Health insurance in 2026, priced honestly

How subsidies work now that the enhanced credits are gone

The premium tax credit still exists. What changed is its shape. HealthCare.gov describes the standing rule: with income between 100% and 400% of the federal poverty level you qualify for a credit that lowers your monthly premium. From 2021 through 2025 an enhancement removed that 400% ceiling and capped benchmark premiums at 8.5% of income. That enhancement expired, so the cliff is back.

Practically, that produces three groups in 2026:

• Under 250% of poverty. You get both a premium credit and cost-sharing reductions, but only on a silver plan. KFF reports the average silver deductible for someone at or below 150% of poverty is about $80, against $5,304 for a standard silver plan.
• 250% to 400% of poverty. You still get a premium credit, just a smaller one than last year, and your required contribution percentage rose.
• Above 400% of poverty. No credit at all. A 60-year-old couple in a high-cost state can face four figures a month, which is why bronze and off-exchange options deserve a fresh look this year.

Two mechanics worth knowing. First, the credit is calculated against the benchmark, meaning the second-lowest-cost silver plan in your county, but you can apply it to any metal tier. Buying the lowest-cost bronze plan with a benchmark-sized credit is how many households get their net premium into the double digits. Second, KFF notes that only 37% of marketplace consumers chose a cost-sharing-reduction plan in 2026, the lowest share on record, and in states on the federal platform the share of eligible consumers picking silver fell from 66% to 45%. If your income qualifies you for cost-sharing reductions, leaving silver is usually a mistake.

How to compare two plans without getting fooled by premium

Premium is one of four numbers. The other three decide what a bad year costs you.

Run the arithmetic for two scenarios: a healthy year where you use almost nothing, and a bad year where you hit the out-of-pocket maximum. Total cost in the healthy year is twelve premiums. Total cost in the bad year is twelve premiums plus the out-of-pocket maximum. A gold plan that costs $80 more a month but carries a $2,500 lower maximum wins the bad year and loses the healthy one, and now you can see by how much.

Then check three details that quietly break plans: whether primary care and generics are covered before the deductible, whether your specialist is in the specific network variant of that plan rather than the carrier's broader network, and whether the plan is an HMO that requires referrals. If you take a brand-name drug, look up its tier on the 2026 formulary before you enroll, because the same medication can be a $30 copay on one plan and 40% coinsurance on another.

If you are choosing between a high-deductible plan with an HSA and a traditional PPO, the tax treatment often decides it. Our HSA versus PPO comparison lays out the break-even, and how much health insurance costs covers total annual cost modeling in more depth.

Short-term plans, gaps and the traps to avoid

Short-term medical is not health insurance in the ACA sense. It is medically underwritten, it can decline you or exclude your condition, and it does not have to cover the essential health benefits. It can still be the right call for a genuinely short, genuinely healthy gap: a two-month window between employers, or a wait for a new plan year to begin when you missed a special enrollment period.

What to check before you buy one: whether pre-existing conditions are excluded outright, whether maternity, mental health and prescriptions are covered at all, whether there is a per-condition cap rather than an out-of-pocket maximum, and whether the plan can refuse to renew you after a claim. Compare it honestly against a bronze marketplace plan with a tax credit, which is often cheaper than people assume. Our short-term versus ACA comparison puts them side by side.

Also verify whether you have a special enrollment period before you settle for a gap product. Losing job-based coverage, moving, marriage, birth or adoption, and certain income changes open a 60-day window to enroll in a marketplace plan outside open enrollment. Losing coverage because you did not pay your premium generally does not.

Finally, watch for products marketed as health coverage that are not: fixed-indemnity plans that pay a flat amount per day, health care sharing ministries with no contractual obligation to pay, and discount cards. Any of those can sit alongside real coverage. None should replace it.