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The original Affordable Care Act (ACA) dramatically changed the health insurance landscape. Some of the highlights to this legislation are;
- All Qualified Health Plans have to offer the same Essential Health Benefits , so you know that from plan to plan, and carrier to carrier your benefits are similar.
- All plans are required to offer Preventive Services for free as long as you are using an in network provider.
- The ACA also set a cap on Out of Pocket Maximum . This is the most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.
- One other major change are Advanced Premium Tax Credits A tax credit you can take in advance to lower your monthly health insurance payment (or “premium”). These tax credits can dramatically reduce the cost of health insurance for individuals and families. Oregon uses Healthcare.gov to connect tax credits for families. This is the main function of healthcare.gov, they link up with federal databases (IRS, Social Security, Department of Homeland Security) to verify a families information and eligibility for tax credits.
- Our quoting tool above will help you understand how much credit you may be eligible for based on your families income.
This sounds like a lot of information, but we are here to help you understand all of these provisions, apply for subsidies (tax credits) and enroll in coverage. Our services are offered to you at no cost. We are paid by the insurance companies, so you pay the same to have us help you navigate all of this, or tackle it on your own.
2026 Health Insurance & Tax Credit Changes — FAQ
🧾 When do these changes take effect?
All of the new provisions apply to the 2026 plan year (coverage effective January 1, 2026).
Your 2026 premiums and tax credits will be based on your 2026 tax return, which you’ll file in 2027.
💸 How are tax credits changing?
The expanded Affordable Care Act (ACA) premium tax credits under the American Rescue Plan Act (ARPA) will expire.
Beginning in 2026, households earning more than 400% of the Federal Poverty Level (FPL) will no longer qualify for premium tax credits.
400% FPL Income Limits (approximate):
| Household Size | Income Limit |
|---|---|
| 1 Person | $62,600 |
| 2 People | $84,600 |
| 3 People | $106,600 |
| 4 People | $128,600 |
📈 What will happen to premiums?
Premiums are expected to increase significantly in 2026.
Example Estimates:
| ZIP Code | Ages | Income | 2025 Premium | 2026 Premium |
|---|---|---|---|---|
| 97058 | 62 & 64 | $100 k | $80 / mo | $2,226 / mo |
| 97031 | 58 & 55 | $85 k | $91 / mo | $1,811 / mo |
| 97041 | 50, 55, 20, 18 | $128 k | $333 / mo | $2,067 / mo |
Most people will see an increase of $50 – $200 per month or more depending on income and plan.
📊 How do I calculate my income for 2026?
Your subsidy is based on your Modified Adjusted Gross Income (MAGI).
MAGI = Line 11 of your Federal Tax Return +
-
Non-taxable Social Security
-
Foreign earned income
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Tax-exempt interest
Also counts as income:
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Dividends
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Capital gains
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Retirement account distributions
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Rental income (from Schedule E)
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Lottery winnings
🧮 What about Medicaid and the Oregon Bridge Program?
Starting 2026:
| Income Level | Program | Approx. Monthly Income Limit |
|---|---|---|
| Under 138% FPL | Medicaid (OHP) | $1,800 (single) |
| 138% – 200% FPL | Oregon Bridge Program | $2,608 (single) |
⚠️ If you qualify for OHP or the Bridge Program but stay on a Marketplace plan, you may be required to repay 2026 tax credits when filing in 2027.
🧍♀️ What should current Medicaid members do?
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Make sure your mailing address is current with OHA or Apple Health.
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Do not renew during Open Enrollment unless you receive a notice.
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Renewals will soon happen every 6 months instead of 12.
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Work, volunteer, or school participation requirements start January 1, 2027 (states may start sooner).
🩺 Are there alternative coverage options?
Health Sharing Ministries
Non-profit member groups that share medical costs.
➡️ Not regulated by the ACA; coverage not guaranteed.
Indemnity Plans
Pay a fixed cash amount for services instead of full medical coverage.
➡️ Usually lower cost but limited protection and not ACA-compliant.
Short-Term Plans
Temporary coverage for gaps between jobs or benefits.
➡️ Typically exclude pre-existing conditions and preventive care.
🕒 What should I do now?
If you’re considering canceling coverage or expect big changes in 2026:
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Complete preventive care before your plan ends.
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Request longer RX refills (up to 90 days).
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Update your Healthcare.gov application to reflect accurate 2026 income.
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Plan ahead for Open Enrollment: Nov 1 – Jan 15 each year.
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Keep resources handy for local low-cost clinics, hospital discounts, and prescription assistance.