2025 ACA Marketplace · Premium Tax Credits · Bronze · Silver · Gold
| Household Size | 100% FPL | 138% (Medicaid) | 250% FPL (CSR) | 400% FPL |
|---|---|---|---|---|
| 1 person | $15,060 | $20,783 | $37,650 | $60,240 |
| 2 people | $20,440 | $28,207 | $51,100 | $81,760 |
| 3 people | $25,820 | $35,631 | $64,550 | $103,280 |
| 4 people | $31,200 | $43,056 | $78,000 | $124,800 |
| 5 people | $36,580 | $50,480 | $91,450 | $146,320 |
| 6 people | $41,960 | $57,905 | $104,900 | $167,840 |
FPL figures for 48 contiguous states + D.C. (2025). Alaska and Hawaii have higher FPL thresholds.
The subsidy estimate above is based on the income and household size you enter today. But ACA subsidies are actually an advance on a tax credit that gets reconciled against your actual income when you file taxes — and that reconciliation step catches a lot of people off guard.
Report changes as they happen, not at tax time. If your income goes up during the year — a raise, new job, freelance income, or a spouse returning to work — your Advance Premium Tax Credit (APTC) may end up higher than what you actually qualified for. The Marketplace lets you update your income estimate anytime at healthcare.gov, and doing so promptly adjusts your subsidy going forward instead of creating a large repayment when you file your tax return.
Repayment caps exist, but only below 400% FPL. If your household ends up under 400% of the Federal Poverty Level, IRS repayment limits cap how much excess subsidy you owe back (the cap scales with income, e.g., a few hundred to a few thousand dollars). Above 400% FPL, there is no cap — you could owe back the full difference between what you received and what you actually qualified for, which is why overestimating income slightly is generally safer than underestimating it if you expect a raise.
Qualifying life events open a 60-day window. Outside open enrollment, marriage, divorce, birth/adoption, loss of other coverage, moving to a new zip code, or a significant income change all trigger a Special Enrollment Period. You generally have 60 days from the event to enroll or switch plans — missing that window usually means waiting until the next open enrollment period.
In 2025, you may qualify for a Premium Tax Credit (subsidy) if your income is between 100% and 400% of the Federal Poverty Level (FPL) — and in many states, even above 400% FPL due to enhanced subsidies. You must not have access to affordable employer-sponsored coverage and must enroll through the ACA Marketplace at healthcare.gov.
ACA metal tiers differ in how costs are split: Bronze plans have the lowest premiums but highest out-of-pocket costs (you pay ~40% of healthcare costs). Silver plans split costs 70/30 and are the only plans eligible for Cost-Sharing Reductions (CSR) if your income is under 250% FPL. Gold plans have higher premiums but lower out-of-pocket costs (80/20 split). If you qualify for CSR, Silver is almost always the best value.
ACA Open Enrollment for 2025 coverage ran November 1 – January 15, 2025. Outside open enrollment, you can only enroll if you have a qualifying life event (losing job-based coverage, getting married, having a baby, moving, etc.) which triggers a Special Enrollment Period (SEP). Some states have year-round enrollment for low-income individuals.
Medicaid provides free or low-cost health coverage for eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. In 2025, most states that expanded Medicaid cover adults with incomes up to 138% of FPL (~$20,783 for a single person). Medicaid expansion status varies by state — 40+ states have expanded. Check your state's Medicaid office for eligibility.
COBRA lets you keep your employer's health insurance for up to 18 months after leaving a job (36 months in some cases). The major downside: you pay the full premium — both your share and your employer's share — plus a 2% admin fee. This often costs $500–$800/month for an individual. Compare COBRA to ACA Marketplace plans, which may be significantly cheaper with subsidies.