Quarterly Updates

HSA Contribution Limits

The IRS adjusts HSA contribution limits annually for inflation. For the 2026 plan year, the limits increased from prior year levels. Self-only coverage and family coverage have separate limits. Check the current IRS Publication 969 for exact figures, as these are verified annually.

The minimum deductible thresholds that define a qualifying High-Deductible Health Plan also adjusted slightly. A plan must meet both the minimum deductible and maximum out-of-pocket requirements to qualify for HSA pairing.

Subsidy Eligibility

Federal poverty level guidelines, which determine subsidy eligibility and amount, are updated each year. The 2026 figures reflect adjustments for inflation. People with incomes between 100% and 400% of the federal poverty level have been eligible for premium tax credits in recent years, and expanded eligibility provisions have also applied in recent plan years. Verify current thresholds at HealthCare.gov before enrolling.

Out-of-Pocket Maximums

The ACA sets a maximum limit on what you can be required to pay out of pocket for covered services in a plan year. This cap adjusts annually. For 2026, the limits increased modestly from 2024 levels. Plans cannot exceed this cap, though many plans set lower limits than the federal maximum.

Enrollment Window

The annual Open Enrollment Period for marketplace coverage typically runs from November 1 through January 15 in most states, with coverage starting January 1 for enrollments completed by December 15. Some state-based marketplaces have different windows. Check your state's marketplace for exact dates.

Special Enrollment Periods

Qualifying life events that trigger a Special Enrollment Period include losing other health coverage, changes in household size through marriage or birth, moving to a new coverage area, and certain income changes. The SEP window is typically 60 days from the qualifying event. Documentation requirements vary by event type.

Medicaid and CHIP

Medicaid and the Children's Health Insurance Program have year-round enrollment, not limited to the Open Enrollment Period. If your income falls below the Medicaid threshold in your state, you may qualify regardless of when you apply. Medicaid expansion status varies by state.

The Deduction Interaction

Self-employed individuals can generally deduct health insurance premiums paid for themselves and their families from their federal income taxes. This deduction reduces adjusted gross income, which in turn affects subsidy calculations since subsidies are income-based. The interaction between the deduction and the subsidy is circular and requires careful calculation, often with tax software or a tax professional.

The deduction is not available for months when you were eligible for employer-sponsored coverage through a spouse's employer. IRS Publication 535 covers this in detail.

Income Estimation for the Self-Employed

When applying for marketplace coverage, you report your projected annual income. Self-employed income is often variable. Reporting too low can result in having to repay subsidy amounts at tax time. Reporting too high means you may receive a smaller advance credit than you're entitled to, which you can claim when filing. Updating your income estimate during the year if it changes significantly is possible through your marketplace account.

What CSRs Are

Cost-sharing reductions are a separate form of financial assistance from premium tax credits. While premium tax credits reduce your monthly payment, CSRs reduce the amount you pay when you actually use healthcare, specifically the deductible, copays, and coinsurance. CSRs are only available on Silver tier plans.

To receive CSRs, your income must fall within a specific range relative to the federal poverty level. If you qualify for CSRs, a Silver plan may offer significantly lower cost-sharing than its standard actuarial value would suggest, sometimes functioning more like a Gold or Platinum plan in terms of what you actually pay for care.