For individuals under 65 · 2026 coverage guide

Your health coverage options,
compared honestly.

If you buy your own health coverage — because you’re self-employed, between jobs, or simply don’t have an employer plan — this is the resource built for you. ACA plans, Health Shares, direct primary care, and more, explained side by side with real numbers — updated for 2026.

2026 monthly cost estimate — 40-year-old, Texas
ACA benchmark premium (unsubsidized)
$661/mo
After subsidy — household income of $45,000/yr
$359/mo
Non-ACA alternatives (est.)
$230/mo
Benchmark premium from KFF.org (2026 verified figures). Subsidy estimate based on ACA affordability formula (IRS Rev. Proc. 2025-25) for a single adult at $45,000/yr income. Non-ACA alternative cost is an illustrative estimate, not a quote.
Who this site is for

Built for people buying coverage on their own

This site covers the individual market only — people under 65 who don’t receive coverage through an employer and aren’t yet on Medicare.

Self-employed & freelancers

If you work for yourself, you’re buying coverage without an employer contribution. Your options depend on your income and which state you’re in.

Gig & contract workers

Platforms like Uber, DoorDash, and Fiverr don’t offer health benefits. This site helps you compare what’s actually available to you.

Early retirees (ages 55–64)

Retired before Medicare eligibility at 65? You need coverage for the gap years — and the options vary significantly in cost and structure.

Coverage types

Individual health coverage — all your options

Each works differently. Cost, coverage rules, and who qualifies varies widely. Here’s what each one is — and when it makes sense.

ACA plans

Marketplace insurance plans regulated under the Affordable Care Act. Subsidies are available based on income. Coverage of pre-existing conditions is guaranteed by law.

Subsidies available Learn more →
Health shares

Member communities that pool funds to pay medical bills. Not insurance. Often lower monthly cost than ACA plans, but with different rules about what is and isn’t shared.

Not insurance Learn more →
Direct primary care

A monthly membership for unlimited primary care visits. Covers day-to-day health needs at a flat fee. Typically paired with other coverage for major medical events — not a standalone plan.

Often combined Learn more →
MEC plans

Minimum Essential Coverage plans satisfy the ACA’s definition of coverage. Bare-bones and low cost, but they don’t cover most services — typically preventive care only.

Low cost Learn more →
Virtual medicine

Telehealth memberships providing on-demand access to physicians, mental health providers, and specialists. Not a replacement for full coverage — a complement to it.

Supplemental Learn more →
Indemnity benefits

Fixed-benefit plans that pay a set dollar amount per medical event regardless of actual cost. Not comprehensive coverage, but can reduce out-of-pocket exposure for specific events.

Supplemental Learn more →
Short-term medical

Licensed insurance designed for temporary gaps — between jobs, before employer coverage starts, or after missing open enrollment. Premiums run $70–$165/month. Excludes pre-existing conditions and ACA essential benefits. Terms are capped by evolving federal and state rules.

Temporary gap coverage Learn more →
COBRA

Keep your employer’s group plan after leaving a job — but you pay the full premium plus a 2% admin fee. Identical coverage, very high cost. Average $723/month for single coverage. Best when actively treating a serious condition.

Post-employment bridge Learn more →
Farm Bureau plans

Health plans offered through state Farm Bureau organizations in select states (TX, IA, KS, IN, TN, NC, MS, AL, NE). Not ACA-compliant — can exclude pre-existing conditions. Lower premiums for healthy individuals above the subsidy cliff.

Select states only Learn more →
Comparison tool

Compare all your coverage options for your state and income

Enter your ZIP code, household size, age, and income. The tool shows what ACA plans, Health Shares, DPC combinations, and short-term medical cost side by side — no forms, no data collected.

Open the comparison tool →
State coverage guides

ACA premiums and coverage options by state

2026 health coverage options vary by state. Benchmark premiums are verified 2026 KFF figures. Each guide covers what coverage actually costs where you live, sourced from KFF.org.

