or your state Medicaid agency. State-named Medicaid programs such as California's Medi-Cal, Arizona's AHCCCS, Massachusetts's MassHealth, and Washington's Apple Health operate under the same federal floor but may have slightly different application processes and income-counting rules. Above 138% FPL but below 150% FPL, the Marketplace is the main option, but only during a qualifying-event SEP (60-day window from a life event such as job loss, birth, or loss of other coverage) or during the next Open Enrollment Period starting November 1, 2026. Subsidies remain available at that income level, though they are smaller than the enhanced credits that expired January 1, 2026. This page explains each path, the documents you need, and the income thresholds that determine which door is open to you right now.
7 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most costly mistakes people at 100% to 150% FPL make when trying to get coverage in 2026:
- Trying to use the 150% FPL income-based SEP after August 25, 2025. The SEP is eliminated permanently. Healthcare.gov will no longer accept enrollments through it, and even if a state exchange offered it, you would be ineligible for premium tax credits.
- Not checking Medicaid first. Anyone under 138% FPL in an expansion state qualifies for free Medicaid. Many people in the 100% to 138% FPL range assume they must use the Marketplace when Medicaid is actually the better and free option.
- Missing a qualifying-event SEP window. If you lost job-based coverage, had a baby, or experienced another qualifying event in the past 60 days, you have an active SEP right now. Waiting beyond 60 days forces you to wait for the next Open Enrollment in November 2026.
- Reporting last year's income instead of projected 2026 income. Subsidies are based on what you will earn this year. If your income dropped significantly, reporting the lower projected number qualifies you for larger subsidies or Medicaid.
- Forgetting that CHIP covers children year-round up to 200% to 300% FPL, even if the parent does not qualify for Medicaid or a Marketplace SEP. Children in most states can enroll in CHIP any time through healthcare.gov.
- Assuming zero-dollar premiums still exist at 150% FPL. Enhanced premium tax credits that guaranteed zero-dollar Silver plan premiums for incomes under 150% FPL expired January 1, 2026. At 150% FPL in 2026, you pay approximately 4.19% of income per year toward the benchmark plan, which is roughly $82 per month for a single person.
What the 150% FPL SEP Was and Why It No Longer Exists in 2026
From 2021 through August 24, 2025, the ACA Marketplace offered a special enrollment pathway exclusively for households earning at or below 150% of the federal poverty level. Under that pathway, eligible applicants could enroll in a Marketplace plan any month of the year, coverage began the first of the following month, and the enhanced premium tax credits enacted by the American Rescue Plan (2021) and extended by the Inflation Reduction Act (2022) guaranteed that the benchmark Silver plan cost $0 in monthly premiums for most enrollees at that income level. No qualifying life event was required: income alone opened the door.
Two separate federal actions ended this pathway. The Trump administration's 2025 Marketplace Final Rule suspended the income-based SEP starting August 25, 2025, citing concerns about enrollment verification and fraud. The One Big Beautiful Bill Act (OBBBA), enacted in July 2025, added a statutory prohibition: Marketplace subsidies are unavailable to anyone who enrolls through an income-based SEP not tied to a qualifying life event, effective January 1, 2026. In May 2026, CMS finalized a rule permanently banning all exchanges, including state-based exchanges, from offering the low-income SEP. The result is categorical: no marketplace plan, no subsidized or unsubsidized, can be purchased year-round based on income alone starting in 2026.
Medicaid as the Primary Year-Round Option in 2026: State Program Brands and Income Rules
Medicaid remains the strongest year-round coverage path for people at or below 138% FPL in the 40 states plus DC that expanded Medicaid under the ACA. At 138% FPL in 2026, the income ceiling is $22,025 for a single person and $45,540 for a family of 4 in the 48 contiguous states. Apply on any day through healthcare.gov (which screens and routes to your state Medicaid agency automatically) or directly through your state's Medicaid portal. Coverage typically starts the first day of the following month, though some states process applications and grant coverage retroactively.
