I’ve been placing people into health insurance plans for a long time. I’ve never seen as many confused, frustrated calls as I got this past open enrollment. The enhanced subsidies expired, premiums jumped, and people who thought they had this figured out were suddenly staring at $600+ monthly bills. This guide is what I tell those people.
Here’s what happened: Congress passed enhanced premium tax credits during COVID and then kept extending them. For a few years, a lot of people were getting surprisingly good coverage for surprisingly cheap. That party ended December 31, 2025.
The average benchmark plan jumped $128 a month overnight. People who had been paying $180/month for a Silver plan are now looking at $400+. I had clients call me in January genuinely shocked — they hadn’t changed anything, their plan auto-renewed, and their premium nearly doubled. That’s not a glitch. That’s the new normal.
If your income is above roughly $62,600 as a single person, there’s no subsidy available to you in 2026. You’re paying full freight. At that point the math on plan selection changes completely — which is why I’ll spend some time below on the HDHP+HSA strategy that makes more sense for higher earners than a standard Silver plan does.
Most people don’t realize there are four distinct types. They just go on Healthcare.gov, pick something that looks affordable, and hope for the best. That works sometimes. It’s also how people end up with a $7,000 deductible and a surprise bill they weren’t expecting. Here’s what you’re actually choosing between.
This is where I start with almost everyone. ACA plans have to cover everything: preventive care, ER, hospitalization, maternity, mental health, prescriptions, labs — the whole list. More importantly, they cannot turn you down or charge you more because you’ve had cancer, or diabetes, or a heart condition. That protection alone is worth a lot. And if your income qualifies, the subsidies can bring a solid Silver plan down to genuinely affordable.
Best for: Anyone with income between $15,650 and $62,600 (single). Also anyone with a pre-existing condition — full stop, regardless of whether subsidies apply to you.
I’ll be honest with you about short-term plans: they’re not great. The premiums look attractive until you actually need to use the coverage. They can and will deny claims for anything they classify as a pre-existing condition, which turns out to be a lot of things. No maternity coverage. Often no mental health coverage. I’ve seen people get hit with five-figure bills that their short-term plan refused to pay. Use these as a stopgap only — a few months max while you wait for an enrollment window to open.
Best for: Healthy people who missed Open Enrollment with no qualifying life event and need something in place for a few months. Not a substitute for real coverage.
Catastrophic plans are technically ACA-compliant — same protections, same 10 essential benefits, can’t deny for pre-existing conditions. But that $10,600 out-of-pocket maximum is real, and you need to be honest with yourself about whether you could actually cover that if something went wrong. I see a lot of 26-year-olds who just aged off their parents’ plan consider these. My honest take: if you qualify for even a modest subsidy on a Bronze plan, run that comparison first. Catastrophic plans don’t qualify for subsidies, which often makes them less of a deal than they initially appear.
Best for: Under-30 adults in genuinely excellent health who have the savings to cover a $10,600 emergency and have already confirmed they don’t qualify for subsidies on a Bronze plan.
These are real ACA-compliant plans — same protections, same benefits — just sold outside the government exchange. The problem is they don’t qualify for subsidies even if you’d otherwise be eligible. I almost never recommend these to someone who qualifies for a subsidy because they’re leaving money on the table. The one scenario where they make sense: you’re above the subsidy threshold, and there’s a specific carrier with a better provider network or lower premium available off-marketplace in your area. That does happen. It’s worth a quick comparison if you’re in that income range.
Best for: Above-subsidy-threshold individuals only, and only when a specific off-marketplace plan demonstrably beats the Marketplace options in your area after accounting for the subsidy you’re forfeiting.