Texas
2026 benchmark: $661/mo · Large unsubsidized market
View Texas guide →
Florida
2026 benchmark: $683/mo · High early retiree population
View Florida guide →
Georgia
2026 benchmark: $615/mo · Strong DPC presence
View Georgia guide →
Tennessee
2026 benchmark: $711/mo · High rural ACA premiums
View Tennessee guide →
North Carolina
2026 benchmark: $638/mo · Large gig economy segment
View North Carolina guide →
Indiana
2026 benchmark: $474/mo · Health share-friendly state
View Indiana guide →
Ohio
2026 benchmark: $513/mo · Largest Midwest individual market
View Ohio guide →
Kansas
2026 benchmark: $670/mo · No Medicaid expansion · EPO plans only on-exchange
View Kansas guide →
Arizona
2026 benchmark: $532/mo · Medicaid expanded · HMO plans only on-exchange
View Arizona guide →
The 2026 subsidy cliff — back in full

One thousand dollars of income. Seventeen thousand dollars of consequences.

A 60-year-old couple in Texas earning $84,000 in 2026 pays an estimated $695/month for ACA coverage after their premium tax credit. The same couple earning $85,000 — one thousand dollars more — pays the full benchmark: $2,114/month. No subsidy. No phase-out. The credit drops to zero the moment income crosses 400% of the federal poverty level.

That $1,000 in extra income costs them $17,023 more per year in premiums. This is why enrollment among households just above the cliff fell 44% in 2026 — and why the individual coverage decision matters more this year than it has in a decade.

Read: The ACA subsidy cliff explained →
60-year-old couple · Texas · $84,000/yr income
Full benchmark
$2,114/mo
Estimated subsidy
−$1,419/mo
They pay $695/mo
At 397% FPL — just below the cliff
Same couple · same state · $85,000/yr income
Full benchmark
$2,114/mo
Subsidy
$0
They pay $2,114/mo
At 402% FPL — $400 above the cliff · zero subsidy
Annual cost difference on $1,000 more income
$17,023
Figures calculated using KFF 2026 TX benchmark ($661/mo, age 40), ACA age-rating factor for age 60, and IRS Rev. Proc. 2025-25 applicable percentage table. Estimates only — not tax advice. Use the comparison tool for your ZIP, age, and income.
ACA subsidy estimator · 2026 plan year · IRS Rev. Proc. 2025-25

Will you qualify for an ACA subsidy in 2026?
Enter your details to find out.

Enter your ZIP code, household size, income, and age to see your estimated 2026 premium tax credit, what you’d pay after the subsidy, and how that compares to alternatives. Uses verified 2026 benchmark premiums from KFF.org and the 2026 applicable percentage table from IRS Rev. Proc. 2025-25.

