I can’t afford health insurance and don’t qualify for Medicaid. What can I do?

For people who buy their own health insurance, premiums rose significantly in 2026 after Congress failed to extend federal subsidy enhancements that expired at the end of 2025. Stories of consumers facing unaffordable health insurance premiums are widespread.¹ You’re not alone if you feel like you can’t afford health insurance.

Why you might not qualify for Medicaid

We’ll discuss private health insurance in a moment, but if health coverage feels unaffordable and you’re also not eligible for Medicaid, you might have wondered why you can’t enroll in Medicaid. There are a few reasons this might be the case:

• You might be in a state that hasn’t expanded Medicaid under the ACA (more about that below).
• Your income might be above the eligibility cut off for Medicaid.
• You might be a recent (within the last five years) immigrant.²
• Your kids might be Medicaid/CHIP-eligible but you might not be, because the income limits are higher for kids. ³

Now let’s take a look at a few scenarios to explain why you might be facing unaffordable health insurance premiums, and what you might be able to do about it.

Scenario 1: You earn too much to qualify for a subsidy

The “subsidy cliff” returned in 2026, due to the expiration of the federal subsidy enhancements. This means that federal premium subsidies (premium tax credits) are no longer available to Marketplace enrollees with household income above 400% of the federal poverty level (FPL), regardless of how expensive their coverage options are. (Note that state-funded subsidies do extend above 400% of FPL in Connecticut, New Jersey, and New Mexico.)

What can you do to qualify for subsidies?

If you lost your subsidy altogether at the end of 2025, it’s likely because your household ACA-specific Modified Adjusted Gross Income (MAGI) is over 400% of FPL. (For 2026 coverage in the continental United States, that means you earn more than $62,600 for a single person, or more than $128,600 for a family of four).⁴

Eligibility for a federal Marketplace premium tax credit requires that a household’s Modified Adjusted Gross Income (MAGI) be at or below 400% of the Federal Poverty Level (FPL). Depending on how far above this threshold your projected income is, it may be possible to bring your MAGI within the required range. This is generally done in one of two ways:

• Adjusting projected income if you are working fewer hours, taking on fewer clients, or otherwise earning less.
• Reducing MAGI through allowable tax deductions, including contributions to pre‑tax retirement accounts or health savings accounts.

If your income is too high to qualify for subsidies, you’ll pay full price for whatever plan you select. Here are some tips for choosing the plan that best fits your needs and budget.

If you’re not subsidy-eligible and you prefer a Silver plan, you might consider an off-exchange plan. These are ACA-compliant individual-market policies, but in most states, full-price Silver plans are less expensive off-exchange than on-exchange.⁵ This is because the cost of cost-sharing reductions is added to the premiums for on-exchange Silver plans in most states.

Premium subsidies are not available for off-exchange plans. But if you’re not eligible for subsidies due to your income, you won’t be giving up anything by opting for an off-exchange plan. (“Off-exchange” refers to fully ACA-compliant individual-market plans, and does not include non-ACA-compliant plans. Those are addressed in more detail below.)

If you prefer a Bronze or Gold plan, the full-price premiums for those plans are generally the same on-exchange or off-exchange because there are no CSRs impacting the price on or off exchange. But depending on where you live, there may be insurers that offer coverage only on-exchange or only off-exchange. So if you’re not subsidy-eligible, a comprehensive comparison of both on-exchange and off-exchange plans will give you a full picture of what’s available in your area.

(Regardless of whether you’re shopping on-exchange or off-exchange, you can complete the process yourself or do it with help from a broker, which won’t cost you anything.)

Scenario 2: You qualify for subsidies, but coverage still seems unaffordable

You’re certainly not alone if you’re in this category. Most Marketplace enrollees are still eligible for subsidies in 2026,⁶ but after-subsidy premiums were projected to more than double in 2026, due to the expiration of the subsidy enhancements at the end of 2025.⁷

As noted above, enrollees with household income above 400% of FPL lost their subsidies altogether at the end of 2025, resulting in substantial premium increases. But even for those who still qualify for subsidies, the subsidies now cover a smaller share of enrollees’ total premiums. To continue to have Marketplace coverage in 2026, these enrollees must either pay higher premiums, downgrade their coverage, or both.

KFF surveyed Marketplace enrollees in November 2025, asking what they would do when confronted with net premiums that were more than doubling. More than half indicated that they would either select a plan with lower premiums but higher deductibles and co-pays, or drop their coverage altogether.⁸

If your coverage feels unaffordable even with subsidies, there are a couple of options to make it more affordable:

• Reduce MAGI. As long as your MAGI stays above the Medicaid eligibility threshold in your state (and doesn’t drop below 100% of FPL), a lower MAGI will result in a larger subsidy. You can use a subsidy calculator to see how changes in your MAGI will affect the size of your subsidy.
• Downgrade to a plan with a lower premium. Several state-run Marketplaces have published data on 2026 plan selections, and there was a clear trend towards higher enrollment in Bronze plans (which have higher out-of-pocket costs but lower premiums than Silver or Gold plans).⁹ But at this point, most current enrollees won’t have an opportunity to change their coverage for the rest of the year, as open enrollment for 2026 has ended and most special enrollment periods limit current enrollees to a different plan at the same metal level as their current plan.¹⁰

Scenario 3: You’re in the coverage gap

The coverage gap is not new in 2026. It has always existed in nine states that haven’t expanded Medicaid as called for in the ACA: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming. Because those states have chosen not to expand Medicaid, many adult residents with income below the federal poverty level are not eligible for any financial assistance with their health coverage and are not eligible for Medicaid.