All four metal tiers cover the same services. What changes is how the cost is split between your monthly premium and what you pay when you actually use the plan. I explain it to people this way: Bronze is a bet that you stay healthy. Platinum is a bet that you won’t. Most people land somewhere in the middle, which is why Silver is the most popular tier — and also why it’s the only tier that qualifies for cost-sharing reductions if your income is below 250% of the poverty level.
| Metal tier | Avg monthly premium (single, 2026) | Typical deductible | Best for |
|---|---|---|---|
| Bronze | ~$380–$450 | $6,000–$8,000 | Healthy people who rarely use care; lowest premium priority |
| Silver | ~$500–$650 | $3,000–$5,000 | Most people; required for cost-sharing reductions below 250% FPL |
| Gold | ~$620–$800 | $1,000–$2,500 | Regular care users; predictable costs worth the higher premium |
| Platinum | ~$750–$950 | $0–$500 | High-utilization individuals; frequent prescriptions, specialist visits |
| Catastrophic | ~$220–$320 | $10,600 | Under-30 or hardship exemption only; emergency-only strategy |
Premiums are illustrative 2026 ranges before subsidies. Actual premiums vary by age, location, and insurer. Source: CMS 2026 plan data and industry averages.
The income range for subsidies in 2026 is 100% to 400% of the Federal Poverty Level. The enhanced credits that bumped that ceiling higher are gone. Here’s the table I walk clients through on every call — find your household size, find where your income lands, and that tells you what tier of financial help you’re working with.
| Household size | Medicaid threshold (138% FPL)* | Subsidy range | Subsidy cutoff (400% FPL) |
|---|---|---|---|
| 1 person | ~$20,783 | $15,650–$62,600 | $62,600 |
| 2 people | ~$28,208 | $21,150–$84,600 | $84,600 |
| 3 people | ~$35,632 | $26,650–$106,600 | $106,600 |
| 4 people | ~$43,056 | $32,150–$128,600 | $128,600 |
*Medicaid expansion applies in 40 states + DC. In non-expansion states, the subsidy floor is 100% FPL with no Medicaid coverage gap. Income thresholds based on 2025 FPL used for 2026 plan year. Source: HealthCare.gov, CMS.
This is what I run through on every new client call. It’s not the final answer — your specific income, health history, and what doctors you need in-network all matter — but it’ll tell you which direction to start in.
This is where people get tripped up. You can’t just decide you want health insurance and sign up any day of the year. There are windows, and if you miss them, your options get a lot worse fast.
Call us. Seriously — a 10-minute conversation usually clarifies everything. We’re independent, which means we compare every carrier available in your area and tell you what we’d actually pick for your situation. No pressure, no obligation.
Call (844) 516‑1739 — Free QuoteAn individual health insurance plan is coverage purchased directly by a person or family rather than through an employer. Individual health insurance plans include ACA Marketplace plans, short-term plans, catastrophic plans, and off-marketplace plans. ACA Marketplace plans are the most comprehensive type and the only individual health insurance plans eligible for premium tax credits.
The average 2026 ACA Marketplace benchmark (Silver) plan costs $625 per month before subsidies — a $128 increase from 2025, driven by the expiration of enhanced premium tax credits. For subsidy-eligible enrollees, the average after-credit premium is $50 per month for the lowest-cost plan. Individuals above the subsidy threshold ($62,600 for a single person) pay full premium with no financial assistance.
ACA Marketplace plans, Gold, Silver, Bronze, Platinum, and Catastrophic tier plans all cover pre-existing conditions and cannot charge higher premiums based on health history. Short-term individual health insurance plans are exempt from ACA rules and can deny coverage or charge more for pre-existing conditions. If you have an ongoing health condition, an ACA Marketplace plan is almost always the appropriate choice.
Individual health insurance plans cover one person. Family plans extend coverage to a spouse and dependents under the same policy. Both types are available through the ACA Marketplace. Family plan premiums are higher, but the family qualifies as a single household unit for subsidy calculations — meaning a larger household income threshold applies before subsidies phase out.
Only through a Special Enrollment Period triggered by a qualifying life event: losing employer coverage, getting married, having a baby, moving, or losing Medicaid eligibility. You have 60 days from the event. Outside of SEPs, short-term plans are the only available alternative — but they lack ACA protections and subsidy eligibility.
For self-employed individuals, yes — 100% of premiums are deductible as the self-employed health insurance deduction on Schedule 1. For employees or individuals who are not self-employed, premiums paid with after-tax dollars can be included in itemized medical expense deductions, but only the portion exceeding 7.5% of adjusted gross income qualifies. Most people claim the standard deduction and do not itemize, so this deduction is less commonly available.