Health Insurance Before Medicare
What Marketplace coverage costs between retiring and 65, after the premium tax credit. The credit falls as income rises and stops entirely above 400% of the poverty line, so this is also what an early Roth conversion or a realized gain really costs. 2026 rules.
- Methods explained
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Who needs covering
Everyone on the return, including a spouse already on Medicare and any dependent. This is what the poverty line is measured against, and it does not change when someone leaves the plan.
The premiums you were quoted
The benchmark is the second-lowest-cost silver plan for that person in your rating area, before any credit; healthcare.gov lists it as the plan the credit is figured on. The other figure is the plan you would actually buy, which can cost less.
The income the credit is figured on
Premiums to pay yourself
$68,786
Over 5 years of coverage, after the credit
Credit over the bridge
$46,997
Of $86,837 in benchmark premiums
Room before the cliff
$4,600
The credit stops above $84,600 of income
What the conversion costs in credit
9.96%
$996 of credit on $10,000, on top of the tax
The first year
Year by year
| Your age | Of poverty line | Your share | Benchmark | Credit | You pay |
|---|---|---|---|---|---|
| 60 | 378.3% | 9.96% | $23,400 | $15,432 | $15,768 |
| 61 | 378.3% | 9.96% | $24,804 | $16,836 | $16,236 |
| 62 | 378.3% | 9.96% | $12,135 | $4,167 | $12,013 |
| 63 | 378.3% | 9.96% | $12,863 | $4,895 | $12,256 |
| 64 | 378.3% | 9.96% | $13,635 | $5,667 | $12,513 |
Coverage ends after 64, the last year before Medicare. A spouse who reaches 65 first leaves the plan then, which is why the benchmark can fall part way through.
How it works›
The credit. The credit is the benchmark premium less the share of income § 36B expects the household to pay itself, and it never exceeds the plan it is spent on. The share comes from the 2026 applicable percentage table in Rev. Proc. 2025-25: flat at 2.10% below 133% of the poverty line, rising on a straight line through the bands above it, and 9.96% from 300% to 400%.
The cliff is back. The enhanced credits of 2021 through 2025 had no upper income limit and capped the household's share at 8.5%. They expired on 2026-01-01, so for 2026 the table ends at 400% of the poverty line: a dollar over it and the whole credit goes, which is the drop this page prices. A later law could restore them, and this page would be wrong until its figures were replaced.
Which poverty line. A plan year uses the guidelines in effect when its open enrollment opened, so 2026 coverage is measured against the 2025 guidelines (26 CFR 1.36B-1(h)). Household size is the tax return's, not the plan's: a spouse on Medicare still raises the poverty line the credit is figured against.
What it leaves out. Cost-sharing reductions under 250% of the poverty line, the age curve that sets each person's premium, the repayment caps that apply when the income estimated at enrollment turns out low, employer coverage that makes the household ineligible, the special rule for lawfully present immigrants under 100%, and state subsidies. Income is entered as modified AGI, so tax-exempt interest and untaxed Social Security are yours to add.
Reference sources. These sources support the component rules. Model choices and exclusions are described in the notes above.IRS: 2026 credit percentages