ACA Marketplace Insurance Cost Estimator
Use this calculator to estimate your potential health insurance premiums and subsidies on the Affordable Care Act (ACA) Marketplace.
Understanding the ACA Marketplace and Subsidies
The Affordable Care Act (ACA) Marketplace (also known as the exchange) is a platform where individuals and families can shop for health insurance plans. It's designed to make health coverage more accessible and affordable, especially for those who don't get insurance through an employer or government programs like Medicare or Medicaid.
Who is Eligible for Subsidies?
Many people qualify for financial assistance, known as subsidies, to help lower their monthly premiums and out-of-pocket costs. These subsidies come in two main forms:
- Premium Tax Credits (PTC): These credits reduce your monthly premium payments. Eligibility and the amount of your credit depend primarily on your household income relative to the Federal Poverty Level (FPL) and your household size. For 2021-2025, the "subsidy cliff" has been removed, meaning more people at higher incomes may qualify if benchmark plan costs exceed a certain percentage of their income.
- Cost-Sharing Reductions (CSRs): These subsidies lower your out-of-pocket costs like deductibles, co-payments, and co-insurance. CSRs are only available if you enroll in a Silver-level plan and your income is below 250% of the FPL.
How Subsidies Are Calculated (Simplified)
The core of subsidy calculation involves comparing your household income to the Federal Poverty Level (FPL) for your household size. The government sets a maximum percentage of your income that you're expected to pay for a benchmark plan (the second-lowest cost Silver plan available in your area). If the actual cost of that benchmark plan is higher than your expected contribution, the difference is covered by a Premium Tax Credit.
Your actual premium will then depend on the plan you choose. If you pick a plan cheaper than the benchmark, your premium will be even lower. If you pick a more expensive plan, you'll pay the difference.
Federal Poverty Level (FPL)
The FPL is a set of income thresholds used to determine eligibility for various federal programs, including ACA subsidies. It varies based on household size. For example, in 2024, the FPL for a single person is $14,580, and for a family of four, it's $30,000 (these numbers are for the contiguous U.S. and may vary slightly in Alaska and Hawaii).
Metal Levels Explained
Marketplace plans are categorized into "metal levels" based on how costs are shared between you and the insurance company:
- Bronze: Lowest monthly premiums, but highest out-of-pocket costs (deductibles, co-pays). Covers about 60% of costs on average. Good for those who don't expect to use much medical care.
- Silver: Moderate premiums and moderate out-of-pocket costs. Covers about 70% of costs on average. This is the only level eligible for Cost-Sharing Reductions. The second-lowest cost Silver plan is used as the "benchmark" for calculating Premium Tax Credits.
- Gold: Higher monthly premiums, but lower out-of-pocket costs. Covers about 80% of costs on average. Good for those who expect to use a fair amount of medical care.
- Platinum: Highest monthly premiums, but lowest out-of-pocket costs. Covers about 90% of costs on average. Best for those who expect significant medical expenses.
Important Disclaimer
This calculator provides an estimate only. Actual premiums and subsidy amounts depend on many factors, including your specific zip code, the plans available in your area, the exact FPL guidelines for the current year, and specific rules for your state. Always verify your eligibility and costs on Healthcare.gov or your state's marketplace.