Yes, Obamacare is still a thing. The Affordable Care Act signed in 2010 remains in force in 2026, and nearly 23 million people enrolled in marketplace plans for this year’s coverage.1Centers for Medicare & Medicaid Services. Marketplace 2026 Open Enrollment Period Report – National Snapshot The insurance rules, the marketplace, the tax credits, and the Medicaid expansion all still exist. What has shifted is the size of the financial help you can get, and how much you owe back if your income estimate turns out to be wrong.
The Law Itself Has Not Been Repealed
Congress has never passed a full repeal of the ACA, and the Supreme Court has twice declined to strike it down. In National Federation of Independent Business v. Sebelius (2012), the Court upheld the individual mandate under Congress’s taxing power and left the Medicaid expansion in place.2Cornell Law Institute. National Federation of Independent Business v. Sebelius (2012) In California v. Texas (2021), the Court held that the challengers lacked standing after Congress zeroed out the mandate penalty, and the statute survived intact.3Supreme Court of the United States. California et al. v. Texas et al.
Federal agencies still publish annual marketplace rules, still run HealthCare.gov, and still enforce the consumer protections that came with the law.
What Changed for 2026
This is where most people will feel a difference from recent years. From 2021 through 2025, temporarily enhanced premium tax credits made marketplace coverage cheaper for nearly everyone and removed the income cap on eligibility. Those enhanced credits expired on January 1, 2026.4Office of the Law Revision Counsel. 26 US Code 36B – Refundable Credit for Coverage Under a Qualified Health Plan Three things followed.
The 400% federal poverty level income cap is back. Premium tax credits are now available only to households earning between 100% and 400% FPL. For a single person in 2026, that means an income between $15,960 and $63,840. For a family of four, the range is $33,000 to $132,000. If you earned above 400% FPL and received subsidies in 2025, you now pay full price.5Federal Register. Annual Update of the HHS Poverty Guidelines
Required premium contributions are higher for people who still qualify. Under the original ACA formula, someone at 200% FPL contributes roughly 4% to 6.3% of income toward premiums, compared with 0% to 2% under the expired enhanced schedule.4Office of the Law Revision Counsel. 26 US Code 36B – Refundable Credit for Coverage Under a Qualified Health Plan
The repayment caps are gone. Through 2025, if you received more in advance premium tax credits than you were entitled to, repayment was capped at a few hundred to a few thousand dollars depending on income. Starting with the 2026 plan year, those caps no longer exist. If your actual income comes in higher than what you estimated on your marketplace application, you owe back the entire excess with no limit.6Centers for Medicare & Medicaid Services. Are There Limits to How Much Excess Advance Payments of the Premium Tax Credit Consumers Must Pay Back Accurate income estimates matter more this year than they have in some time. If you get a raise, pick up a second job, or a spouse returns to work, update your marketplace application right away instead of waiting for tax season.
The Protections You Still Have
The subsidy changes did not touch the insurance rules. Every non-grandfathered plan in the individual and small-group market must still cover ten categories of essential health benefits: emergency care, hospitalization, maternity and newborn care, mental health and substance use treatment, prescription drugs, rehabilitative services, lab work, preventive and chronic disease care, pediatric services including dental and vision for children, and outpatient care.7Centers for Medicare & Medicaid Services. Information on Essential Health Benefits Benchmark Plans
Insurers still cannot deny you coverage, charge you more, or refuse to pay for treatment because of a pre-existing condition, whether that’s diabetes, asthma, cancer, or pregnancy.8HHS.gov. Pre-Existing Conditions Once you are enrolled, your plan cannot drop you or raise your rates because your health changes.9HealthCare.gov. Coverage for Pre-Existing Conditions
Plans that offer dependent coverage must still let adult children stay on a parent’s policy until age 26, married or not, and cannot condition that on residency, financial dependence, or student status.10U.S. Department of Labor. Young Adults and the Affordable Care Act Annual and lifetime dollar limits on essential health benefits are still prohibited. And most plans still cover a set list of preventive services, including immunizations, screenings, and wellness visits, at no cost when you use an in-network provider, even before you meet the deductible.11HealthCare.gov. Preventive Health Services
Will You Be Penalized for Going Without Coverage
Not by the IRS. The federal requirement to carry health insurance is still in the tax code, but the Tax Cuts and Jobs Act of 2017 set the penalty to $0 starting in 2019, and that’s still where it sits.3Supreme Court of the United States. California et al. v. Texas et al.
A handful of states fill that gap with their own mandates. California charges at least $950 per uninsured adult and $475 per uninsured child on the state return, meaning a family of four that goes uncovered all year owes at least $2,850. Massachusetts, New Jersey, Rhode Island, and the District of Columbia also impose penalties, with their own amounts and calculation methods. If you live in one of these places, you’ll need to show proof of qualifying coverage on your state return.
