Am I eligible for Medicaid instead of marketplace subsidies?

If your income is below 138% of the Federal Poverty Level and you live in a state that has expanded Medicaid (40 states plus D.C. as of 2026), you likely qualify for Medicaid instead of marketplace subsidies. In the 10 states that have not expanded Medicaid, adults with income below 100% FPL may fall into the 'coverage gap' where they earn too much for traditional Medicaid but too little for marketplace subsidies. Check your state's eligibility rules at healthcare.gov or see our state-by-state Medicaid eligibility guide.

What is the benchmark Silver plan (SLCSP)?

The Second Lowest Cost Silver Plan (SLCSP) is the benchmark plan used to calculate your premium tax credit. It's the second-cheapest Silver-tier plan available in your area. Your subsidy is calculated as the difference between the SLCSP premium and your expected contribution (based on income). You can use your subsidy toward any marketplace plan — Bronze, Silver, Gold, or Platinum — but the subsidy amount is always based on the SLCSP.

What are Cost-Sharing Reductions (CSRs)?

Cost-Sharing Reductions lower your out-of-pocket costs (deductibles, copays, coinsurance) when you enroll in a Silver plan. CSRs are available to households with income between 100% and 250% of FPL. Below 150% FPL, you get a Silver plan that covers 94% of costs (vs. the standard 70%). Between 150-200% FPL, the plan covers 87% of costs. Between 200-250% FPL, it covers 73%. CSRs are only available on Silver plans — another reason Silver plans are often the best value.

2026 Enrollment — ARPA Expires

NM Medicaid Income Limits 2026 & ACA Subsidy Calculator.

Navigate the complexities of ACA subsidies, Medicaid eligibility, and Federal Poverty Levels with a precision-engineered calculator. Designed for clarity, transparency, and 2026 accuracy.

Start Full Assessment → Medicaid by State

Precision Analysis in Seconds

Three critical data points to unlock your savings potential.

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Household Definition

Accurately identify tax dependents and primary earners to establish your base eligibility tier.

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MAGI Benchmarking

We calculate your Modified Adjusted Gross Income against 2026 Federal Poverty Level standards.

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Regional Compliance

State-specific rules and Medicaid expansion status are automatically applied based on location.

🔒 All calculations run in your browser. No data is collected, stored, or sent to any server.

1 Your Location

State

2 Household Information

Annual Household Income ($)

Household Size

3 Who Needs Coverage?

Enter the age of each person who needs marketplace coverage. Children under 21 are rated the same. Household members with other coverage (employer, Medicare, etc.) should not be listed.

Any tobacco users? (may affect premium)

Your 2026 Subsidy Estimate

Subsidy Cliff Warning: Your income is close to the 400% FPL cutoff. A small increase in income could eliminate your entire subsidy. Consider contributing to a traditional IRA or HSA to reduce your modified adjusted gross income (MAGI).

Income as % of FPL

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Monthly Premium After Subsidy
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Benchmark Silver plan

Annual Contribution

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Monthly Premium Breakdown

Full Premium Subsidy Covers You Pay

Compare with 2025 (ARPA enhanced subsidies)

2025 (ARPA)

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Monthly premium you'd pay

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2026 (Post-ARPA)

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Monthly premium you'll pay

Your monthly cost increases by --

Guides & Analysis

Beyond the Calculator

The math behind the numbers, the rules behind the math, and the changes that just kicked in for 2026.

All guides

2026 Key Income Thresholds

Household Size	138% FPL (Medicaid)	400% FPL (Cliff)
1 Individual	$21,597	$62,600
2 People	$29,187	$84,600
3 People	$36,777	$106,600
4 People	$44,367	$128,600

Note: Thresholds are based on 2026 FPL guidelines for the 48 contiguous states + D.C. Alaska and Hawaii use adjusted FPL. Medicaid eligibility also depends on whether your state has expanded Medicaid under the ACA.

Navigating Medicaid Expansion?

States set their own eligibility criteria. Some expand coverage to 138% of the FPL; others limit Medicaid to parents, pregnant women, and the disabled.

Explore state-by-state guide →

How the ACA Subsidy Calculator Works

The Affordable Care Act (ACA) provides premium tax credits to help eligible individuals and families afford health insurance purchased through the Health Insurance Marketplace. This calculator estimates your 2026 subsidy using the official ACA formula that returns after the American Rescue Plan Act (ARPA) enhanced subsidies expire at the end of 2025.

The Subsidy Formula

Your premium tax credit is calculated as:

Subsidy = Benchmark Premium − Expected Contribution

Where your Expected Contribution equals your household income multiplied by an applicable percentage that increases with income. The benchmark premium is the cost of the second-lowest-cost Silver plan (SLCSP) in your area, adjusted for the ages of the people in your household.

