KFF Health Insurance Marketplace Subsidy Calculator
Estimate your eligibility for premium tax credits to lower your health insurance costs.
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Estimated Eligibility for Premium Tax Credits:
Understanding Health Insurance Marketplace Subsidies
The Affordable Care Act (ACA) established Health Insurance Marketplaces (also known as exchanges) where individuals and families can shop for and enroll in health insurance plans. A key feature of the Marketplaces is the availability of financial assistance in the form of premium tax credits (PTCs) and cost-sharing reductions (CSRs).
Premium Tax Credits (PTCs): These credits are designed to make health insurance more affordable by reducing your monthly premium. The amount of PTC you receive is based on your household income and family size, relative to the Federal Poverty Level (FPL). Generally, if your household income falls between 100% and 400% of the FPL, you are eligible for PTCs.
How Eligibility is Determined:
Household Income: This is your Modified Adjusted Gross Income (MAGI). It's typically your gross income minus certain allowable deductions.
Household Size: The number of people you claim on your taxes.
Federal Poverty Level (FPL): This is a set of poverty thresholds established annually by the Department of Health and Human Services. The FPL varies by family size and is updated each year.
Cost of the Second-Lowest Cost Silver Plan (SLCSP): The Marketplace uses the premium of the second-lowest cost plan in the Silver metal tier available in your area (based on your income and family size) to determine your expected contribution towards your health insurance premium.
The Calculation Logic (Simplified):
The ACA sets a maximum percentage of your household income that you are expected to contribute towards your health insurance premium. This percentage increases gradually as your income rises.
Determine Income Bracket: Your annual household income is compared to the FPL for your household size to determine where you fall on the FPL scale (e.g., 150% FPL, 250% FPL, 380% FPL).
Calculate Expected Contribution: Based on your FPL percentage, a corresponding maximum percentage of your income is determined as your expected contribution to your health insurance premium. For example:
If income is 100-150% FPL, you might be expected to pay 2% of your income.
If income is 300-350% FPL, you might be expected to pay 8.5% of your income.
If income is above 400% FPL, you are generally not eligible for PTCs (though there are exceptions for states that expanded Medicaid and if the lowest-cost plan exceeds 8.5% of income).
Calculate Monthly Premium Contribution: Your expected annual contribution is calculated: (Your Annual Income) * (Expected Contribution Percentage). This is then divided by 12 to get your monthly expected contribution.
Find the SLCSP Premium: The Marketplace identifies the premium for the second-lowest cost Silver plan for your household.
Calculate the Premium Tax Credit: The PTC is the difference between the SLCSP premium and your calculated monthly expected contribution, up to the cost of the SLCSP.
Subsidy Amount = (SLCSP Monthly Premium) - (Your Monthly Expected Contribution)
If this value is negative (meaning your expected contribution is more than the SLCSP), you receive no subsidy. If the SLCSP itself is more than 8.5% of your income (for incomes above 400% FPL), you may still qualify for a subsidy in some cases.
Important Considerations:
This calculator provides an estimate. Actual subsidy amounts are determined by the official Health Insurance Marketplace based on verified income and enrollment in a qualifying plan.
This calculator uses simplified FPL percentages and does not account for all specific state variations or special circumstances (like the ACA's hold harmless provision for those above 400% FPL in states that have not expanded Medicaid).
Eligibility for subsidies can also depend on whether you are offered affordable coverage through an employer or a government program like Medicare or Medicaid.
Cost-sharing reductions (CSRs) further reduce deductibles, copayments, and coinsurance for eligible individuals (typically those with incomes below 250% FPL), but these are not calculated here.
Example Scenario:
Let's consider a household of 3 in Colorado with an annual income of $55,000. The Federal Poverty Level for a household of 3 in 2024 is approximately $24,860. Their income is about 221% of the FPL.
Income Bracket: 221% FPL falls within a range where the expected premium contribution is around 4.5% of income.
This household could save approximately $293.75 per month on their health insurance premiums, reducing their out-of-pocket cost for the Silver plan to about $206.25 per month.
function calculateSubsidy() {
var incomeInput = document.getElementById("householdIncome");
var sizeInput = document.getElementById("householdSize");
var stateSelect = document.getElementById("state");
var resultDiv = document.getElementById("result");
var resultValueDiv = document.getElementById("result-value");
var eligibilityDetailsDiv = document.getElementById("eligibility-details");
var errorMessageDiv = document.getElementById("error-message");
// Clear previous results and error messages
resultDiv.style.display = 'none';
resultValueDiv.textContent = ";
eligibilityDetailsDiv.textContent = ";
errorMessageDiv.textContent = ";
// Get values from inputs
var householdIncome = parseFloat(incomeInput.value);
var householdSize = parseInt(sizeInput.value);
var state = stateSelect.value;
// — Input Validation —
if (isNaN(householdIncome) || householdIncome <= 0) {
errorMessageDiv.textContent = "Please enter a valid annual household income.";
return;
}
if (isNaN(householdSize) || householdSize = 1.00 && fplPercentage <= 4.00) {
isEligibleForSubsidy = true;
for (var i = 0; i = incomeBrackets[i].minFPL && fplPercentage 4.00) {
// In states that expanded Medicaid, anyone below 138% FPL is eligible for Medicaid.