What Coverage Costs and Who Gets Help
Marketplace plans are organized into metal tiers. Every tier covers the same essential health benefits; the difference is how costs split between you and the insurer.
- Bronze plans cover about 60% of average costs. Lowest premiums, highest costs when you actually use care.
- Silver plans cover about 70%, and are the only tier that qualifies for cost-sharing reductions.
- Gold plans cover about 80%.
- Platinum plans cover about 90%. Highest premiums, lowest costs at the point of care.12HealthCare.gov. Health Plan Categories – Bronze, Silver, Gold and Platinum
Catastrophic plans are available to people under 30 or to anyone with a hardship or affordability exemption. They carry very low premiums and very high deductibles, and function mostly as a safety net.13HealthCare.gov. Catastrophic Health Plans Whichever tier you pick, the most you can be required to pay out of pocket in 2026 is $10,600 for individual coverage and $21,200 for family coverage. After that, the plan covers 100% of covered services for the rest of the year.
Premium Tax Credits
If your household income falls between 100% and 400% FPL, you likely qualify for a premium tax credit that lowers your monthly bill. You can apply it in advance each month or claim it as a lump sum on your tax return.14Internal Revenue Service. Questions and Answers on the Premium Tax Credit The marketplace uses modified adjusted gross income for eligibility, which starts with your adjusted gross income and adds untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. Supplemental Security Income does not count.15HealthCare.gov. What’s Included as Income
If your employer offers health insurance, you generally cannot receive marketplace subsidies unless that plan is considered unaffordable. For 2026, an employer plan is unaffordable if your share of the premium for employee-only coverage exceeds 9.96% of your household income.
Cost-Sharing Reductions
Cost-sharing reductions lower your deductibles, copays, and out-of-pocket maximum, but only on a Silver plan.
- At 100–150% FPL, the most substantial reductions apply, and the annual out-of-pocket maximum drops to roughly $3,500.
- At 151–200% FPL, the reductions are similar, with the same approximate $3,500 cap.
- At 201–250% FPL, reductions are more modest, with an out-of-pocket cap around $8,450.
If your income puts you in one of these brackets, a Silver plan will often save you more overall than a cheaper Bronze plan, because the cost-sharing savings can easily outweigh the monthly premium difference.
Medicaid Instead of a Marketplace Plan
The ACA gave states the option to expand Medicaid to adults earning up to 138% FPL. As of 2026, 41 states, including the District of Columbia, have adopted the expansion. In those states, a single adult earning under roughly $22,000 a year may qualify for Medicaid rather than a marketplace plan, with lower or no premiums and minimal cost-sharing. States that have not expanded leave a coverage gap for some low-income adults who earn too much for traditional Medicaid but too little for marketplace tax credits.
When You Can Sign Up
Open enrollment typically runs from November 1 through January 15. Enroll by December 15 and coverage starts January 1; enroll between December 16 and January 15 and coverage starts February 1.16HealthCare.gov. When Can You Get Health Insurance Some state-run exchanges use their own deadlines, so check your state’s marketplace if you don’t use HealthCare.gov.
Outside open enrollment, you can sign up or switch plans only after a qualifying life event, and you have 60 days from the event to act (or up to 60 days before an expected event). Common triggers include:17HealthCare.gov. Getting Health Coverage Outside Open Enrollment
- Losing job-based coverage, aging off a parent’s plan at 26, or losing Medicaid or CHIP eligibility.
- Getting married, having or adopting a child, or losing coverage through divorce.
- Moving to a new ZIP code or county, or moving to the U.S. from abroad. A trip or a move for medical treatment does not qualify.
- Gaining citizenship, leaving incarceration, or being affected by a natural disaster.
If you lost Medicaid or CHIP, you get 90 days instead of 60 to enroll in a marketplace plan.
How to Apply
You can apply through HealthCare.gov (or your state’s exchange), by phone, by mail, or in person with a certified navigator or broker.18HealthCare.gov. Apply for Health Insurance You’ll need Social Security numbers for citizens or immigration document numbers for lawful residents, recent income documentation such as pay stubs, W-2s, 1099s, or your latest tax return, a list of everyone on your tax return (they count toward household size even if they don’t need coverage), and details on any employer coverage available to household members.
Selecting a plan is not the last step. Coverage does not start until you pay your first premium directly to the insurer by the deadline in your enrollment package. Miss that payment and the whole enrollment lapses. If the marketplace asks for documents to verify your identity, income, or immigration status, respond by the stated deadline or your eligibility will be recalculated using federal data rather than what you reported.19HealthCare.gov. Health Plan Required Documents and Deadlines