State Medicaid programs use different brand names that carry significant Bing search volume: California's Medi-Cal, Arizona's AHCCCS (Arizona Health Care Cost Containment System), Wisconsin's BadgerCare, Massachusetts's MassHealth, Washington's Apple Health, Tennessee's TennCare, Oregon's OHP (Oregon Health Plan), Connecticut's HUSKY Health, Indiana's HIP (Healthy Indiana Plan), New Jersey's NJ FamilyCare, Arkansas's ARHOME, Oklahoma's SoonerCare, and Hawaii's Med-QUEST. All operate under the same federal Medicaid floor but may use the state-named brand on their application portals. The 10 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming) have much stricter income limits, often capping eligibility under 100% FPL for non-pregnant, non-disabled adults. If you live in a non-expansion state and your income is 100% to 150% FPL, Medicaid is likely unavailable and the Marketplace qualifying-event SEP or next Open Enrollment are your only paths.
State-Based Alternatives and Basic Health Programs in 2026
Several states operate programs that fill the gap between Medicaid and the Marketplace for people in the 138% to 200% FPL band, especially after the year-round SEP was eliminated. Basic Health Programs (BHPs) allow states to provide year-round, low-cost or zero-cost coverage to people between 138% and 200% FPL who would otherwise be forced to use the Marketplace. Three jurisdictions operate BHPs: Minnesota (MinnesotaCare), Oregon (Oregon Integrated and Qualified Health Plans under OHP), and Washington DC (DC Healthy Families expansion). New York announced it will relaunch a BHP covering up to 200% FPL beginning July 2026.
Massachusetts operates Connector Care, a state-funded program available to individuals up to 300% FPL (and in some cases up to 400% or 500% FPL depending on age), with lower premiums and cost-sharing than standard Marketplace plans. Connecticut's Covered Connecticut program provides zero-premium coverage to adults up to 175% FPL and does not depend on the federal year-round SEP. If you live in one of these states, apply through the state exchange directly: MNsure (Minnesota's state marketplace), GetCoveredNJ (New Jersey), Connect for Health Colorado (using kynect-equivalent tools), or your state's dedicated portal. These programs may have year-round or quarterly enrollment windows that differ from the federal Marketplace calendar.
Documents Needed to Apply for Medicaid or a Qualifying-Event Marketplace SEP
Incomplete applications are the single biggest cause of delayed coverage for low-income households. For Medicaid, gather proof of identity (photo ID or passport), Social Security numbers for everyone in the household, proof of state residency (utility bill, lease, or bank statement dated within 60 days), and proof of income. Income proof for Medicaid can be recent pay stubs, a written self-certification if self-employed, an unemployment award letter, or Social Security benefit statements. For a Marketplace qualifying-event SEP, you also need proof of the qualifying event: an employer termination letter with your last day of coverage, a birth certificate or hospital discharge record dated within 60 days, a marriage license, or a letter from Medicaid or CHIP showing your coverage ended. Submit all documents within the 60-day SEP window; late submissions result in denial.
Frequently Asked Questions
Is the 150% FPL year-round Special Enrollment Period still available in 2026?
No. The 150% FPL income-based year-round Special Enrollment Period was permanently eliminated on August 25, 2025. A federal rulemaking finalized in June 2025 suspended it first, and the One Big Beautiful Bill Act (signed July 2025) added a statutory prohibition barring subsidies for income-based enrollments outside of open enrollment. CMS finalized a permanent ban in May 2026. As of today, healthcare.gov no longer accepts applications through this pathway, and any state exchange that offered it would be required to deny premium tax credits to enrollees.
What are my options if I am under 150% FPL and missed the last Open Enrollment Period?
Three paths remain in 2026. First: if your income is under 138% FPL and you live in one of the 40 expansion states plus DC, apply for Medicaid any day of the year through healthcare.gov or your state Medicaid agency. Second: if you experienced a qualifying life event within the last 60 days, such as losing job-based coverage, having a baby, or getting married, you have an active 60-day Marketplace Special Enrollment Period. Third: if neither applies, wait for the next ACA Open Enrollment Period starting November 1, 2026, for 2027 coverage. Children in most states can enroll in CHIP year-round regardless of the adult situation.
