No subsidy on the Marketplace? Above 400% FPL you pay full retail.
Nearly everything written about health insurance assumes you want help paying for it. Type your income into healthcare.gov, see a number with no credit applied, and the internet stops being useful to you.
This page is for that situation specifically.
On January 1, 2026, the enhanced premium tax credits from the American Rescue Plan expired. They had been extended through 2025 by the Inflation Reduction Act, and while they were in force there was no upper income limit on subsidy eligibility — help phased down gradually and never fully disappeared.
That's over. The original ACA structure is back, and it has a hard cutoff at 400% of the federal poverty level:
One dollar above the line and the credit is zero. Not reduced — gone. Someone at $62,601 pays the same unsubsidized premium as someone at $300,000.
Carriers also raised Marketplace rates roughly 26% for 2026, and benchmark silver premiums rose about 21.7% against a five-year average of 2.0% per year. If you're in one of the 22 states I serve that use healthcare.gov, the increase averaged closer to 30%. Losing the subsidy and absorbing a rate increase in the same January is why the numbers feel absurd. The full breakdown is here.
This is the part most people miss, and it's the whole point.
Below the cliff, the Marketplace is almost always the best available deal, because the subsidy is worth more than any premium difference elsewhere. I tell people that constantly and it's the right advice.
Above the cliff, that structural advantage is gone. You're paying full retail for a plan whose price was set assuming most buyers would be subsidized. And in exchange for that full-retail price, on-exchange menus have drifted toward narrow HMOs and EPOs with tight local networks and referral requirements.
So the question stops being "which metal tier" and becomes "what does the entire market look like." For a healthy household above the threshold, a non-Marketplace PPO frequently costs meaningfully less per month than the unsubsidized Marketplace equivalent, with a wider network. Healthcare.gov cannot show you that comparison, and neither can any single carrier's website.
How far above the line are you, really? Eligibility runs on modified adjusted gross income, not revenue. If you're self-employed and a few thousand dollars over, deductions may put you back under — a question for your CPA, but one that's far more productive when you know the exact threshold you need to clear. Here's the detail on that.
Have you priced Bronze with an HSA? Unsubsidized, the logic of plan selection inverts. Silver plans are priced around the subsidy structure you no longer have. Bronze plus an HSA often produces a lower total annual cost for someone who doesn't expect heavy utilization, and the HSA contribution reduces the MAGI that put you over the line in the first place.
Is anyone in the household managing a condition? If so, that usually decides it. Guaranteed coverage is worth paying for, and I'd rather tell you that on a first call than sell you something that fails when you need it.
Vague descriptions are how people end up surprised, so here it is directly. The non-Marketplace plans I work with are medically underwritten — the application asks about your health history, and coverage can be declined, limited, or priced based on what it says. They are not ACA-compliant, which means pre-existing conditions may be excluded and the essential health benefits guaranteed on every Marketplace plan are not automatic.
What you get in exchange is a materially lower premium, a real maximum out-of-pocket, and usually a broader network. Term length and renewal rules vary by plan and by state, and I'll tell you precisely what applies to yours before you sign anything.
Whether that trade favors you comes down almost entirely to your health. That's why it's the first thing I ask about, before I quote a number. If you have an ongoing condition, an ACA plan's guaranteed coverage is frequently worth more than the premium difference — and I'll tell you that even though it's the less profitable answer for me. A plan sold to someone it doesn't fit comes back as a denied claim, and neither of us wants that phone call.
Nothing. Brokers are paid a commission by the carrier, built into the premium whether you use a broker or not. Enroll direct and the carrier keeps it. The plan price is identical either way — there's a fuller explanation, plus my NPN, on the licensing page.
Above 400% of the federal poverty level you can still buy an unsubsidized Marketplace plan, look at an off-exchange ACA plan, price Bronze with an HSA, or consider non-Marketplace products such as medically underwritten PPO plans. Which is best depends on your health history and your state. For a healthy household the non-Marketplace option frequently costs less per month; for someone managing a condition, guaranteed ACA coverage is usually worth the premium difference.
It can be, but only in specific circumstances. Below 400% FPL, subsidies almost always make the Marketplace the cheapest real option. Above that line, where the subsidy is zero, medically underwritten non-Marketplace plans frequently carry lower premiums and broader networks — with the tradeoff that they are underwritten and not ACA-compliant, so pre-existing conditions may be excluded.
In the continental U.S. for 2026: $62,600 for one person, $84,600 for two, $106,600 for three, $128,600 for four, and $150,600 for five. Premium tax credits end completely above these figures rather than phasing out gradually.
Two changes landed at once. Carriers raised Marketplace rates roughly 26% on average, and the enhanced premium tax credits expired on January 1, 2026. Average premium payments after subsidies rose 58% across the market. In states using healthcare.gov, benchmark premiums rose about 30% versus about 17% in states running their own marketplaces.
Rohr Health Advisors LLC — Cavin Rohr, licensed in 29 states, NPN 21388659. Verify that before you call me.
Twenty minutes. Unsubsidized Marketplace and non-Marketplace, priced side by side for your household.
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