Availability, Eligibility, and Program Comparisons (2025-2026)
The concept of $0 per month health insurance plans—coverage with no monthly premium—has become a focal point in U.S. health policy, especially as federal and state programs expand access and affordability. However, the reality behind these plans is nuanced: while millions now qualify for $0 premium options through Medicaid, the Affordable Care Act (ACA) Marketplace, and select state or private initiatives, eligibility criteria, out-of-pocket costs, and program sustainability vary widely. This report provides a comprehensive, up-to-date analysis of $0 premium health insurance in the United States, examining federal, state, and private offerings, eligibility thresholds, demographic and geographic differences, and the impact of recent and upcoming policy changes. It also addresses common misconceptions, consumer protections, and practical guidance for comparing and enrolling in $0 premium plans.
The U.S. health insurance landscape has undergone significant transformation since the implementation of the ACA, with record-low uninsured rates and expanded access to subsidized or free coverage. As of 2025, approximately 44 million Americans are enrolled in ACA-related coverage expansions: 21.4 million through Marketplace plans, 21.3 million via Medicaid expansion, and 1.3 million in Basic Health Programs (BHPs)$^1$. The uninsured rate for working-age adults dropped from 20.4% in 2013 to 11% in 2023.
$0 premium plans are available through several mechanisms:
Despite these advances, out-of-pocket costs (deductibles, copays, coinsurance) and coverage limitations remain important considerations, and eligibility is subject to income, household size, citizenship status, and state policy choices$^2$.
Medicaid is a joint federal-state program providing health coverage to over 72 million Americans. It is designed to offer $0 premium coverage to those who meet income and categorical eligibility criteria. Federal law sets minimum standards, but states have significant flexibility.
The ACA’s Medicaid expansion allows states to cover nearly all adults with incomes up to 138% of the FPL ($21,597 for an individual in 2025)$^3$. As of late 2025, 41 states (including DC) have adopted expansion, while 10 states have not (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming)$^4$.
Eligibility is determined by income as a percentage of the FPL. For example, in 2025, Medicaid Expansion covers adults up to 138% FPL, while Pregnant Women and Children often have higher thresholds, up to 200-300% FPL or more.
| State | Regular Medicaid (Single, Aged/Disabled) | Medicaid Expansion (Adults 19-64) | Pregnant Women/Children (FPL %) |
|---|---|---|---|
| California | $1,801/month | Up to 138% FPL | Up to 322% FPL (pregnancy) |
| Texas | $994/month | Not adopted | Up to 198% FPL (pregnancy) |
| New York | $1,800/month | Up to 138% FPL | Up to 324% FPL (pregnancy) |
| Florida | $1,149/month | Not adopted | Up to 196% FPL (pregnancy) |
| Kentucky | $235/month | Up to 138% FPL | Up to 215% FPL (pregnancy) |
| Illinois | $1,304/month | Up to 138% FPL | Up to 213% FPL (pregnancy) |
| Source: Medicaid Planning Assistance, KFF, state Medicaid agencies | |||
In non-expansion states, eligibility is much narrower, leading to a persistent "coverage gap" for adults with incomes too high for Medicaid but too low for Marketplace subsidies$^4$.
Medicaid and the Children’s Health Insurance Program (CHIP) provide $0 premium coverage. As of 2025, nearly all states have extended postpartum Medicaid coverage to 12 months$^6$.
$0 premium plans are possible when the Premium Tax Credit (PTC) fully offsets the plan’s monthly premium. This is most common for individuals and families with incomes between 100% and 150% FPL$^7$.
The Inflation Reduction Act (IRA), extended through 2025, temporarily increased the generosity of premium tax credits:
As a result, 39% of HealthCare.gov consumers selected a $0 premium plan in 2025$^1$.
| Income (% FPL) | Max % of Income for Benchmark Plan | Typical Net Premium (Single Adult) | $0 Premium Plan Availability |
|---|---|---|---|
| 100-150% | 0% | $0 | Yes (Silver, Bronze) |
| 150-200% | 0-2% | $0-$20 | Often |
| 200-250% | 2-4% | $20-$50 | Sometimes |
| 250-400% | 4-8.5% | $50-$200 | Rare |
| >400% | 8.5% cap (if eligible) | Varies | Rare |
| Source: Healthcare.gov, KFF, CBPP, CMS | |||
Cost-Sharing Reductions (CSRs) are available to enrollees with incomes up to 250% FPL who select a Silver plan. CSRs significantly lower deductibles, copays, and out-of-pocket maximums. For example, a 94% Actuarial Value (AV) Silver plan for those $\le$150% FPL may have a $0 deductible and a $2,200 out-of-pocket maximum.
