2026 Income Limits: What You Can Earn and Still Get Help

"Do I make too much for help?"

It's one of the most common questions people have about ACA coverage — and one of the most confusing. The answer depends on your income, your household size, what year we're talking about, and (critically) whether Congress extends the enhanced subsidies.

This guide breaks down the income thresholds that determine your eligibility for premium subsidies and Cost-Sharing Reductions, with specific numbers you can compare to your situation. We'll cover both 2025 rules and the 2026 changes that could dramatically affect your costs.

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How Income Eligibility Works

ACA subsidies aren't based on your raw income — they're based on your income as a percentage of the Federal Poverty Level (FPL). The FPL is updated annually and varies by household size.

This means: - A single person earning $50,000 is at a different FPL percentage than... - A family of four earning $50,000

The family gets more help because $50,000 represents a smaller percentage of the poverty level for a larger household.

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2025 Federal Poverty Level Guidelines

These are the numbers used to calculate your FPL percentage for 2025 coverage:

Household Size	100% FPL	150% FPL	200% FPL	250% FPL	300% FPL	400% FPL
1	$15,060	$22,590	$30,120	$37,650	$45,180	$60,240
2	$20,440	$30,660	$40,880	$51,100	$61,320	$81,760
3	$25,820	$38,730	$51,640	$64,550	$77,460	$103,280
4	$31,200	$46,800	$62,400	$78,000	$93,600	$124,800
5	$36,580	$54,870	$73,160	$91,450	$109,740	$146,320
6	$41,960	$62,940	$83,920	$104,900	$125,880	$167,840
7	$47,340	$71,010	$94,680	$118,350	$142,020	$189,360
8	$52,720	$79,080	$105,440	$131,800	$158,160	$210,880

For households larger than 8, add $5,380 per additional person.

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What These Thresholds Mean

100% FPL — Medicaid Floor

In states that expanded Medicaid, adults with income below 138% FPL qualify for Medicaid (free or very low-cost coverage), not marketplace subsidies.

In non-expansion states, adults below 100% FPL may fall into the "coverage gap" — too poor for marketplace help, but not eligible for Medicaid.

138-150% FPL — Maximum Subsidies + Best CSRs

This income range gets: - Largest premium subsidies (often $0-50/month plans) - CSR 94 (the best Cost-Sharing Reductions) - Deductibles often under $500

Example: Single person earning $20,000 (131% FPL) - Likely pays $0-50/month for Silver plan - Deductible around $250-500 - Maximum out-of-pocket around $1,500

150-200% FPL — Strong Subsidies + CSR 87

This income range gets: - Substantial premium subsidies - CSR 87 (excellent Cost-Sharing Reductions) - Deductibles often under $1,000

Example: Family of 4 earning $55,000 (176% FPL) - Likely pays $100-200/month for Silver plan - Family deductible around $1,500 - Strong copay reductions

200-250% FPL — Moderate Subsidies + CSR 73

This income range gets: - Meaningful premium subsidies - CSR 73 (moderate Cost-Sharing Reductions) - Some improvement in deductibles/copays

Example: Single person earning $35,000 (232% FPL) - Likely pays $150-250/month for Silver plan - Deductible around $3,500 (reduced from ~$6,000)

250-400% FPL — Subsidies Only (2025)

This income range gets: - Premium subsidies (capped at 8.5% of income in 2025) - No Cost-Sharing Reductions - Standard plan deductibles

Example: Single person earning $50,000 (331% FPL) - Pays maximum ~$354/month for benchmark Silver - Standard Silver deductible (~$5,000) - Full copays

Above 400% FPL — The Cliff (2026)

In 2025: Still eligible for subsidies if premiums exceed 8.5% of income In 2026: No subsidies at all if even $1 over 400% FPL

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The 2026 Crisis: Subsidy Cliff Returns

Here's where it gets serious. The enhanced subsidies that removed the 400% FPL cliff are set to expire on December 31, 2025.

What's Changing:

	2025	2026 (if not extended)
Income ceiling	None (subsidies available at any income if premiums exceed 8.5%)	Hard cutoff at 400% FPL
Max contribution	8.5% of income for everyone	2-10% sliding scale up to 400% FPL
Above 400% FPL	Still get subsidy if local premiums are high	Zero subsidy, full premium

What This Means in Dollars

Single 60-year-old earning $62,000 (just over 400% FPL):

	2025	2026
Full premium	$850/month	$850/month
Subsidy	~$410/month	$0
You pay	~$440/month	$850/month
Annual cost	~$5,280	~$10,200

Couple (both 58) earning $87,000 (just over 400% FPL for 2):

	2025	2026
Full premium	$1,600/month	$1,600/month
Subsidy	~$980/month	$0
You pay	~$620/month	$1,600/month
Annual cost	~$7,440	~$19,200

That's an $11,760 annual increase just for being $1,000 over the FPL line.

