To qualify for financial help through Pennie insurance for 2026, your household’s annual income generally needs to fall between 100% and 400% of the federal poverty level. For a single person, that’s roughly $15,650 to $62,600. For a family of four, it runs from about $32,150 to $128,600. Below the floor, most Pennsylvania adults are routed to Medical Assistance (Medicaid) instead. Above the ceiling, no premium tax credits are available at all. These are the Pennie insurance income guidelines that took effect after the enhanced federal subsidies expired on December 31, 2025.1Pennie. Affordability
2026 Income Limits by Household Size
Pennie measures your income against the federal poverty level (FPL) for your household size. The figures below apply to Pennsylvania residents for coverage year 2026.2Health Reform Beyond the Basics. Yearly Guidelines CY2026
- 1 person: 100% FPL = $15,650 | 150% = $23,475 | 200% = $31,300 | 250% = $39,125 | 400% = $62,600
- 2 people: 100% FPL = $21,150 | 150% = $31,725 | 200% = $42,300 | 250% = $52,875 | 400% = $84,600
- 3 people: 100% FPL = $26,650 | 150% = $39,975 | 200% = $53,300 | 250% = $66,625 | 400% = $106,600
- 4 people: 100% FPL = $32,150 | 150% = $48,225 | 200% = $64,300 | 250% = $80,375 | 400% = $128,600
- 5 people: 100% FPL = $37,650 | 150% = $56,475 | 200% = $75,300 | 250% = $94,125 | 400% = $150,600
- 6 people: 100% FPL = $43,150 | 150% = $64,725 | 200% = $86,300 | 250% = $107,875 | 400% = $172,600
- 7 people: 100% FPL = $48,650 | 150% = $72,975 | 200% = $97,300 | 250% = $121,625 | 400% = $194,600
- 8 people: 100% FPL = $54,150 | 150% = $81,225 | 200% = $108,300 | 250% = $135,375 | 400% = $216,600
For households larger than eight, add roughly $5,500 per additional person at each percentage.
Why the markers at 150%, 200%, and 250%? Those are the income points where the amount of help you get changes. Premium tax credits phase down gradually across the full 100% to 400% range. Cost Sharing Reductions, a second type of help, only apply up to 250% FPL and only if you pick a silver plan.
How Pennie Measures Your Income
Pennie uses Modified Adjusted Gross Income (MAGI). Start with the Adjusted Gross Income from line 11 of your most recent Form 1040, then add back three items if they apply to you: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest.3HealthCare.gov. Modified Adjusted Gross Income (MAGI) For most people, MAGI is the same as AGI or very close to it.
The number Pennie wants is what you expect to earn during the coverage year, not what you earned last year. The application walks you through adjusting your prior AGI for any changes you anticipate. Have your last four weeks of pay stubs and your most recent tax return ready when you apply.4Pennie. How to Enroll
What Counts
Pennie’s income count is broad. It includes wages and tips (gross, before employer deductions for health insurance, childcare, or retirement if your pay stub doesn’t already show federal taxable wages), net self-employment income from Schedule C, Social Security benefits including SSDI (both the taxable and non-taxable portions), most IRA and 401(k) withdrawals other than qualified Roth distributions, investment and capital gains income, net rental or royalty income, tax-exempt interest, unemployment compensation, farming and fishing income, excluded foreign income, and alimony from divorces finalized before January 1, 2019.5Pennie Help Center. What to Include as Income
Several common sources don’t count: child support, gifts, Supplemental Security Income (SSI), veterans’ disability payments, workers’ compensation, loan proceeds, stimulus payments, Child Tax Credit payments, and alimony from agreements finalized on or after January 1, 2019.5Pennie Help Center. What to Include as Income
Who Counts in Your Household
Your household for Pennie purposes is the tax filer, a spouse if you’re legally married, and anyone you claim as a tax dependent, whether or not those dependents need health coverage themselves. Children under 21 who live with you count even if you won’t claim them. Roommates, unmarried partners without a shared child, and unborn children don’t count. And everyone in the household must have their income reported, even someone already covered by a job, Medicaid, or Medicare.6HealthCare.gov. Household Size
A filing-status rule to know: married couples who file separately are generally not eligible for premium tax credits. The exception is for victims of domestic abuse or spousal abandonment, who may apply as “unmarried” and still qualify.6HealthCare.gov. Household Size
How Much You’re Expected to Pay
With the enhanced subsidies gone, the formula has reverted to the pre-2021 schedule. The amount you’re expected to contribute toward your benchmark silver plan is a percentage of household income that rises as income rises:2Health Reform Beyond the Basics. Yearly Guidelines CY2026
- Below 133% FPL: 2.10% of income
- 133% FPL: 3.14%
- 150% FPL: 4.19%
- 200% FPL: 6.60%
- 250% FPL: 8.44%
- 300%–400% FPL: 9.96%
- Above 400% FPL: no premium tax credit
The tax credit covers the gap between your expected contribution and the actual cost of the second-lowest-cost silver plan in your area. So a single person at 150% FPL (about $23,475) pays roughly 4.19% of income toward the benchmark plan, and the credit covers the rest. You can apply that same credit to a bronze, gold, or platinum plan if you prefer, but your out-of-pocket premium shifts accordingly.
