ACA Marketplace Premiums Are Up More Than 20% — Here's What Low-Income Households Can Do Right Now
ACA Marketplace premiums surged by more than one-fifth in 2025, driven largely by the expiration of enhanced federal tax credits that had been in place since 2021. For millions of Americans who relied on those extra subsidies to make monthly premiums manageable, the sticker shock is real — and the pressure to find affordable health coverage is urgent. If you're in that situation, this guide walks through the programs that may still be available to you, what income thresholds apply, and the concrete steps you can take today.
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Data Snapshot
According to data published by the Kaiser Family Foundation and tracked through CMS enrollment reports, approximately 21.4 million people enrolled in ACA Marketplace plans during the 2024 Open Enrollment Period — a record high, fueled in part by the enhanced subsidies that are now gone. The enhanced Premium Tax Credits (PTCs), originally authorized under the American Rescue Plan Act of 2021 and extended through the Inflation Reduction Act of 2022, expired at the end of 2024. For a benchmark household of four, the 2025 Federal Poverty Level is set at $32,150 annually (contiguous U.S.), per HHS guidelines at aspe.hhs.gov. Standard PTCs remain available for households between 100% and 400% FPL — but without the enhanced credits, many households in the 200%–400% FPL range are now paying significantly more out of pocket each month.
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What Changed and Why It Matters
The enhanced subsidies that expired at the end of 2024 had two major effects:
- They extended eligibility for premium tax credits to households above 400% FPL — a group that previously received no federal help at all.
- They increased the size of credits for households already eligible, often bringing premiums down to $0 or near-zero for lower-income enrollees.
With those credits gone, households that were paying very little in 2024 may now face monthly premiums that are hundreds of dollars higher. That's not a small adjustment — for a family living paycheck to paycheck, it can mean going uninsured.
The good news: several programs remain in place that may help reduce or eliminate your health coverage costs, depending on your income and state.
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Programs That May Still Be Available to You
1. Standard ACA Premium Tax Credits (PTCs)
Even without the enhanced credits, the original Premium Tax Credit program still exists. If your household income falls between 100% and 400% of the Federal Poverty Level, you may qualify for a subsidy that reduces your monthly marketplace premium.
How it works: - You apply through Healthcare.gov or your state's marketplace. - The credit is calculated based on your projected annual income and the cost of the benchmark "Silver" plan in your area. - You can apply the credit monthly (lowering your premium bill) or claim it when you file your federal taxes.
What you'll need to apply: - Social Security numbers for all household members applying for coverage - Employer and income information for everyone in your household - Policy numbers for any current health insurance - Information about job-based coverage you or household members are eligible for
2. Medicaid
If your household income is at or below 138% of the Federal Poverty Level and you live in a Medicaid expansion state, you may be eligible for Medicaid — which provides comprehensive coverage at little or no cost.
As of 2025, 40 states plus Washington D.C. have adopted Medicaid expansion. If you live in a non-expansion state, income thresholds vary significantly and may be much lower.
Key facts: - Medicaid is administered by your state, so eligibility rules, covered services, and application processes differ. - You can apply year-round — there's no enrollment window. - In most states, you can apply online, by phone, by mail, or in person at your local Medicaid office. - If your income fluctuates, you may move between Medicaid and marketplace coverage during the year.
Documents typically required: - Proof of identity (driver's license, passport, or state ID) - Proof of residency (utility bill, lease agreement) - Proof of income (recent pay stubs, tax return, or employer letter) - Social Security number - Immigration documentation, if applicable
3. Children's Health Insurance Program (CHIP)
CHIP covers children in households that earn too much to qualify for Medicaid but can't afford private insurance. Income thresholds vary by state but generally extend to 200%–300% FPL for children, and some states cover pregnant women as well.
- Coverage includes doctor visits, immunizations, dental care, vision, and hospital care.
- Premiums, if any, are low — often $0 to $50 per month depending on income.
- You can apply through your state Medicaid agency or through Healthcare.gov.
