HealthPlan Moms2027 ACA & Subsidy Cheat Sheet
Everything you need on one page: Federal Poverty Level chart for household sizes 1 to 8, expected premium contributions, Marketplace out-of-pocket maximums, Medicaid and CHIP eligibility lines, employer affordability threshold, APTC repayment rules, and key dates for the 2027 coverage year.
This reference pulls together every income and threshold figure HealthPlan Moms agents (and their clients) commonly need when talking about 2027 ACA Marketplace coverage. Every number on this page comes directly from the U.S. Department of Health & Human Services, the IRS, or the Federal Register. All amounts apply to the 48 contiguous states and Washington, D.C. Alaska and Hawai'i use separate, higher poverty guidelines (listed under the chart below); see aspe.hhs.gov/poverty-guidelines for those.
On This Page
1. 2026 Federal Poverty Level Chart
Eligibility for ACA premium tax credits, cost-sharing reductions, Medicaid expansion, and CHIP is measured against the prior year's Federal Poverty Level. Coverage Year 2027 uses the HHS 2026 poverty guidelines. Figures shown are annual household income in U.S. dollars.
2026 FPL by Household Size
For determining 2027 ACA subsidy eligibility. 48 contiguous states and D.C.
| Household Size | 100% FPL | 138% FPL Medicaid (expansion) |
150% FPL | 200% FPL | 250% FPL | 300% FPL | 400% FPL Subsidy cliff |
|---|---|---|---|---|---|---|---|
| 1 person | $15,960 | $22,025 | $23,940 | $31,920 | $39,900 | $47,880 | $63,840 |
| 2 people | $21,640 | $29,863 | $32,460 | $43,280 | $54,100 | $64,920 | $86,560 |
| 3 people | $27,320 | $37,702 | $40,980 | $54,640 | $68,300 | $81,960 | $109,280 |
| 4 people | $33,000 | $45,540 | $49,500 | $66,000 | $82,500 | $99,000 | $132,000 |
| 5 people | $38,680 | $53,378 | $58,020 | $77,360 | $96,700 | $116,040 | $154,720 |
| 6 people | $44,360 | $61,217 | $66,540 | $88,720 | $110,900 | $133,080 | $177,440 |
| 7 people | $50,040 | $69,055 | $75,060 | $100,080 | $125,100 | $150,120 | $200,160 |
| 8 people | $55,720 | $76,894 | $83,580 | $111,440 | $139,300 | $167,160 | $222,880 |
3. Medicaid & CHIP Eligibility
Medicaid and CHIP (Children's Health Insurance Program) cover different populations depending on state. Eligibility is set at the state level within federal minimums. Enrollees at or below these thresholds typically qualify for Medicaid or CHIP instead of Marketplace subsidies.
Typical Income Lines for Medicaid & CHIP
Ranges reflect federal minimums and common state thresholds. Check your specific state for exact cutoffs.
| Program / Group | Typical Income Threshold | Notes |
|---|---|---|
| Medicaid: adults (expansion states) | Up to 138% FPL | 41 states + D.C. have expanded Medicaid. Work requirements and 6-month renewals begin in 2027 (see below) |
| Medicaid: adults (non-expansion states) | Varies; typically well below 100% FPL for parents, usually none for childless adults | TX, FL, TN, AL, MS, SC, GA, WY, KS; coverage gap exists |
| Medicaid: pregnant women | Typically 138% to 200% FPL (state-dependent) | Many states extend higher, up to 300% FPL |
| Medicaid: children | At least 138% FPL nationwide; many states higher | Children under 19 have the broadest Medicaid eligibility |
| CHIP: children | Typically 170% to 400% FPL depending on state | Bridges the gap above Medicaid for children; median cutoff ~255% FPL |
| CHIP: pregnant women (some states) | Up to 300% FPL in participating states | Not offered in all states |
4. Marketplace Out-of-Pocket Maximums (2027)
The maximum a consumer can be required to pay out-of-pocket in a single plan year for in-network essential health benefits. Silver plans qualify for Cost-Sharing Reductions (CSRs) at lower income levels, which lower the MOOP substantially.
2027 MOOP by Plan Type & CSR Level
Federal limits for non-grandfathered individual and group plans.
| Plan Type | Income Level | Individual MOOP | Family MOOP |
|---|---|---|---|
| Standard (all plans) | All income levels | $12,000 | $24,000 |
| CSR Silver, 73% AV | 200% to 250% FPL | $9,600 | $19,200 |
| CSR Silver, 87% AV | 150% to 200% FPL | $4,000 | $8,000 |
| CSR Silver, 94% AV | 100% to 150% FPL | $4,000 | $8,000 |
5. Employer Coverage Affordability
If an employee is offered health coverage through their job, they generally can't qualify for Marketplace subsidies unless the employer offer is deemed "unaffordable" by the IRS standard. The 2027 threshold is pegged to self-only coverage cost, but family-affordability determinations now look at the cost of family coverage (a 2023 IRS rule change).
