Health Insurance Premium Calculator

ACA marketplace pricing is a formula wearing a shopping site: the government computes a benchmark (second-cheapest silver) premium for your age and area, caps your share at a percentage of income, and pays the difference as a subsidy. Since the enhanced credits expired after 2025, the original curve — and its notorious 400% subsidy cliff — is back. This calculator runs the current math so you know your real monthly cost before browsing plans.

How the Subsidy Actually Works

The cliff's return changes planning: a household at 401% FPL pays the entire benchmark (often $15–25k/yr for a 60-something couple) while 399% pays ~9.6% of income. One dollar of MAGI can cost $10,000+ — making 401(k)/HSA/IRA contributions near the line among the highest-ROI moves in the tax code (see the HSA tool).

The Metal Tiers, Decoded

• Bronze (~60% actuarial): lowest premium, $7,000+ deductibles — pairs with HSAs; right for the healthy-and-liquid.
• Silver (~70%): the benchmark — and the mandatory choice below 250% FPL, where cost-sharing reductions secretly upgrade silver to 73–94% actuarial value. A CSR-silver at 200% FPL outperforms gold at a fraction of the price; buying bronze at that income forfeits free coverage quality.
• Gold (~80%): lower deductibles for the care-heavy; often oddly priced due to "silver loading" — in many states gold costs barely more than silver for subsidized buyers. Compare.
• Catastrophic: under-30s only, no subsidies usable — rarely optimal.

The Rules Around the Edges

• Open enrollment: Nov 1 – Jan 15 in most states; outside it you need a qualifying event (job loss, move, birth, marriage). Losing employer coverage is the classic one — you get 60 days.
• Employer coverage blocks subsidies if it's "affordable" (~9% of income for employee-only) — the family-glitch fix now measures family coverage cost for dependents.
• Subsidies reconcile at tax time: underestimate income and you repay; overestimate and you're refunded. Report changes mid-year.
• Early retirees and freelancers are the power users: MAGI management (Roth vs Traditional withdrawals, harvesting the 0% gains bracket carefully) effectively sets their premium — see the FIRE tool's healthcare section.

How to Use the Calculator

1. Enter household MAGI, size, and the oldest adult's age.
2. Read your silver cost, the subsidy, and the tier table.
3. Near 400% FPL? The note quantifies the cliff — and the contribution strategy that ducks it. Then browse actual plans at healthcare.gov with your real number in hand.

Frequently Asked Questions

How accurate is this vs healthcare.gov?

The subsidy formula is the real one; the benchmark premium is a national estimate (local benchmarks vary ±30% — rural areas and older markets run higher). Your percentage-of-income cap is exact, which is what matters below 400% FPL: subsidized buyers' costs barely depend on local prices.

What income counts (MAGI)?

AGI plus tax-exempt interest, untaxed Social Security and foreign income — for the whole tax household. Pre-tax 401(k)/HSA/IRA contributions REDUCE it (the planning lever); Roth withdrawals don't count at all (the early-retiree lever).

What happened to the enhanced subsidies?

The ARPA/IRA enhancements (no cliff, richer percentages) expired after 2025. The original curve returned: higher expected contributions and the 400% cliff. Congress may revisit; this tool tracks current law.

I'm just over 400% FPL — what do I do?

Every pre-tax dollar helps: max the 401(k), HSA, traditional IRA; time capital gains; for the self-employed, the health-premium deduction itself reduces MAGI (a circular calculation your tax software solves). Getting under the line can be worth $5–15k/yr.

Why is silver 'mandatory' under 250% FPL?

Cost-sharing reductions — the deductible/copay upgrades worth thousands — attach ONLY to silver plans. At 150% FPL, CSR-silver has a ~$300 deductible and 94% actuarial value: platinum quality at subsidized-silver price. No other tier gets it.

What about short-term or sharing-ministry plans?

Cheaper premiums, but they underwrite health, exclude pre-existing conditions, cap benefits and aren't insurance in any enforceable sense (ministries). For anyone subsidy-eligible, ACA plans dominate; for cliff-stranded healthy households they're a gamble worth understanding fully before taking.

Is my information private?

Yes — every figure computes locally in your browser.

Know your FPL percentage and the rest follows: silver below 250%, MAGI management near 400%, and actual plan-shopping only after this math. The marketplace rewards people who arrive knowing their number.