Important 2026 change: The enhanced ACA subsidies in place from 2021 through 2025 have expired. The 400% FPL subsidy cliff has returned — if your household income exceeds the threshold for your household size, you receive zero premium tax credit and pay full benchmark premiums. 2026 benchmark premiums also increased an average of 26% nationally (KFF.org).
Determines your state & 2026 benchmark rate
Enter a valid 5-digit ZIP
Everyone on your tax return
Premiums vary by age (18–64)
Enter an age between 18 and 64
See guidance below if self-employed
$
Enter your annual household income
Self-employed? Your MAGI is not your gross revenue — and it is more complex to calculate.
Freelancers, independent contractors, and business owners calculate MAGI differently. Using gross revenue or net profit without above-the-line deductions gives you the wrong number.
W-2 employee
Wages from Box 1 of your W-2
Plus other income — interest, dividends, rental
Minus above-the-line deductions — student loan interest, IRA contributions
Plus ACA add-backs: non-taxable Social Security, tax-exempt interest
For most W-2 employees, MAGI ≈ gross wages
Self-employed / freelancer
Net profit from Schedule C — not gross revenue
Minus deductible portion of self-employment tax (Schedule SE line 13)
Minus SEP-IRA, SIMPLE IRA, or Solo 401(k) contributions
Health insurance deduction requires separate calculation — see note
Plus ACA add-backs: non-taxable Social Security, tax-exempt interest
The self-employed health insurance deduction is not a simple subtraction
If you are self-employed and receiving an ACA premium tax credit, the health insurance deduction and your subsidy are interdependent. The IRS addresses this in Revenue Procedure 2014-41 and IRS Publication 974. This requires an iterative worksheet — not simple arithmetic. Work with a CPA who handles self-employed ACA filers.
1
Use projected income, not last year’s return. With the 400% FPL cliff back in 2026, it is especially important to update your Marketplace income estimate if income changes during the year.
2
Start from net Schedule C profit, not gross revenue. Business expenses reduce your income before you reach MAGI.
3
Include all household income. Both spouses’ income counts if filing jointly — wages, net SE income, rental income, interest, dividends, capital gains, taxable Social Security.
4
Work with a CPA who handles self-employed ACA filers. The interaction between Schedule C, self-employment tax, retirement contributions, the health insurance deduction, and the premium tax credit requires the IRS iterative worksheet in Publication 974.
Verified IRS resources

2026 benchmark premium
Before subsidy / month
Estimated subsidy
Monthly premium tax credit
You pay after subsidy
Estimated monthly premium
Your income is
of the federal poverty level
Where your income falls on the 2026 subsidy scale
100% FPL
400% FPL — cliff
How your 2026 ACA cost compares to other coverage types
2026 ACA benchmark premium (full price)
ACA after your estimated subsidy
Typical Health Share (individual)
~$230/mo No subsidies
DPC + Health Share combo
~$305/mo No subsidies
This calculator uses verified 2026 benchmark premiums from KFF.org and the 2026 applicable percentage table from IRS Rev. Proc. 2025-25. FPL figures are 2025 HHS poverty guidelines as required by §36B(d)(3)(B) for 2026 plan-year coverage. Benchmark premiums reflect the average second-lowest-cost silver plan for a 40-year-old weighted by county plan selections; actual premiums vary by county, age, and plan. Self-employed individuals should calculate MAGI using the iterative method in IRS Publication 974. This tool provides an estimate only — not tax advice. For an exact figure visit healthcare.gov/tax-tool or work with a licensed tax professional. Health share costs shown are estimates, not quotes.
ACA subsidy reconciliation

If your income changes, you may have to repay part of your subsidy

ACA subsidies are paid in advance based on your projected income. When you file your taxes, the IRS reconciles what you received against what you actually earned. If your income came in higher than projected, you repay the difference. Most people do not realize this until they file — and the rules became significantly stricter starting with plan year 2026.