Affordability Threshold
Employer-sponsored coverage is considered unaffordable if the employee's share of premium exceeds this percentage of household income. Above this line, the employee (and family) may qualify for Marketplace subsidies instead.
Family Affordability Basis
For dependents, affordability is measured against the cost to enroll the family, not just the employee. This expanded eligibility significantly starting in 2023 and remains in effect for 2027.
6. APTC Repayment: No Cap Starting Tax Year 2026
If a household receives more Advance Premium Tax Credit (APTC) than it qualifies for based on actual year-end income, it owes the excess back at tax time. Through tax year 2025, lower-income households had a repayment cap. Public Law 119-21 removed those caps for tax years beginning after December 31, 2025, so 2026 and 2027 coverage is reconciled with full repayment at every income level.
Maximum Excess APTC Repayment: Before and After
Single / all other filers.
| Income (% of FPL) | Tax Year 2025 (old caps) | Tax Year 2026 and 2027 |
|---|---|---|
| Under 200% FPL | $375 / $750 | Full excess owed |
| 200% to 299% FPL | $975 / $1,950 | Full excess owed |
| 300% to 399% FPL | $1,625 / $3,250 | Full excess owed |
| 400% FPL and above | No cap | Full excess owed |
7. Tax Filing Thresholds (Tax Year 2026)
The minimum gross income at which a taxpayer under age 65 must file a federal return. Important for ACA subsidy reconciliation because APTC recipients must file a return even if their income is below these thresholds.
Must-File Income Thresholds (under age 65)
Based on the 2026 standard deduction by filing status (returns filed in 2027).
| Filing Status | Threshold |
|---|---|
| Single | $16,100 |
| Head of Household | $24,150 |
| Married Filing Jointly (both under 65) | $32,200 |
| Qualifying Surviving Spouse w/ Qualifying Child | $32,200 |
| Married Filing Separately | Any gross income |
8. Affordability Exemption (Catastrophic Coverage, Age 30+)
Catastrophic health plans on the Marketplace are normally limited to enrollees under 30. People 30 and older can qualify under a "hardship exemption" if no affordable Marketplace or employer plan is available.
Affordability Cutoff
If the lowest-cost Marketplace or employer coverage (after APTC) would cost more than this percentage of household income, the enrollee age 30+ can purchase a catastrophic plan under the affordability exemption.
What Catastrophic Plans Cover
Essential health benefits, three primary-care visits per year before deductible, and all preventive services. Very high deductibles (close to the annual MOOP) make them best suited as a bridge or emergency-only coverage option.
Sources
- U.S. Department of Health & Human Services, 2026 Poverty Guidelines (Federal Register Vol. 91, No. 10, January 15, 2026), aspe.hhs.gov/poverty-guidelines
- IRS Revenue Procedure 2026-26, 2027 Applicable Percentage Table and Required Contribution Percentage, irs.gov/pub/irs-drop/rp-26-26.pdf
- IRS Revenue Procedure 2025-25, Applicable Figures for CY 2026 (comparison), irs.gov/pub/irs-drop/rp-25-25.pdf
- IRS Revenue Procedure 2025-32, Inflation Adjustments for Tax Year 2026, irs.gov
- IRS Revenue Procedure 2024-40, Inflation Adjustments for Tax Year 2025 (prior APTC caps), irs.gov/pub/irs-drop/rp-24-40.pdf
- CMS, 2027 Benefit Year Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing, and Required Contribution Percentage guidance, cms.gov
- IRS, One Big Beautiful Bill provisions (premium tax credit), irs.gov/obbb
- Public Law 119-21 (One Big Beautiful Bill Act of 2025), full text at congress.gov
- Medicaid.gov Eligibility & State Standards, medicaid.gov/medicaid/eligibility
- KFF, State-level Medicaid and CHIP eligibility data, kff.org
- Healthcare.gov, Dates and deadlines for 2027 coverage, healthcare.gov
Disclaimer: This page compiles publicly available federal data for quick reference. Amounts and rules are accurate as of publication (October 9, 2026) but change with new annual guidelines, IRS procedures, and legislation. Always verify with the original source or with a licensed insurance agent before relying on any figure for a specific enrollment or tax filing decision. HealthPlan Moms is a licensed insurance agency and is not affiliated with or endorsed by any government agency.
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