Marketplace subsidies include premium tax credits that cut monthly premiums and cost-sharing reductions that lower out-of-pocket costs. Eligibility turns on income, household size, and whether affordable job-based coverage is available.
On-exchange plans are bought through the marketplace (HealthCare.gov or a state exchange) and are the only way to get premium tax credits. Off-exchange plans are bought directly from an insurer or broker; they follow the same ACA rules but are not eligible for subsidies.
Lower-income beneficiaries can get major help. Extra Help (the Part D Low-Income Subsidy) cuts prescription costs, and Medicare Savings Programs help pay Part B premiums and other costs. In 2026, Extra Help covers full premiums (up to the benchmark) and caps drug copays at $5.10 generic and $12.65 brand.