Is the Affordable Care Act Still in Effect Today?

Yes, the Affordable Care Act is still in effect. It remains federal law, and its core structure — marketplace coverage, subsidies, pre-existing condition protections, essential benefit requirements, Medicaid expansion, and employer coverage rules — continues to govern how Americans get health insurance. Roughly 23 million people signed up for 2026 marketplace coverage during the most recent open enrollment period, and more than 40 states plus the District of Columbia have expanded Medicaid under the law.¹ The law has survived three Supreme Court challenges, most recently California v. Texas in 2021, and repeal bills introduced in Congress as recently as 2025 have not passed.² What has changed is worth knowing: the enhanced premium subsidies that ran from 2021 through 2025 expired on January 1, 2026.

Protections That Remain in Full Force

The provisions most people think of when they think of the ACA are all still on the books and still enforceable.

Insurers cannot deny you coverage, charge you more, or exclude treatment because of a pre-existing condition. Federal law prohibits pre-existing condition exclusions in both individual and group health plans.³ In the individual and small group markets, premiums can vary only by age (within a 3-to-1 ratio for adults), geographic rating area, family size, and tobacco use (within a 1.5-to-1 ratio).⁴ Insurers must accept every applicant who applies during an enrollment period, a rule known as guaranteed issue.⁵

Plans sold in the individual and small group markets must cover ten categories of essential health benefits: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care for children.⁶ Plans cannot impose annual or lifetime dollar limits on these benefits. For 2026, the most you can be required to pay out of pocket in a marketplace plan is $10,600 for individual coverage and $21,200 for family coverage; after that, the plan pays 100% of covered services for the rest of the year.⁷

If you are under 26, you can stay on a parent’s plan regardless of whether you are married, financially independent, living on your own, or enrolled in school.⁸ Plans cannot impose eligibility restrictions based on marital status, student status, or where you live.⁹ Plans are not required to cover a grandchild, only the child of the policyholder.

Will You Be Penalized for Not Having Insurance?

Not by the federal government. The individual mandate in 26 U.S.C. § 5000A is still on the books, but the Tax Cuts and Jobs Act of 2017 reduced the penalty to $0 for any month beginning after December 31, 2018.¹⁰ Starting with tax year 2019, the IRS removed the health coverage checkbox from Form 1040 and stopped requiring Form 8965.¹¹ The federal requirement exists on paper with no enforcement mechanism attached.

A handful of states and the District of Columbia have enacted their own mandates with real penalties, generally structured as the greater of a flat per-adult fee or a percentage of household income. If you live in one of those states, you could owe a state penalty even though you owe nothing federally. Check your state tax agency’s website to see whether your state imposes its own requirement.

What Changed for 2026

The biggest recent change is the expiration of the enhanced premium tax credits. From 2021 through 2025, temporary legislation (first the American Rescue Plan Act, then the Inflation Reduction Act) expanded the premium tax credit under 26 U.S.C. § 36B in two ways: it eliminated the 400% federal poverty level income cap so higher earners could qualify, and it reduced the percentage of income households at every level were expected to pay toward premiums.¹² That expansion ended on January 1, 2026. Two things follow:

The income cap is back. People earning above 400% of the federal poverty level no longer qualify for any premium tax credit. As a reference, 400% of FPL is roughly $62,600 for a single person and $128,600 for a family of four.
Expected contributions are higher at every income level, so credits are smaller and out-of-pocket premium costs are higher for many enrollees.

Congress was considering an extension in early 2026. The House passed a bill, but it had not cleared the Senate at the time of writing. If an extension is enacted retroactively, the more generous credit amounts could be restored for 2026. Check HealthCare.gov for current subsidy levels when you apply.

The rest of the subsidy structure is unchanged. The premium tax credit still runs on a sliding scale between 100% and 400% of FPL, still gets paid directly to your insurer each month, and still has to be reconciled on your tax return if your actual income differs from what you estimated. Cost-sharing reductions, which lower deductibles, copays, and coinsurance for people between 100% and 250% of FPL who enroll in a silver marketplace plan, are also still in place and applied automatically.

