ACA Marketplace: Health Insurance Subsidies Explained

What the ACA does

The Affordable Care Act (ACA) — sometimes called Obamacare — created a federal health insurance marketplace where individuals and families can buy private insurance, often with significant government subsidies that lower the cost.

For many low- and middle-income families, ACA plans now cost $0–$50/month thanks to the enhanced premium tax credits.

Need help enrolling? Call Healthcare.gov at 1-800-318-2596 — 24/7, free, multilingual.

Who can use the Marketplace

Anyone who:

• Lives in the U.S.
• Is a U.S. citizen, national, or lawfully present
• Is not currently in jail
• Is not currently enrolled in Medicare

If your income qualifies you for Medicaid, the Marketplace will route you there automatically — Medicaid is usually free or much cheaper.

When to enroll

• Open Enrollment: November 1 – January 15 each year
• Special Enrollment Period (SEP): triggered by life events — losing job-based coverage, marriage, divorce, having a baby, moving, etc. You have 60 days from the event to enroll.

How subsidies work

Two kinds of subsidies lower your costs:

1. Premium Tax Credits (PTC)

Reduce your monthly premium. Available if your income is between 100%–400% of the Federal Poverty Level, and currently above 400% as well thanks to the Inflation Reduction Act extension.

For 2026, that means subsidies are available up to roughly:

• $58,320 for a single person
• $98,880 for a family of 3
• ...and even higher incomes, with subsidies phasing out gradually

2. Cost-Sharing Reductions (CSR)

Lower your deductibles, copays, and out-of-pocket maximums — but only if you pick a Silver plan AND your income is below 250% of FPL. This is huge: a family at 150% of FPL might have a $0 deductible on a Silver plan.

The 4 metal tiers

| Tier | Premium | Deductible | When it makes sense | |---|---|---|---| | Bronze | Lowest | Highest | Healthy, rarely use care | | Silver | Mid | Mid | Best for low-income — get CSR | | Gold | Higher | Lower | Use care often, want predictable costs | | Platinum | Highest | Lowest | Heavy ongoing medical needs |

Silver is almost always the right answer if your income is below 250% of FPL — the cost-sharing reduction makes it function like Gold or Platinum at Silver prices.

How to apply

1. Go to Healthcare.gov (or your state's marketplace if it has one — like Covered California, NY State of Health, etc.)
2. Create an account
3. Fill out the application — it'll calculate your subsidy in real-time
4. Compare plans
5. Enroll
6. Pay your first premium to activate coverage

It takes about 45 minutes to complete.

Documents you'll need

• Social Security numbers for everyone applying
• Income info (pay stubs, last year's tax return)
• Information about any current health coverage
• Employer info if you have access to job-based coverage

A note from us

ACA enrollment runs Nov 1 – Jan 15. A team members know which Marketplace your state uses (Healthcare.gov or a state-run exchange), what the subsidy windows look like for your income, and which SHIP counselors in your area can help with detailed plan comparison. Call (844) 572-3682 and we'll point you to the right help.