How much will a Marketplace plan cost me at 150% FPL in 2026?
At exactly 150% FPL in 2026, the benchmark Silver plan costs approximately 4.19% of your income per year under standard 2026 premium tax credit rules. For a single person earning $23,940 per year (150% FPL), that is roughly $1,002 per year, or $82 per month. That is significantly more than the zero-dollar premium many enrollees at this income level paid in 2025 under enhanced tax credits, which expired January 1, 2026. At lower income levels closer to 100% FPL, the required contribution is zero. Silver plans at 100% to 150% FPL also qualify for cost-sharing reductions (Silver 94 plans) that dramatically lower deductibles and out-of-pocket costs.
Do I qualify for Medicaid if my income is between 138% and 150% FPL?
In the 40 expansion states plus DC, Medicaid expansion covers adults up to 138% FPL only. If your income is between 138% and 150% FPL (for a single person in 2026, that is between $22,025 and $23,940), you do not qualify for Medicaid in those states and must use the Marketplace. Some states have separate programs above 138% FPL: New York's BHP (launching July 2026, up to 200% FPL), Minnesota's MinnesotaCare (up to 200% FPL via MNsure), and Connecticut's Covered Connecticut (up to 175% FPL). Children in most states qualify for CHIP up to 200% to 300% FPL regardless of the adult income.
What documents do I need to enroll in Medicaid in 2026?
To enroll in Medicaid in 2026, gather: a government-issued photo ID or birth certificate for identity; Social Security numbers for all household members; proof of state residency such as a utility bill or lease dated within 60 days; and proof of projected 2026 income such as recent pay stubs, an unemployment award letter, or a self-employment income statement. Immigration status documentation is also required for non-citizens. Apply through healthcare.gov or your state Medicaid agency's portal. Most applications are decided within 45 days, though emergency Medicaid determinations can be faster.
What is a qualifying life event that opens a 60-day Marketplace SEP in 2026?
Qualifying life events that trigger a 60-day Special Enrollment Period include: losing job-based health insurance (including losing COBRA, CHIP, or Medicaid); having a baby or adopting a child; getting married; moving to a new state or county where your current plan is not available; aging off a parent's plan (turning 26); or gaining or losing eligibility for Medicaid or CHIP. The 60-day window starts the day the event occurs, not the day you became aware of it. Missing the 60-day deadline forces you to wait for the next Open Enrollment in November 2026.
Does my state have a program that covers me year-round above 138% FPL?
Several states offer coverage above 138% FPL on a year-round basis. Minnesota's MinnesotaCare through MNsure covers individuals up to 200% FPL year-round. Oregon's OHP expansion covers up to 200% FPL. Washington DC's Medicaid expansion covers up to 215% FPL for adults. New York is launching a Basic Health Program in July 2026 covering up to 200% FPL. Massachusetts's Connector Care covers individuals up to 300% or 400% FPL depending on age and situation. Connecticut's Covered Connecticut provides zero-premium coverage up to 175% FPL. Apply directly through your state exchange or Medicaid portal for these state-specific programs.
What happens to my Form 1095-A and tax credit if I enrolled mid-year?
If you enrolled in a Marketplace plan with advance premium tax credits during a qualifying-event SEP in 2026, you will receive Form 1095-A from your Marketplace in January or February 2027. Use Form 1095-A to complete IRS Form 8962 (Premium Tax Credit) when you file your 2026 taxes. If your 2026 actual income was higher than projected when you enrolled, you may owe some of the credit back. If lower, you receive a refund for the difference. Medicaid enrollees do not receive a 1095-A and owe no reconciliation. If you had Marketplace coverage part of the year and Medicaid another part, you only reconcile the Marketplace portion.