Important change for 2026 and beyond
Through plan year 2025, repayment caps limited how much excess subsidy you had to repay. Those caps are gone starting with plan year 2026. If you received more subsidy than you were entitled to, you now repay the full amount — no limit — when you file your taxes. Source: IRS Q&A on the Premium Tax Credit, updated December 2025.
W-2 employees — common repayment triggers
·Getting a raise, bonus, or overtime not projected at enrollment
·A spouse returns to work or changes to a higher-paying job
·Selling investments or property with a taxable gain
·Receiving a severance payment or large one-time income
·Gaining access to employer-sponsored insurance mid-year
Self-employed — additional repayment risks
·Revenue coming in higher than projected at enrollment
·Business expenses lower than expected — raising net profit
·A large contract or project not anticipated at enrollment
·Overestimating retirement plan contributions that reduce MAGI
·Failing to update income estimates when revenue trends upward
How to reduce your risk of a large repayment
1
Update your income estimate on healthcare.gov during the year if your income changes. The Marketplace recalculates your subsidy going forward.
2
Consider electing a lower advance credit if your income is uncertain. You can claim the full credit at tax time instead of receiving it monthly.
3
HSA or pre-tax retirement contributions can reduce your ACA-specific MAGI and may be made up until the tax filing deadline.
4
File Form 8962 every year you received advance subsidies. Failure to file makes you ineligible for subsidies in future years.
Verified resources on ACA subsidy reconciliation
IRS — Questions and Answers on the Premium Tax Credit IRS · Updated Dec 2025
The authoritative IRS Q&A on how the premium tax credit works, how reconciliation is calculated, and the removal of repayment caps for tax years after 2025.
Read on IRS.gov →
IRS Publication 974 — Premium Tax Credit IRS
Complete IRS publication covering eligibility, calculation, reconciliation on Form 8962, and the iterative worksheet for self-employed filers.
Read on IRS.gov →
IRS Form 8962 — Premium Tax Credit IRS
The form used to reconcile advance subsidy payments with your actual allowable credit at tax time. Required for anyone who received advance premium tax credits.
Read on IRS.gov →
healthinsurance.org — If your income was higher than expected, do you have to repay? Reference
Plain-language explanation of APTC repayment rules including the 2026 removal of repayment caps. Regularly updated.
Read on healthinsurance.org →
healthinsurance.org — How the IRS calculates premium tax credits for self-employed people Self-employed
Explains the circular relationship between AGI, the self-employed health insurance deduction, and the premium tax credit — with reference to IRS Revenue Procedure 2014-41.
Read on healthinsurance.org →
NATP — IRS updates premium tax credit for 2026 Tax professional reference
Written for tax professionals by the National Association of Tax Professionals. Covers IRS Fact Sheet FS-2025-10 and what accurate income reporting means for subsidy recipients.
Read on natptax.com →
Repayment rules sourced from IRS Q&A on the Premium Tax Credit (updated December 2025) and CMS Agent & Broker FAQ. Removal of repayment caps codified in Section 71305 of Public Law 119-21. Educational information only — not tax advice.
Common questions

What people ask most

What are my health coverage options if I don’t have employer insurance?
If you’re under 65 and buy your own coverage, your main options are ACA plans, Health Sharing Ministries, direct primary care memberships, MEC plans, virtual medicine plans, indemnity benefit plans, and short-term medical insurance. If you’re leaving a job, COBRA lets you keep your employer plan at full cost. Farm Bureau health plans are available in select states as a non-ACA alternative. Each works differently and costs differently — this site compares all of them.
What is the ACA subsidy cliff?
If your income exceeds 400% of the federal poverty level, you no longer qualify for ACA premium tax credits. For the 2026 plan year, that threshold is roughly $62,600 for a single adult and $128,600 for a family of four — exact cutoffs depend on household size. Above that threshold, full unsubsidized premiums apply. Many individuals at or above that income level compare alternatives. Use the comparison tool to see options side by side for your specific income and state.
Are Health Shares real insurance?
No. Health sharing ministries are not insurance. Members agree to share each other’s eligible medical costs. They are exempt from ACA requirements, which means they can set their own rules about what they will and won’t share — including rules about pre-existing conditions.
What is direct primary care and how does it work?
Direct primary care (DPC) is a monthly membership — typically $50–$100/month — that gives you unlimited access to a primary care physician. It covers day-to-day care but not hospitalizations or specialist care. Most people pair DPC with a Health Share or a high-deductible plan for major medical coverage.
What does MEC mean?
MEC stands for Minimum Essential Coverage — the ACA’s definition of coverage that satisfies the individual mandate (where one still exists). MEC plans typically cover preventive care only. They are low-cost but are not a substitute for comprehensive coverage.
Can I combine different types of coverage?
Yes. Many individuals combine a Health Share with a DPC membership for day-to-day care and a virtual medicine plan for telehealth access. These combinations can reduce overall cost while broadening coverage — though they are more complex to manage than a single ACA plan.