4. Cost-Sharing Reductions (CSRs)
If your income falls between 100% and 250% FPL and you enroll in a Silver-tier marketplace plan, you may also be eligible for Cost-Sharing Reductions. These lower your deductibles, copayments, and out-of-pocket maximums — not just your monthly premium.
CSRs are only available on Silver plans purchased through the official marketplace. They don't require a separate application — eligibility is determined automatically when you apply for marketplace coverage.
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When Can You Enroll?
Open Enrollment for ACA Marketplace plans typically runs from November 1 through January 15 each year. Outside of that window, you generally cannot enroll in a marketplace plan unless you qualify for a Special Enrollment Period (SEP).
Common qualifying events for an SEP include: - Loss of job-based health coverage - Marriage or divorce - Birth or adoption of a child - Moving to a new coverage area - Gaining citizenship or lawful presence - Release from incarceration
If you've experienced any of these in the past 60 days, you may be eligible to enroll outside of Open Enrollment. Visit Healthcare.gov or call 1-800-318-2596 to find out.
Medicaid and CHIP have no enrollment windows — you can apply at any time of year.
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Step-by-Step: How to Check Your Options
Step 1: Estimate your household income. Use your projected annual income for the current year, not last year's tax return. Include wages, self-employment income, Social Security, and other sources.
Step 2: Compare your income to the FPL. The 2025 FPL for a household of four is approximately $32,150 (contiguous U.S.). For other household sizes, visit aspe.hhs.gov.
Step 3: Visit Benefits.gov or Healthcare.gov. Benefits.gov can help you identify which programs you may be eligible for based on your situation. Healthcare.gov walks you through marketplace plan options and subsidy estimates.
Step 4: Gather your documents. Before you start an application, collect proof of identity, income, residency, and Social Security numbers for all household members.
Step 5: Apply. - For Medicaid or CHIP: Contact your state Medicaid agency directly or apply through Healthcare.gov. - For marketplace coverage: Apply at Healthcare.gov or your state marketplace. - For help: Free, certified Navigators and enrollment assisters are available in every state. Find one at localhelp.healthcare.gov.
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A Note on State Variation
Every program described here operates differently depending on where you live. Medicaid income thresholds, CHIP eligibility limits, and even marketplace plan availability vary significantly by state. Some states run their own marketplaces with different rules and deadlines. Always verify current eligibility requirements with your state agency or a certified enrollment assister.
Program eligibility and availability vary by state. Not affiliated with any government agency.
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People Also Ask
Q: Do I still get ACA subsidies if I make more than 400% of the FPL? With the expiration of enhanced credits at the end of 2024, households above 400% FPL generally no longer receive Premium Tax Credits. Standard PTCs apply to incomes between 100% and 400% FPL. Some states have their own additional subsidy programs — check your state marketplace for details.
Q: What if I can't afford any marketplace plan even with subsidies? If marketplace premiums remain unaffordable after subsidies, you may qualify for a hardship exemption from the coverage requirement. You should also check Medicaid eligibility, which provides coverage at little or no cost for households at or below 138% FPL in expansion states.
Q: Can I switch from a marketplace plan to Medicaid mid-year? Yes. If your income drops during the year and you become eligible for Medicaid, you can enroll in Medicaid at any time — it has no enrollment window. You would cancel your marketplace plan once Medicaid coverage begins to avoid paying for both.
Q: How do Cost-Sharing Reductions work with the premium increase? Cost-Sharing Reductions (CSRs) lower your out-of-pocket costs — deductibles, copays, and maximums — but do not directly reduce your monthly premium. They're available only on Silver marketplace plans for households between 100% and 250% FPL. They remain in effect for 2025 and were not affected by the expiration of enhanced PTCs.
Q: Is there free help applying for marketplace coverage or Medicaid? Yes. Certified Navigators and enrollment assisters are available in every state at no cost to you. They can help you compare plans, estimate subsidies, and complete your application. Find one at localhelp.healthcare.gov or by calling 1-800-318-2596.
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Last reviewed: July 2026