Medicaid Expansion and the Coverage Gap

The ACA’s Medicaid expansion covers adults with household income up to 138% of the federal poverty level, which is roughly $21,597 for a single person in 2026. More than 40 states plus the District of Columbia have adopted it.¹³ In those states, most adults aged 18 to 64 below the threshold qualify regardless of family status or health.

In states that have not expanded, adults without children or a qualifying disability may not qualify for Medicaid at any income level. People below 100% of FPL in those states can fall into a coverage gap: too little income for marketplace subsidies, too much (or the wrong household situation) for Medicaid. Medicaid and CHIP applications are accepted year-round, with no open enrollment window.

Employer Coverage Rules

Businesses with 50 or more full-time equivalent employees, known as Applicable Large Employers, must offer health coverage to their full-time workers or face potential penalties under 26 U.S.C. § 4980H.¹⁴ Qualifying coverage must provide minimum value (covering at least 60% of expected health care costs) and be affordable to the employee. For plan years beginning in 2026, coverage is affordable if the employee’s share of the premium for the lowest-cost self-only plan does not exceed 9.96% of household income.¹⁵ Because employers rarely know an employee’s household income, the IRS allows safe harbors based on W-2 wages, rate of pay, or the federal poverty level.

If your employer offers coverage that meets both tests, you generally cannot get a premium tax credit for a marketplace plan instead. If the employer’s coverage is unaffordable or does not meet minimum value, you may qualify for marketplace subsidies.

When You Can Actually Enroll

Marketplace enrollment is limited to specific windows. Open enrollment for 2026 coverage ran from November 1, 2025 through January 15, 2026. Plans selected by December 15, 2025 took effect January 1, 2026; plans selected between December 16 and January 15 took effect February 1.¹⁶

Outside open enrollment, you can enroll or switch plans only after a qualifying life event that triggers a Special Enrollment Period. Common events include:

Losing existing coverage, such as through a job change or aging off a parent’s plan
Getting married or divorced
Having or adopting a child
Moving to a new state or county
Losing Medicaid or CHIP eligibility

You typically have 60 days from the qualifying event to enroll through the marketplace. Medicaid and CHIP remain the exception: you can apply any time of year.¹⁶

1
Centers for Medicare and Medicaid Services. Marketplace 2026 Open Enrollment Period Report
2
Supreme Court of the United States. California v. Texas, 593 U.S. 659 (2021)
3
Office of the Law Revision Counsel. 42 U.S.C. 300gg-3 – Prohibition of Preexisting Condition Exclusions or Other Discrimination Based on Health Status
4
Office of the Law Revision Counsel. 42 U.S.C. 300gg – Fair Health Insurance Premiums
5
Office of the Law Revision Counsel. 42 U.S.C. 300gg-1 – Guaranteed Availability of Coverage
6
Office of the Law Revision Counsel. 42 U.S.C. 18022 – Essential Health Benefits Requirements
7
HealthCare.gov. Out-of-Pocket Maximum/Limit
8
Office of the Law Revision Counsel. 42 U.S.C. 300gg-14 – Extension of Dependent Coverage
9
U.S. Department of Labor. Young Adults and the Affordable Care Act FAQs
10
Office of the Law Revision Counsel. 26 U.S.C. 5000A – Requirement to Maintain Minimum Essential Coverage
11
Internal Revenue Service. Affordable Care Act Tax Provisions for Individuals and Families
12
Office of the Law Revision Counsel. 26 U.S.C. 36B – Refundable Credit for Coverage Under a Qualified Health Plan
13
HealthCare.gov. Medicaid Expansion and What It Means for You
14
Office of the Law Revision Counsel. 26 U.S.C. 4980H – Shared Responsibility for Employers Regarding Health Coverage
15
Internal Revenue Service. Rev. Proc. 2025-25
16
HealthCare.gov. When Can You Get Health Insurance?