// For incomes above 400% FPL, eligibility for PTCs is limited.
// For simplicity, this calculator assumes no PTC eligibility above 400% FPL unless specific conditions apply (which are not modeled here).
isEligibleForSubsidy = false;
expectedContributionPct = 0.00; // Effectively paying full price for plans purchased on the marketplace
} else if (fplPercentage < 1.00) {
// Incomes below 100% FPL are generally eligible for Medicaid (or CHIP), not marketplace subsidies.
isEligibleForSubsidy = false; // Not eligible for marketplace PTCs
expectedContributionPct = 0.00; // Though their "contribution" could be considered 0 if they get Medicaid
}
// — Placeholder for SLCSP (Second Lowest Cost Silver Plan) Premium —
// THIS IS A CRITICAL SIMPLIFICATION. The actual SLCSP premium varies significantly by
// location (county/zip code), age, tobacco use, and specific plan offerings.
// For a real-world calculator, this would require a complex lookup or API integration.
// We will use a placeholder average premium for demonstration.
// Source: KFF analysis suggests average benchmark Silver plan premiums can range from $350-$600+ per month for a 40-year-old.
var estimatedSlcspPremium = 0;
if (isEligibleForSubsidy) {
// A very rough estimate based on income and household size – this is highly variable.
// Lower incomes might have lower SLCSP costs in some areas, higher incomes might see them rise.
if (fplPercentage < 1.5) estimatedSlcspPremium = 400;
else if (fplPercentage < 2.5) estimatedSlcspPremium = 450;
else if (fplPercentage < 3.5) estimatedSlcspPremium = 500;
else if (fplPercentage <= 4.0) estimatedSlcspPremium = 550;
else estimatedSlcspPremium = 600; // Fallback for higher end if logic were extended
// Further adjust slightly by household size (very simplified)
estimatedSlcspPremium = estimatedSlcspPremium * (householdSize / 2);
} else {
estimatedSlcspPremium = 500; // Default if not eligible for subsidy
}
var monthlyExpectedContribution = householdIncome / 12 * expectedContributionPct;
var monthlySubsidy = 0;
var finalMonthlyPremium = estimatedSlcspPremium;
var details = [];
if (isEligibleForSubsidy) {
monthlySubsidy = estimatedSlcspPremium – monthlyExpectedContribution;
if (monthlySubsidy < 0) {
monthlySubsidy = 0; // Cannot receive negative subsidy
}
finalMonthlyPremium = estimatedSlcspPremium – monthlySubsidy;
// Ensure final premium isn't negative (though unlikely with this logic)
if (finalMonthlyPremium < 0) {
finalMonthlyPremium = 0;
}
details.push("Household Income: $" + householdIncome.toLocaleString());
details.push("Household Size: " + householdSize);
details.push("Estimated Income as % of FPL: " + (fplPercentage * 100).toFixed(1) + "%");
details.push("Your Expected Monthly Premium Contribution: $" + monthlyExpectedContribution.toFixed(2));
details.push("Estimated Monthly Premium for Second Lowest Cost Silver Plan (SLCSP): $" + estimatedSlcspPremium.toFixed(2));
details.push("Estimated Monthly Premium Tax Credit (Subsidy): $" + monthlySubsidy.toFixed(2));
} else {
// Check if income is below 100% FPL or above 400% FPL
if (fplPercentage 4.00) {
details.push("Household income is above 400% FPL. Generally not eligible for premium tax credits on the Marketplace.");
} else {
// This case might occur if estimatedSlcspPremium calculation failed or for edge cases.
details.push("No premium tax credit calculated based on inputs. You may be responsible for the full premium.");
}
finalMonthlyPremium = estimatedSlcspPremium; // Full premium
}
resultValueDiv.textContent = "$" + finalMonthlyPremium.toFixed(2) + " / month";
eligibilityDetailsDiv.innerHTML = "Details:" + details.join("");
resultDiv.style.display = 'block';
}