Federal Marketplace Open Enrollment: Get the Right Plan the First Time

The Federal Marketplace (also called the ACA Marketplace or healthcare.gov) is for people who buy health insurance on their own — not through a job, not through Medicare, not through Medicaid. It can be a great deal or a brutal one depending on which side of the income line you’re on. Here’s everything that changed for 2026.

Two big changes for 2026 you need to know

1. The “subsidy cliff” at 400% FPL is BACK. The Inflation Reduction Act’s enhanced premium tax credits expired at the end of 2025. For 2026 coverage, people above $62,600 single / $128,600 family-of-4 get no subsidy at all. KFF saw a 44% drop in plan sign-ups for the income bracket just above the cliff.

2. Open Enrollment for 2027 is SHORTER. Starting with plan year 2027, OE runs November 1 – December 15, 2026 (NOT January 15). Most people assume they have until mid-January based on prior years — they don’t.

The three income zones that matter for 2026

2026 coverage uses the 2025 Federal Poverty Level for subsidy math (ACA always uses prior year’s FPL). Here’s where you land.

Zone 1 — Below 100% FPL (Medicaid gap territory)

Single under $15,650 / Family of 4 under $32,150. In Medicaid-expansion states, you qualify for Medicaid. In non-expansion states, you may fall into the “Medicaid gap” — you make too little for ACA subsidies AND too little for state Medicaid as an adult without dependent children. You either pay full price for an ACA plan OR look at Private Market alternatives (STM, Fixed Benefit, Indemnity).

Heads up: this is one of the biggest gotchas across the country. Plenty of lower-income people assume they qualify for subsidies and find out they don’t. There are still real options — they’re just not on the Marketplace. That’s a Healthcare Review conversation.

Zone 2 — 100% to 400% FPL (subsidy eligible)

Single $15,650 – $62,600 / Family of 4 $32,150 – $128,600. You qualify for Premium Tax Credits that reduce your monthly premium. The lower your income within this band, the larger the credit.

CSR (Cost-Sharing Reductions) bonus: if you’re under 250% FPL AND you pick a Silver plan, you also get reduced deductibles, copays, and out-of-pocket maxes:

• 100–150% FPL (Single $15,650–$23,475 / Family of 4 $32,150–$48,225): annual OOP cap reduced to no more than $3,500
• 151–200% FPL (Single $23,476–$31,300 / Family of 4 $48,226–$64,300): annual OOP cap also $3,500
• 201–250% FPL (Single $31,301–$39,125 / Family of 4 $64,301–$80,375): annual OOP cap reduced to $8,450

CSR ONLY works on Silver-tier plans. If you pick Bronze or Gold, you get the premium subsidy but not the CSR. This is the most-missed savings in ACA enrollment.

Zone 3 — Above 400% FPL (subsidy cliff is back in 2026)

Single above $62,600 / Family of 4 above $128,600. From 2021–2025, the IRA capped your premium at 8.5% of income regardless of how high your income was. For 2026, that cap is gone. You pay full unsubsidized premium.

This is where the Private Market (STM, Fixed Benefit, Indemnity) becomes mathematically competitive for healthy people who don’t need ACA’s guaranteed-issue protection. If you fall into this band, a Healthcare Review is the right call before you decide.

2026 Federal Poverty Level — the numbers behind the zones

For 2026 coverage, subsidy math uses the 2025 FPL table (48 contiguous states + DC):

Household Size	100% FPL	150% (CSR top tier)	200%	250% (CSR cliff)	400% (subsidy cliff)
1	$15,650	$23,475	$31,300	$39,125	$62,600
2	$21,150	$31,725	$42,300	$52,875	$84,600
3	$26,650	$39,975	$53,300	$66,625	$106,600
4	$32,150	$48,225	$64,300	$80,375	$128,600
5	$37,650	$56,475	$75,300	$94,125	$150,600
6	$43,150	$64,725	$86,300	$107,875	$172,600

Each additional household member: add $5,500 to the 100% column.

Open Enrollment dates — don’t get this wrong

Plan Year	OE Window	Notes
2026 (current)	Nov 1, 2025 – Jan 15, 2026	Already closed in most states. State exchanges (CA, CT, DC, IL, NJ, NY, PA, RI) had Jan 31 deadlines.
2027	Nov 1, 2026 – Dec 15, 2026	SHORTER than prior years. Per CMS’s 2025 Marketplace Integrity and Affordability Rule, OE ends Dec 15 for all exchanges.

Special Enrollment Periods (SEPs) — outside OE

If you have a qualifying life event, you can enroll outside of Open Enrollment:

• Loss of employer coverage (job loss, hours reduction, employer dropping plan)
• Marriage, divorce, birth, adoption
• Moving to a new ZIP that changes your plan options
• Income change that suddenly qualifies you for subsidies (or no longer qualifies you for Medicaid)
• Gaining U.S. citizenship or lawful permanent resident status
• Leaving incarceration

Most SEPs give you 60 days from the event to enroll. Miss the window, wait until Open Enrollment.

Choosing a Metal Tier

• Bronze — lowest premium, highest out-of-pocket when you use it. Good for people who rarely use medical care and want catastrophic protection.
• Silver — middle ground. The tier where one of the most overlooked benefits in the Marketplace lives (CSR — see above).
• Gold — higher premium, lower out-of-pocket. Good for people who use a lot of care.
• Platinum — highest premium, lowest out-of-pocket. Rare and not offered everywhere.

Counterintuitive rule: if your income is under 250% FPL, a Silver plan is almost always better than Bronze or Gold because of CSR. We’ve seen people pick Bronze for the cheap premium and lose thousands in CSR savings.

The Family Glitch Fix

For years, if anyone in the household had an “affordable” offer of employer coverage for the employee, the whole family was disqualified from Marketplace subsidies. That’s the “family glitch.” It’s been fixed. Now affordability for family members is evaluated based on the cost of family coverage, not just the employee-only cost. If you’ve ever been told you don’t qualify because of a spouse’s job offer, it’s worth running the numbers again.

A few other things worth knowing

Subsidies are based on PROJECTED income, not last year’s tax return. You estimate what you expect to earn this year. If you’re way off, you reconcile at tax time.

Most people qualify for something. The income ceiling for at least some subsidy is higher than most people assume. Don’t self-disqualify before you run the numbers.

Reporting income changes mid-year matters. If you get a raise or lose a job, update the Marketplace. Otherwise you may owe back at tax time or miss out on additional savings during the year.