What Changed in 2026

Under the ARPA (2021-2025), nobody paid more than 8.5% of income for the benchmark plan, and people below 150% FPL paid nothing. In 2026, required contributions increase significantly: families at 150% FPL now pay up to 4% of income, and the 400% FPL subsidy cliff returns — meaning if your income exceeds 400% of the Federal Poverty Level, you get zero subsidy regardless of how expensive premiums are.

Key Income Thresholds for 2026

Below 138% FPL (Medicaid expansion states): Likely eligible for Medicaid, not marketplace subsidies
100% - 150% FPL: Smallest required contributions; eligible for the best Cost-Sharing Reductions (94% AV Silver plan)
150% - 250% FPL: Moderate contributions with some Cost-Sharing Reductions
250% - 400% FPL: Higher contributions but still subsidy-eligible
Above 400% FPL: No subsidy available (the "subsidy cliff")

Frequently Asked Questions

What is the ACA subsidy cliff?

The ACA subsidy cliff is the income threshold at 400% of the Federal Poverty Level where marketplace subsidies completely cut off. In 2026, if your household income exceeds 400% FPL (e.g., $62,600 for a family of 4), you receive zero premium tax credit — even if you're just $1 over the limit. This cliff was temporarily eliminated by the American Rescue Plan Act (2021-2025), which capped contributions at 8.5% of income for all income levels. With the return of the cliff in 2026, families near the threshold should carefully manage their Modified Adjusted Gross Income (MAGI) through strategies like traditional IRA or HSA contributions.

What happened to the enhanced subsidies?

The American Rescue Plan Act (ARPA) of 2021 significantly boosted ACA subsidies by lowering the percentage of income people had to pay toward premiums and eliminating the 400% FPL subsidy cliff. Under ARPA, people below 150% FPL paid $0, and nobody paid more than 8.5% of income. These enhanced subsidies were extended through 2025 by the Inflation Reduction Act. However, Congress did not extend them further, so in 2026 the original ACA subsidy formula returns. For a family of 4 earning $80,000, this could mean thousands of dollars more in annual premiums compared to what they paid in 2025. Read our 2026 ACA subsidy cliff explained for a full breakdown of what changed and who is affected.

Am I eligible for Medicaid instead?

If your income is below 138% of the Federal Poverty Level and you live in one of the 40 states (plus D.C.) that have expanded Medicaid, you likely qualify for Medicaid instead of marketplace subsidies. Medicaid provides free or very low-cost coverage. In the 10 states that have not expanded Medicaid (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming), adults with income below 100% FPL may fall into the "coverage gap" — they earn too much for traditional Medicaid but too little for marketplace subsidies. Wisconsin is a special case: it covers adults up to 100% FPL without formal expansion.

What is the benchmark Silver plan?

The Second Lowest Cost Silver Plan (SLCSP) is the plan used to calculate your premium tax credit. It's the second-cheapest Silver-tier plan available in your rating area. Your subsidy equals the SLCSP premium minus your expected contribution based on income. You can apply your subsidy to any marketplace Metal tier — Bronze, Silver, Gold, or Platinum. Choosing a Bronze plan (with lower premiums) might result in a $0 monthly cost after the subsidy. Choosing a Gold or Platinum plan means you'd pay the difference between that plan's premium and your subsidy amount.

How accurate is this calculator?

This calculator uses the official 2026 Federal Poverty Level guidelines, the standard ACA applicable percentage table, federal age curve rating factors, and state-average benchmark premiums. Because premiums vary by county and rating area, the benchmark premiums used here are statewide averages and may differ from your exact location. For the most accurate subsidy amount and to see actual plan options, visit healthcare.gov during Open Enrollment and enter your specific ZIP code and household information.

What are Cost-Sharing Reductions?

Cost-Sharing Reductions (CSRs) lower your out-of-pocket costs — deductibles, copays, and coinsurance — when you enroll in a Silver plan through the marketplace. CSRs are available to households with income between 100% and 250% of FPL. Below 150% FPL, you get a Silver plan that covers about 94% of your healthcare costs (vs. the standard 70%). Between 150-200% FPL, the plan covers about 87%. Between 200-250% FPL, about 73%. CSRs are only available on Silver plans, which is why Silver is often the best value for lower-income households even if a Bronze plan has a lower premium.

Medicaid Eligibility by State

Select your state for detailed income limits, eligibility requirements, and how to apply. State Medicaid expansion status directly affects your options.

Expansion States

40 + D.C.

Non-Expansion States

10 States

⚠ Wisconsin covers adults up to 100% FPL through BadgerCare Plus without formal expansion.