Above 400% of the federal poverty level the premium tax credit is not reduced. It is gone. Here is what is actually available to you, including the two routes worth avoiding.
The Four Real Options
I make too much for an ACA subsidy. What are my options? You have four realistic routes. Get under the line using deductible contributions if you are close to it. Join a spouse’s employer plan if one is available. Buy a marketplace plan at full price, which is the right answer if your health history is complicated. Or, if you are in good health, price a medically underwritten plan sold outside the exchange, which is the only one of the four where being healthy actually saves you money.
Most people never get past the third. The order matters, so take them in turn.
1. Check Whether You Are Really Above the Line
The test is modified adjusted gross income, not revenue and not salary, so it is more movable than most people assume. A deductible retirement contribution, an HSA contribution or the self-employed health insurance deduction can each pull a household back under. How the cliff arithmetic works, in detail →
If you are within a few thousand dollars of the threshold, do this before anything else. The credit you recover is almost always worth more than any plan you could switch to.
2. A Spouse’s Employer Plan
Since 2023 the affordability test for family members has been based on the cost of the family premium rather than employee-only coverage. If the family option at that job costs more than 9.96% of household income in 2026, the family can decline it and still qualify for marketplace credits. Worth checking rather than assuming either way. When employer family coverage costs too much →
3. A Marketplace Plan at Full Price
Is off-exchange health insurance cheaper than the marketplace? An off-exchange ACA plan is not. It is the same regulated product at the same filed price, so buying one only makes sense if it offers a network the exchange does not carry. What is genuinely different is medically underwritten coverage, which asks health questions and prices on your answers rather than on a filed rate.
Paying full freight on the exchange is the correct answer for a lot of households, and there is no shame in it. If anyone in your family has a meaningful health history, the guaranteed-issue protection you are buying is the point, and it is worth the money.
4. The Underwritten Market, If You Are Healthy
Does being healthy actually get me a lower price? On the marketplace, no. Insurers there are not permitted to ask about your health, so a 40-year-old marathon runner and a 40-year-old with three chronic conditions pay exactly the same premium in the same county. Outside the exchange, medically underwritten plans do ask, and a healthy applicant is frequently offered less. That is the entire reason to look at them, and the entire reason they are wrong for someone with a significant health history.
Those plans can rate you up or decline you, they do not treat pre-existing conditions the way an ACA plan does, and no premium tax credit applies — though if you are getting no credit anyway, that last point costs you nothing.
Two Routes To Think Twice About
Should I use a health care sharing ministry instead? Be careful with these. A health care sharing ministry is not insurance, is not regulated as insurance in most states, and has no legal obligation to pay your claim. Members share costs voluntarily. They can be cheaper month to month, and some people are happy with them, but if a large claim is declined there is no insurance department to appeal to. Understand that trade before you make it, not afterwards.
Can I get a catastrophic plan if I have no subsidy? Only if you are under 30, or if you qualify for an affordability or hardship exemption. If coverage in your area would cost more than a set share of your income, you can apply for that exemption and it unlocks catastrophic plans at any age. It is worth checking when premiums are consuming an unreasonable share of what you earn.
Where To Start
Work out your projected modified adjusted gross income first, then how far from the line you are, and only then shop. Doing it the other way round is how people end up paying full price for a plan they did not need to buy. Why premiums jumped this year →