Learn more about the coverage gap.

What can you do to qualify for financial assistance?

If you’re an adult in one of those nine states and your income is below the federal poverty level, you’re not eligible for Marketplace subsidies.¹¹ You may find that you’re not eligible for Medicaid either (unless you’re pregnant or the parent of a minor child, although Medicaid income rules for this vary by state).¹²

To become eligible for Marketplace subsidies, you would need an ACA-specific modified adjusted gross income (MAGI) of at least 100% of the prior year’s FPL.

For 2026 coverage, that’s $15,650 for a single adult, or $21,150 for a household of two.⁴

Note: If you’re in a coverage gap state and you enter an income below the FPL on the Marketplace plan comparison tool, it will tell you that you aren’t subsidy eligible, but it won’t tell you why. The reason is that your income is below the FPL.

Here’s how MAGI is calculated under the ACA. Note that it’s gross income, rather than take-home pay, and it's different than the MAGI used for other purposes.

Be sure to include all income, and remember it’s household income, not just your own income.¹³

If you’re in the coverage gap and your income increases to at least the FPL, you’ll qualify for a special enrollment period to enroll in a Marketplace plan.

Medicaid eligibility varies by state, with the states that expanded Medicaid eligibility under the Affordable Care Act covering a much greater portion of the low-income adult population. If you’re affected by the coverage gap, you may find that you’d actually be eligible for Medicaid if you lived in one of your neighboring states.

Starting in 2027, Medicaid recipients in expansion states will face a work requirement (nationwide), which will require at least 80 hours per month of work or other community engagement.¹⁴

Scenario 4: You cannot afford ACA-compliant health insurance

If you’ve tried all of the above strategies and can’t make an ACA-compliant health plan work with your budget, you may have already dropped your coverage or be planning to do so soon.

There are some additional coverage options you may consider, which might be better than going without any coverage at all. None of these alternatives is regulated by the ACA. Some aren’t considered insurance at all, and thus aren’t subject to a state’s insurance laws. Because these plans aren’t ACA-compliant, they don’t have to cover the essential health benefits, typically exclude pre-existing conditions, and generally have annual and lifetime benefit caps. But depending on your circumstances and budget, they may pay for some health care costs that you would otherwise pay entirely out-of-pocket if you had no coverage at all. It’s important to review the plan details thoroughly before making a decision.

Non-ACA-compliant insurance options

These include short-term health insurance, fixed-indemnity plans, and various types of supplemental coverage such as accident insurance and critical illness insurance. Short-term health insurance availability varies by state: In some states there are no plans available, while in others there are plans available with total durations of up to three years, including renewals. None of these plans are considered comprehensive coverage under the ACA.

Non-ACA-compliant options that aren’t considered insurance

There are a variety of “coverage options” that aren’t actually insurance, although consumers aren’t always aware of that. These include, for example, direct primary care memberships, Farm Bureau plans available in certain states, and health care sharing ministry plans.

The specific benefits vary from one plan to another. But since these types of coverage are not considered insurance, consumers who have problems with them cannot turn to the state insurance department for assistance.

Free and low-cost health care

Depending on your financial situation, you may qualify for free or low-cost care at a federally qualified health center.¹⁵ (Here’s a tool that can help you find one near you.)

Almost all hospital emergency departments are required to assess and stabilize patients regardless of their ability to pay.¹⁶ But the hospital can still bill you for the care you receive in the emergency department.¹⁷

How to get help finding coverage

There are people online, on the phone, and in your community who can help you with the process of getting health coverage. You don’t have to pay anything for their assistance, as premiums are the same whether you have assistance or take a DIY approach. Here’s an overview of the help that’s available to you:

• Agents and brokers can help with on-exchange or off-exchange plans. They receive a commission from the insurance carrier if they enroll you in a plan, but it doesn't affect the price you pay.
• Navigators and Certified Application Counselors (CACs) can help with on-exchange plans as well as Medicaid
• The Marketplace call center can answer questions and help with enrollment. If you’re in a state that uses HealthCare.gov, the number is 1-800-318-2596. If you’re in a state that runs its own exchange (20 states plus DC), there will be a state-run call center.
• The “find local help” tool on HealthCare.gov will let you see agents, brokers, Navigators, and CACs in your area. State-run Marketplaces have similar tools.
• An Enhanced Direct Enrollment (EDE) entity can walk you through the enrollment process for an on-exchange or off-exchange plan. See a current list of approved EDE entities.
• Dial 211. If you aren’t sure where to turn, calling 211 will get you to a local or regional call center that can connect you to helpful health coverage resources.¹⁸

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written hundreds of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.