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Under Age 65 Health Insurance Quotes – See If You Qualify & Search Plans
Open Enrollment for 2026 Marketplace health insurance starts November 1, 2025, and runs thru January 15, 2026.
Enroll by December 15th for a January 1 start date or January 15th for a February 1 start date.
There are SEPs (Special Enrollment Periods) for persons with a Qualifying Life Event.
Examples of SEP events are losing your insurance coverage, moving out of the area, getting married, and having a baby.
Other SEPs may include natural disasters and the inability to enroll due to incapacitation.
Here is a link to the Heathcare.gov website for a list of SEPs: https://www.healthcare.gov/sep-list/
The income you list for the upcoming year is only an estimate. Most people do not know their future income. (Read below.)
If your income is below the FPL (Federal Poverty Level) you may be referred to your state’s Medicaid Program.
Here is a link to the Heathcare.gov website for the FPL: https://www.healthcare.gov/glossary/federal-poverty-level-fpl/
For 2026 – 100% of the FPL income levels start at $15,650 for an individual & $21,150 for a couple.
If you do not qualify for a SEP, you can use the Quote Tool to estimate premiums by selecting any Qualifying Life Event.
Online results, no email required.
To best understand your options, pricing, and who qualifies, please read the brief overview below.
According to CMS.gov –
“Four out of five enrollees will be able to find a plan for $10 or less/month after premium tax credits, and over 50% will be able to find a Silver plan for $10 or less.”
Who Qualifies For Premium Tax Credits?
Who Qualifies For PTC?
Premium Tax Credits vary with income level. People under age 65 with incomes below 400% of the Federal Poverty Level may qualify for a PTC. For 2026, 400% of the FPL is $62,600 for an individual, $84,600 for 2, etc. (higher in Alaska & Hawaii). Higher incomes can apply, but they are not eligible for Premium Tax Credits. (High-income earners, see below.)
Low-wage earners should contact their State’s Medicaid Office.
- Income below 138% FPL: If your state has expanded Medicaid, you may qualify for Medicaid.
- Income below 100% FPL: You probably won’t qualify for savings on a Marketplace health plan, but you may qualify for Medicaid.
These states have not expanded Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.
What Determines PTC & Cost?
A formula is used which includes your upcoming year’s income estimate and the number of people you include on your tax return (spouse & dependents). You must file an IRS tax return to qualify for a Premium Tax Credit, and your account will be reconciled annually when your actual income is determined.
Generally, people over the age of 65 are no longer eligible for a Premium Tax Credit if they are eligible for Medicare.
When you file your taxes for the year, you will use form 8962 and the government will send you form 1095-A to reconcile your Premium Tax Credit from estimate to actual earnings. If you under-estimated your income you may have to pay more. In prior years, there was a repayment range; for 2026, the amount owed for underestimating will be a dollar-for-dollar difference.
How to reconcile your premium tax credit.
Truly free quoting tool. – No Contact Information Required.
Quotes may need zip code, age, and gender to form a quote, but not your name or email, unless you elect to enroll in a plan.
After getting an insurance quote, if you want to self-enroll,
you can still contact me with your questions.
Using The Marketplace Quote Tool
PTCs are based on several things including income and your household size. You estimate your upcoming year’s income, add your household size, and the quote tool will estimate your Premium Tax Credit (PTC) saving.
Then scroll down to see insurance plans, plan information, and the estimated plan cost after your PTC is applied.
How To Estimate Your Income
For your income “estimate”, you use your MAGI – Modified Adjusted Gross Income. You can modify your income estimate in your account if your income changes during the year.
See your accountant and the government website page: https://www.healthcare.gov/income-and-household-information/income/
MAGI doesn’t appear as a line on your tax return.
To figure out your MAGI:
- Start with your adjusted gross income (AGI). This is the figure on IRS Form 1040, line 11 of your federal income tax return.
- Take your adjusted gross income amount and add any untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. Don’t add any Supplemental Security Income (SSI) you got.
It is not required that all members of a household apply, children may be on a CHIP program or adults on Medicare, but you still must specify the number of people in your taxable household, such as the tax filer, a spouse, and dependents, and use the total adjusted income amount of that household.
Which Insurance Plan To Select
It is often best to select a “Silver” insurance plan for the best savings and benefits, but it varies. (See government page: https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs/ )
High-income earners, please see the information below on how the Marketplace applies to you and other options.
High Income Earners – Over 400% Of The Federal Poverty Level
400% of Federal Poverty Level (FPL) for 2026 (different in Alaska and Hawaii) is:
$62,600 for an individual, $84,600 for 2 people, $106,600 for 3 people,
$128,600 for 4 people, $150,600 for 5 people, $172,600 for 6 people,
$194,600 for 7 people, $216,600 for 8 people, $238,600 for 9 people
$260,600 for 10 people, and $5,500 for each additional person.
(See government page: https://www.healthcare.gov/lower-costs/ )
While high-income earners may not qualify for Premium Tax Credits (PTC),
they can still apply for health insurance on the Marketplace. Run a quote to see what your cost would be.
If a household uses Premium Tax Credits to reduce their cost, but their actual income exceeds the government’s 400% limit, Premium Tax Credits may be lost, and all PTCs used may have to be repaid to the government.
High-income earners can use the Marketplace without any PTCs, or they may get an Off-Marketplace health insurance plan. Currently, the quote tool does not calculate Off-Marketplace plans.
High incomes earners may want to consider non-insurance options such as hospital indemnity plans and
health-sharing groups. These options do not qualify as health insurance, but since 2019, the federal tax penalty for not having health insurance is set to zero, making these options possible alternatives at this time.
Alternative – Health Sharing – Not Insurance — Simple & Easy Sharing Options.
OneShare – Health Sharing
Under the Tax Cuts and Jobs Act, which was enacted on December 22, 2017, the individual shared responsibility payment was reduced to $0, effective for months after December 31, 2018. Therefore, starting with the 2019 tax year, taxpayers will not have to pay the individual shared responsibility payment if they do not have minimum essential coverage or qualify for an exemption.
Located in west Fort Worth, TX
(817) 874-7569 -- -- Call or Text
Marilyn Kaye Walker
mk@marilyn-kaye.com
Visit Resource Pages
Several pages of sharing.
These pages include some tips & helpful links.
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