Cost Sharing Reductions for Silver Plans
If your household income is between 100% and 250% of the federal poverty level and you pick a silver plan, Pennie also applies Cost Sharing Reductions. These lower your deductibles, copays, and coinsurance by upgrading the silver plan to cover more of your medical costs:7Health Reform Beyond the Basics. Cost-Sharing Charges in Marketplace Health Insurance Plans
- Up to 150% FPL: silver covers 94% of costs (standard silver covers 70%)
- 151%–200% FPL: silver covers 87%
- 201%–250% FPL: silver covers 73%
CSRs only apply to silver-level plans.8Pennie Help Center. Cost Sharing Reduction (CSR) A single person earning up to $39,125, or a family of four earning up to $80,375, qualifies for some level of CSR if they choose silver.
If Your Income Is Below 100% FPL
Pennsylvania expanded Medicaid under the Affordable Care Act, so most adults under 65 with household income up to 138% of the federal poverty level qualify for Medical Assistance rather than a Pennie plan. For 2026, those limits are approximately $22,025 for one person, $29,864 for two, $37,702 for three, and $45,540 for four.9Pennsylvania Department of Human Services. Medicaid
Children up to age 18 may qualify for Medicaid or CHIP in households with income up to 314% FPL.10Pennie Help Center. Medicaid and CHIP Coverage That threshold is higher than the subsidy range for adults, so a family can end up with children on CHIP while the parents hold a subsidized Pennie plan.
If you’re found ineligible for Medicaid at renewal, you’re referred automatically to Pennie, and you get a 120-day special enrollment period to pick a plan. Selecting coverage within 60 days of your Medicaid end date can produce retroactive seamless coverage.11Healthinsurance.org. Pennsylvania Medicaid
One boundary worth noting: before 2026, lawfully present immigrants with income below 100% FPL who were in the Medicaid five-year waiting period could still receive marketplace tax credits. Starting January 1, 2026, that path was eliminated. They can still enroll in a Pennie plan but must pay the full unsubsidized premium.12Health Reform Beyond the Basics. New Immigration-Related Restrictions for Medicaid, CHIP, Medicare, and Marketplace
If Your Income Is Above 400% FPL
The hard cutoff is back. Anyone earning above 400% of the federal poverty level receives no premium tax credits in 2026, regardless of what the plan costs or how high the premium is as a share of income. For an individual, that cliff falls at about $62,600. For a couple, roughly $84,600.13Pennie. What’s New A dollar of extra income that pushes you across the line can mean losing thousands in annual assistance. If you’re near the ceiling, pay attention to anything that could change your MAGI, including capital gains realizations and retirement account distributions.
Why Accurate Income Reporting Matters More in 2026
Because the application is based on what you expect to earn, Pennie compares your estimate against data it can verify electronically. A mismatch generates a Data Matching Issue and a 90-day Reasonable Opportunity Period to submit documentation.14Pennie Help Center. What Is the Reasonable Opportunity Period Acceptable proof for wage income includes pay stubs covering the four weeks before the notice date, prior-year tax returns, W-2s, or 1099s.15Pennie Help Center. What Documents Should You Submit to Resolve a Data Matching Issue Miss the window and Pennie can strip your financial assistance or end the policy.
Self-employed enrollees should report net income from Schedule C, use their best estimate when income is unpredictable, report net losses, and update the application whenever income shifts.16Pennie Help Center. Reporting Self-Employment Income to Pennie A significant mid-year change in income is itself a qualifying life event, allowing you to adjust coverage outside open enrollment.17Pennie Help Center. Qualifying Life Event (QLE)
At tax time, anyone who received Advance Premium Tax Credits reconciles them on Form 8962, comparing what was paid to the insurer during the year against what the final income actually qualified for. Earn less than estimated and you may get a larger refund. Earn more and you owe the excess back. And starting with the 2026 tax year, the repayment caps that previously limited how much lower-income enrollees had to return no longer apply. You repay the full excess, regardless of income.18IRS. Questions and Answers on the Premium Tax Credit Skipping Form 8962 entirely blocks future advance credit payments, leaving you responsible for the full monthly premium going forward.19HealthCare.gov. Reconciling Your Premium Tax Credit
In 2026 that math is less forgiving than it was. Underestimate your income and you’ll owe real money. Update Pennie as soon as something changes.