| Household Size | 48 States & DC | Alaska | Hawaii |
|---|---|---|---|
| 1 | $15,650 | $19,550 | $17,990 |
| 2 | $21,150 | $26,430 | $24,320 |
| 3 | $26,650 | $33,310 | $30,650 |
| 4 | $32,150 | $40,190 | $36,980 |
| Source: HHS, My Benefit Advisor, Factually | |||
| Program/Plan Type | Income Threshold (Single) | Income Threshold (Family of 4) | Notes |
|---|---|---|---|
| Medicaid Expansion | ≤138% FPL ($21,597) | $44,946 | Expansion states only |
| Marketplace $0 Silver Plan | 100-150% FPL ($15,650-$23,475) | $32,150-$48,225 | Enhanced subsidies required |
| CHIP (Children) | Up to 300% FPL ($46,950) | $96,450 | Varies by state |
| BHP (NY, MN, OR) | ≤200% FPL ($31,300) | $66,300 | NY’s Essential Plan up to 250% FPL |
| Source: HHS, CMS, state agencies | |||
State policy choices create substantial disparities:
| State | Medicaid Expansion | Marketplace $0 Plans | BHP/State Program | Notable Features |
|---|---|---|---|---|
| California | Yes | Yes (25% enrollees) | No | Enhanced CSRs, state subsidies, DACA coverage |
| Texas | No | Yes (many, via ACA) | No | High uninsured, coverage gap |
| New York | Yes | Yes (via BHP) | Yes (Essential Plan) | BHP up to 250% FPL (ending July 2026) |
| Florida | No | Yes (via ACA) | No | High Marketplace enrollment, coverage gap |
| Massachusetts | Yes | Yes (ConnectorCare) | No | State subsidies, low uninsured rate |
| Source: CMS, KFF, state agencies | ||||
All ACA-compliant $0 premium plans must include the 10 Essential Health Benefits (e.g., preventive care, hospitalization, prescription drugs).
$0 premium does not mean $0 total cost.
Enrollees may still face deductibles (often $1,000–$8,000), copays, and coinsurance. The out-of-pocket maximum for Marketplace plans in 2025 is $9,200 (individual), though it is much lower for those eligible for CSRs$^10, ^22$.
| Plan Type | Deductible | OOP Max (Individual) | Notes |
|---|---|---|---|
| Silver (94% AV) | $0–$500 | $2,200–$3,000 | For ≤150% FPL, with CSR |
| Bronze (60% AV) | $3,000–$8,000 | $9,200 | $0 premium possible, but high OOP |
| Medicaid | $0 | $0 | No cost-sharing for most services |
| Source: Healthcare.gov, HealthReformBeyondTheBasics, CMS, Penuw.com | |||
Enhanced premium tax credits under the Inflation Reduction Act (IRA) are set to expire at the end of 2025 unless Congress acts.
If not extended, average premiums for subsidized enrollees could increase by 75–114% in 2026, with millions losing $0 premium eligibility and up to 8 million becoming uninsured by 2034$^8, ^25$. The "subsidy cliff" would return, sharply increasing costs for many low- and middle-income enrollees.
States like New York are already facing changes, with federal funding cuts forcing a reduction in $0 premium eligibility for the Essential Plan in 2026$^16$. California and Massachusetts may continue state subsidies, but budget constraints are a concern.
Consumers should compare plans carefully using resources like the Healthcare.gov Plan Finder$^27$ or the KFF Subsidy Calculator.
Key comparison factors include:
Local assistance is available from Certified Navigators and Brokers or State Medicaid Agencies.
$0 per month health insurance plans are more widely available in the United States than ever before. However, eligibility is complex, and the plans do not eliminate out-of-pocket costs. The major challenge is the pending expiration of enhanced federal subsidies after 2025, which threatens to sharply reduce $0 premium options and increase uninsured rates. Consumers must be vigilant, compare total costs, and utilize available local assistance.
| Program/Plan Type | Income Threshold (Single) | $0 Premium? | Out-of-Pocket Costs |
|---|---|---|---|
| Medicaid Expansion | ≤138% FPL | Yes | Minimal/None |
| ACA Marketplace (Silver) | 100-150% FPL | Yes | Reduced with CSR |
| ACA Marketplace (Bronze) | Up to 400%+ FPL | Sometimes | High |
| BHP (NY, MN, OR) | ≤200% FPL (NY: 250% FPL) | Yes | Low |
| Medicare Advantage | N/A | Yes* | Varies |
| Source: Medicaid.gov, Healthcare.gov, state agencies, MedicareFAQ. *Must still pay Part B premium. | |||