Health insurance numbers for 2026
The figures that decide what U.S. health insurance costs in 2026, in one place. Every number is dated and linked to its official source, and we update the page when the agencies release new ones.
For 2026, the ACA out-of-pocket maximum is $10,600 for one person and $21,200 for a family. Marketplace subsidies now phase out at 400% of the federal poverty level ($62,600 for a single person, $128,600 for a family of four) because the enhanced 2021 to 2025 credits expired on January 1, 2026. You can put up to $4,400 into an HSA ($8,750 for a family) and $3,400 into a health FSA. Open enrollment for 2027 coverage runs November 1 to December 15, 2026.
Marketplace subsidies and income limits
Premium subsidies (tax credits) lower what you pay for a Marketplace plan. For 2026 the enhanced subsidies of 2021 to 2025 have expired, so the old income cap, the "400% cliff," is back: earn one dollar over the limit and your subsidy drops to zero. Eligibility is measured as a percent of the federal poverty level (FPL).
| Income (% of FPL) | One person | Family of 4 | What it means |
|---|---|---|---|
| 100% | $15,650 | $32,150 | Lower edge of subsidy eligibility (where Medicaid is not available) |
| 138% | ~$21,600 | ~$44,400 | Medicaid ceiling in expansion states; subsidies start just above this |
| 400% | $62,600 | $128,600 | Subsidy cutoff for 2026, the "cliff" that returned this year |
Sources: poverty guidelines, HHS/ASPE (2025 guidelines, used for 2026 coverage); return of the subsidy cliff, KFF. A House-passed bill to extend the enhanced credits had not become law as of mid-2026.
Open enrollment and key dates
You can buy or change a Marketplace plan during open enrollment, or after a qualifying life event. The window has shortened: it now ends December 15 instead of January 15.
| When | Window |
|---|---|
| Open enrollment, 2027 coverage (federal Marketplace) | November 1 to December 15, 2026 |
| Special Enrollment Period after a qualifying life event | Generally 60 days from the event (job loss, move, marriage, a new baby) |
Source: HealthCare.gov. State-run exchanges may run slightly later but cannot extend past December 31.
What a plan can charge you
Federal law caps how much you can pay out of pocket in a year, and metal levels tell you roughly how a plan splits costs with you.
| Out-of-pocket maximum (2026) | Cap |
|---|---|
| One person | $10,600 |
| Family | $21,200 |
| Metal level | Plan pays (avg) | You pay (avg) |
|---|---|---|
| Bronze | ~60% | ~40% |
| Silver | ~70% | ~30% |
| Gold | ~80% | ~20% |
| Platinum | ~90% | ~10% |
A Catastrophic plan is a fifth option with very low premiums and very high deductibles, available mainly to people under 30 or those with a hardship exemption.
Sources: out-of-pocket cap, HealthCare.gov; metal levels, HealthCare.gov.
HSA, HDHP, and FSA limits
Tax-advantaged accounts have IRS-set limits that change every year.
| Item (2026) | Self-only | Family |
|---|---|---|
| HSA contribution | $4,400 | $8,750 |
| HSA catch-up (age 55+) | +$1,000 | +$1,000 |
| HDHP minimum deductible | $1,700 | $3,400 |
| HDHP out-of-pocket limit | $8,500 | $17,000 |
| Health FSA contribution | $3,400 | $3,400 (per employee) |
| Health FSA carryover | $680 | $680 |
Note: the HDHP out-of-pocket limit ($8,500 / $17,000) is lower than the general ACA cap above. HSA-eligible plans must use the lower one.
Sources: HSA and HDHP, IRS Rev. Proc. 2025-19; health FSA, IRS Rev. Proc. 2025-32.
Employer coverage and average costs
If you have a job-based or ICHRA offer, "affordability" decides whether you could instead take a Marketplace subsidy. An offer counts as affordable for 2026 if your share of the premium for self-only coverage is no more than 9.96% of household income, the highest that threshold has ever been. Here is what employer coverage costs on average.
| Measure (most recent survey) | Amount |
|---|---|
| Average annual premium, single coverage | $9,325 |
| Average annual premium, family coverage | $26,993 |
| Average worker share, family coverage | $6,850 |
| Average deductible, single coverage | $1,886 |
Sources: affordability percentage, IRS Rev. Proc. 2025-25; average costs, KFF 2025 Employer Health Benefits Survey (latest available).
States that require coverage
Most of the U.S. has had no penalty for being uninsured since 2019, but five places still run their own individual mandate: California, the District of Columbia, Massachusetts, New Jersey, and Rhode Island. The penalty is generally the greater of a flat amount (roughly $750 to $950 per uninsured adult) or about 2.5% of household income; Massachusetts uses a monthly, income-based schedule. Amounts change yearly, so check your state.
Source: healthinsurance.org.
Frequently asked questions
What is the 2026 ACA out-of-pocket maximum?
For 2026, federal law caps in-network out-of-pocket costs at $10,600 for one person and $21,200 for a family. Once you hit it, the plan pays 100% of covered care for the rest of the year.
What is the income limit for ACA marketplace subsidies in 2026?
In 2026, premium subsidies phase out at 400% of the federal poverty level, about $62,600 for a single person and $128,600 for a family of four, because the enhanced pandemic-era credits expired on January 1, 2026. Earn one dollar above the limit and the subsidy drops to zero.
What is the 2026 HSA contribution limit?
For 2026 you can contribute up to $4,400 to an HSA with self-only coverage or $8,750 with family coverage, plus an extra $1,000 if you are 55 or older.
What is the 2026 health FSA contribution limit?
The 2026 health FSA limit is $3,400 per employee, with up to $680 eligible to carry over into the next year if your plan allows it.
When is open enrollment for 2027 health coverage?
On the federal Marketplace, open enrollment for 2027 coverage runs November 1 to December 15, 2026. That is shorter than past years, which ran through January 15.
These figures are for education and planning, not tax or insurance advice. Confirm specifics with the official source or a licensed professional before you act.