2027 ACA Proposed Rules & How to Maximize the Current ACA Market

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State Health Insurance Marketplace Types, 2026

The Sliding Scale

That sliding scale is called the Applicable Percentages Table. The applicable percentages were lowered significantly between 2021 and 2025. It reduced the amount that many people pay for their ACA health insurance. These percentages will go up sharply in 2026.

Here are the applicable percentages for different income levels in 2025 and 2026:

(Source: https://thefinancebuff.com/aca-premium-tax-credit-percentages.html)

Medicaid Expansion

The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations.
 
To date, 41 states (including DC) have adopted the Medicaid expansion and 10 states have not adopted the expansion. Current status for each state is based on KFF tracking and analysis of state expansion activity.

(Source: https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/)

PY2026 Open Enrollment Roadmap

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Federal Poverty Level Chart

How FPL (Federal Poverty Level) Determines Coverage Eligibility
• 100% – 400% FPL (Marketplace Subsidies): Households in this range qualify for premium
tax credits to lower monthly payments on HealthCare.gov. The 400% cap was temporarily
lifted, but the “subsidy cliff” is scheduled to return in 2026.
• Below 138% FPL (Medicaid/CHIP): In states that expanded Medicaid, adults under 65 with
incomes up to 138% of the FPL are eligible for Medicaid.
• 100% – 250% FPL (Cost-Sharing Reductions): In addition to premium tax credits,
individuals with incomes in this range who purchase a “Silver” plan on the Marketplace qualify
for cost-sharing reductions that lower deductibles, copayments, and out-of-pocket maximums.
• Below 100% FPL: In states that did not expand Medicaid, individuals below 100% FPL may
not qualify for subsidies, creating a “coverage gap”.
Key Factors in Determining FPL Percentage
• Modified Adjusted Gross Income (MAGI): The formula uses the projected MAGI for the year
of coverage, not necessarily the previous year’s tax return.
• Household Size: The 2026 FPL guidelines range from $15,960 for a single person to $55,720
for a family of eight.
• Geography: Alaska and Hawaii have higher FPL guidelines due to higher costs of living.

(Source: Federal Poverty Level (FPL) – Glossary | HealthCare.gov )

Medicaid Expansion

Medicaid expansion & what it means for you

Some states have expanded their Medicaid programs to cover all people with household incomes below a certain level. Others haven’t.

Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program.

• In all states: You can qualify for Medicaid based on income, household size, disability, family status, and other factors. Eligibility rules differ between states.
• In states that have expanded Medicaid coverage: You can qualify based on your income alone. If your household income is below 133% of the federal poverty level, you qualify. (Because of the way this is calculated, it turns out to be 138% of the federal poverty level. A few states use a different income limit.)

Status of State Action on Medicaid Expansion Decision (Map Below)

(Source: https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/ & https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/ )

Marketplace Enrollment Snapshot

(Source: ACA Marketplace 2026 OEP Report National Snapshot |CMS.gov)