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Income Planning Strategies (Legal)

If you're near the 400% FPL threshold, there are legal ways to manage your Modified Adjusted Gross Income (MAGI):

1. Traditional IRA Contributions

• 2025 limit: $7,000 ($8,000 if 50+)
• Directly reduces MAGI
• Must be made by April 15 of the following year

Example: $62,000 income - $7,000 IRA = $55,000 MAGI (now under 400% FPL)

2. HSA Contributions (if eligible)

• 2025 limit: $4,300 individual / $8,550 family
• Requires HSA-eligible high-deductible health plan
• Reduces MAGI dollar-for-dollar

3. SEP-IRA or Solo 401(k) (self-employed)

• SEP-IRA: Up to 25% of net self-employment income
• Solo 401(k): Employee + employer contribution combined
• Major MAGI reduction for high-earning self-employed

4. Business Expense Timing (self-employed)

• Accelerate deductible expenses before year-end
• Defer income if possible (carefully)
• Ensure you're capturing all legitimate deductions

5. Capital Gain/Loss Harvesting

• Realize capital losses to offset gains
• Be strategic about when you sell investments
• Consider deferring large gains to higher-subsidy years

Important: These should be legitimate financial moves that make sense for your overall situation — not just tax games. Consult a tax professional.

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Special Situations

Self-Employed with Variable Income

If your income fluctuates year to year, you may cross the 400% FPL threshold in some years but not others.

Strategy: - Estimate conservatively - Update your marketplace estimate throughout the year - Maximize retirement contributions in high-income years - Plan for tax reconciliation if estimates are off

Early Retirees (Under 65)

Early retirees often have: - Pension income - Investment income - IRA/401(k) distributions

All of these count toward MAGI. Planning distributions carefully can keep you under 400% FPL.

Example: Instead of taking a $30,000 IRA distribution, consider taking smaller amounts over multiple years or relying on Roth withdrawals (which don't count toward MAGI).

Married Couples with One Higher Earner

Combined income determines household FPL percentage. In some cases: - Filing married filing separately affects subsidy calculations - ACA uses household income regardless of filing status

Note: Filing separately has other tax implications — consult a professional.

ACA-Specific Income (MAGI)

Your MAGI for ACA purposes includes: - Wages, salaries, tips - Self-employment income (net) - Interest and dividends - Capital gains - Rental income - Alimony (pre-2019 agreements) - Unemployment compensation - Social Security benefits (taxable portion)

Does NOT include: - Child support received - Workers' compensation - Gifts or inheritances - Tax-exempt interest - Roth IRA distributions (contributions or qualified distributions)

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The Coverage Gap Problem

In the 10 states that haven't expanded Medicaid (as of 2025), adults with income below 100% FPL face a cruel paradox: - Too poor to qualify for marketplace subsidies (floor is 100% FPL) - Not in a category that qualifies for traditional Medicaid

This affects approximately 1.4 million Americans.

Coverage gap states: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming

If you're in the gap: - Community health centers serve everyone regardless of income - Some states have limited programs - Hospital charity care is available - Consider whether moving is feasible

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2026 Planning Timeline

If the enhanced subsidies expire as scheduled:

Now (2025): - Check your projected 2026 income - Calculate whether you'll be above or below 400% FPL - If borderline, plan MAGI reduction strategies - Maximize 2025 IRA contributions

October 2025: - Monitor Congressional action on subsidy extension - Prepare for worst-case (no extension)

November 1, 2025 (Open Enrollment Begins): - Check 2026 plan prices with and without subsidies - Make enrollment decisions based on current law

December 31, 2025: - Final deadline for 2025 retirement contributions affecting 2026 MAGI - Enhanced subsidies expire if not extended

January 15, 2026 (Open Enrollment Ends): - Last chance to enroll or change plans for 2026 - New (potentially cliff-based) rules in effect

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Quick Reference: What You'll Likely Pay (Benchmark Silver)

2025 (Enhanced Subsidies)

Income as % FPL	Max Premium (% of income)
Up to 150%	0-4%
150-200%	4-6.5%
200-250%	6.5-8.5%
250-300%	8.5%
300-400%	8.5%
Above 400%	8.5% (if eligible)

2026 (If Enhanced Subsidies Expire)

Income as % FPL	Max Premium (% of income)
100-133%	2.00%
133-150%	3-4%
150-200%	4-6.5%
200-250%	6.5-8.5%
250-300%	8.5-10%
300-400%	~10%
Above 400%	No subsidy — full premium

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The Bottom Line

Understanding the income thresholds is crucial for making smart healthcare decisions:

In 2025: - Everyone caps at 8.5% of income (no cliff) - CSRs available under 250% FPL (Silver plans only) - Relatively generous environment

In 2026 (if unchanged): - Hard cutoff at 400% FPL - Crossing the line costs thousands - MAGI management becomes critical

Your action items: 1. Calculate your household's FPL percentage 2. Determine your CSR eligibility (under 250%?) 3. If near 400%, explore MAGI reduction strategies 4. Plan for 2026 worst-case scenario 5. Stay informed about Congressional action

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Find Out Where You Stand

Take our 2-minute quiz to calculate your FPL percentage and see what subsidies and benefits you might qualify for based on your income.

[Calculate My Eligibility →]

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Income guidelines based on 2024 Federal Poverty Level (used for 2025 coverage). 2026 projections assume enhanced subsidies expire; Congressional action could change this.