Medicare Moms
Licensed Insurance Agency
2026 ACA Quick Reference
Coverage Year 2026 · Agent Cheat Sheet
1. 2025 Federal Poverty Level · Annual Household Income
| Household | 100% | 138% Medicaid exp. |
150% | 200% | 250% | 300% | 400% Subsidy cliff |
|---|---|---|---|---|---|---|---|
| 1 person | $15,650 | $21,597 | $23,475 | $31,300 | $39,125 | $46,950 | $62,600 |
| 2 people | $21,150 | $29,187 | $31,725 | $42,300 | $52,875 | $63,450 | $84,600 |
| 3 people | $26,650 | $36,777 | $39,975 | $53,300 | $66,625 | $79,950 | $106,600 |
| 4 people | $32,150 | $44,367 | $48,225 | $64,300 | $80,375 | $96,450 | $128,600 |
| 5 people | $37,650 | $51,957 | $56,475 | $75,300 | $94,125 | $112,950 | $150,600 |
| 6 people | $43,150 | $59,547 | $64,725 | $86,300 | $107,875 | $129,450 | $172,600 |
| 7 people | $48,650 | $67,137 | $72,975 | $97,300 | $121,625 | $145,950 | $194,600 |
| 8 people | $54,150 | $74,727 | $81,225 | $108,300 | $135,375 | $162,450 | $216,600 |
Households > 8: add $5,500 per additional person to 100% FPL. Alaska & Hawai'i use separate guidelines. Source: HHS / ASPE.
2. Expected Premium Contribution (% of Income)
| Income | Contribution |
|---|---|
| < 133% FPL | 2.10% |
| 133% FPL | 3.14% |
| 138% FPL | 3.45% |
| 150% FPL | 4.19% |
| 200% FPL | 6.60% |
| 250% FPL | 8.44% |
| 300–400% FPL | 9.96% |
| > 400% FPL | Ineligible |
Reflects pre-ARPA formula (enhanced subsidies expired Dec 31, 2025). Source: IRS Rev Proc 2025-25.
3. Out-of-Pocket Maximum (2026)
| Plan | Income | Indiv. | Family |
|---|---|---|---|
| Standard | Any | $10,600 | $21,200 |
| CSR 73% | 201–250% | $8,450 | $16,900 |
| CSR 87% | 151–200% | $3,500 | $7,000 |
| CSR 94% | ≤ 150% | $3,500 | $7,000 |
CSR Silver plans only. Bronze/Gold lose the benefit. Source: Federal Register 2025-11606.
4. Medicaid & CHIP Eligibility
- Adults (expansion): up to 138% FPL41 states + DC as of 2026
- Adults (non-expansion): well below 100% FPL; childless adults often ineligible
- Pregnant women: 138–200% FPL typical; up to 300% in some states
- Children (Medicaid): 138% FPL min; many states higher
- CHIP (children): 170–400% FPL depending on state (median ~255%)
State eligibility varies. Source: Medicaid.gov, KFF.
5. Employer Coverage Affordability
9.96%
Unaffordability threshold
ESI unaffordable if employee share exceeds this % of household income. Family affordability based on cost of family coverage (not self-only).
Source: IRS Rev Proc 2025-25.
6. Catastrophic (Age 30+)
8.05%
Affordability exemption
Enrollees 30+ may purchase a catastrophic plan if lowest-cost Marketplace or employer coverage exceeds this % of household income.
Source: Federal Register 2025-11606.
7. APTC Repayment Limits · Tax Year 2025
| Income | Single | All Other |
|---|---|---|
| < 200% FPL | $375 | $750 |
| 200–299% FPL | $975 | $1,950 |
| 300–399% FPL | $1,625 | $3,250 |
| ≥ 400% FPL | No cap | No cap |
TY 2026 warning: P.L. 119-21 eliminates repayment caps entirely starting tax year 2026. Source: IRS Rev Proc 2024-40.
8. Tax Filing Thresholds · TY 2025
- Single: $15,750
- Head of Household: $23,625
- MFJ (both < 65): $31,500
- Qualifying Surviving Spouse: $31,500
- Married Filing Separately: any gross income
- APTC note: Must file + Form 8962 regardless of thresholds.