ACA Subsidy Eligibility by State

21 states plus DC run a full State-based Exchange with their own enrollment website. 2 more (Arkansas and Oregon) administer their own marketplace program but still enroll consumers through HealthCare.gov. The remaining 28 states use the federally-facilitated marketplace at HealthCare.gov end to end.

10 states have not adopted full ACA Medicaid expansion as of 2026 (per KFF's Status of State Medicaid Expansion Decisions tracker). Residents there can fall into a "coverage gap" below 100% of the Federal Poverty Level — too poor for a marketplace subsidy, but above the state's own (often very restrictive) existing Medicaid income limit.

Yes. The enhanced premium tax credit from the Inflation Reduction Act expired December 31, 2025 and was not extended in OBBBA. The 2026 plan year reverts to the pre-2021 schedule, including the hard 400% FPL cliff, per IRS Rev. Proc. 2025-25.