ACA (Obamacare) Health Insurance Calculator

ACA (Obamacare) Plan Calculator

How the Calculator Works

Your total yearly health care costs include what you pay in health insurance premiums plus what you pay out of pocket to cover deductibles, co-pays, and co-insurance up to your plan's out-of-pocket max. The calculator uses your household information to determine your monthly premium amount across example plans from each of the four ACA plan tiers (bronze, silver, gold, and platinum) and to determine if you are eligible for Marketplace subsidies. Then, based on the expected medical care profile you choose, it calculates your total cost for each plan tier factoring in all costs and subsidies.

What Goes Into Your Total ACA Cost

Premiums

The calculator uses national average premiums factoring in your age, tobacco use, and state of residence. Your actual premiums can vary based on county, however, so visit healthcare.gov if you want to see your exact premium.

Subsidies: Premium Tax Credits and Cost Sharing Reductions

Subsidy eligibility is based on your income level and household members. If your income falls between 100% and 400% of the federal Poverty Level (FPL) for your household size, you qualify for a subsidy (assuming you don't have access to an employer provided health plan that fits ACA's 'affordability' definition). There are two types of subsidies: Premium Tax Credits (PTCs) and Cost Sharing Reductions (CSRs). PTCs reduce your monthly premium and apply equally across all four ACA plan tiers. The calculator displays your PTC on the 'Annual Subsidy' line and subtracts it from your monthly premium. CSRs reduce your deductible and out-of-pocket max limits but only apply if you select a Silver tier plan. The calculator displays these reduced values on the Silver plan tier card when you qualify.

Deductible

Deductibles are the amount you pay out of pocket for covered medical services prior to insurance kicking in. Some services, such as preventive care, are covered 100% without you paying anything towards your deductible. Deductibles reset every plan year. Bronze plans have the lowest deductibles with Silver, Gold, and Platinum plans having increasingly higher deductibles.

Co-Pays & Coinsurance

A co-pay is a fixed amount you pay out of pocket for a specific covered expense before insurance pays the rest. For example, you may have to pay your primary care doctor a $15 co-pay for a sick visit. Coinsurance is a percentage of the total amount you must pay out of pocket for a covered procedure. Typically this is only charged once you hit your deductible up and until you hit your out-of-pocket maximum. For example, if you have a $1,000 procedure and the coinsurance percentage for your plan is 20%, you will pay $200.

Expected Medical Care Needs

If you don't need medical care then your total cost for the year is simply the sum of your monthly premiums. If you need medical care, however, your total cost also includes what you pay for deductibles, co-pays, and coinsurance. The calculator allows you to choose from three medical care scenarios — limited, medium, and high — to see how your total cost changes based on your medical care needs.

How to Choose an ACA Plan

The general rule of thumb is:

• Bronze: Best if you are healthy and rarely see a doctor as Bronze has the lowest premiums.
• Silver: Best if you have an ongoing condition, have a recurring prescription, or expect to have specialist visits as the lower deductible and out-of-pocket maximum wlimits ill likely trump the higher premiums.
• Gold/Platinum: Best if you have a planned surgery, pregnancy, or other major treatment as these plans have significantly lower deductibles and out-of-pocket maximums.

What's best for you can change drastically, however, based on the specifics of your household (e.g. number of family members, subsidy eligibility, etc). Use our calculator above to see which plan tier has the lowest total cost based on your household and expected medical care needs. If your expected usage is Limited or Medium, rerun the calculator with the High profile to make sure you are comfortable with all scenarios. Although keep in mind that most providers will work with you on payment plans for emergency medical care so you don't necessarily need to have the full out of pocket amount already in your savings account in order to feel comfortable selecting a particular plan. This is where an HSA account comes in handy. The money you save in premiums during averages years can be put into an HSA account and used in years where you have higher medical needs. It takes some discipline, but its better to pay yourself than your insurance company.

Once you have an idea which plan tier will result in the lowest cost for you, check the following:

• Network and Drug Coverage: These change based on plan tier and plan provider so make sure you validate against the plans available in your area to ensure your doctor and prescriptions needs are met.
• Plan Type: Plan types — HMO, PPO, and EPO — affect how you access medical services (e.g. whether a referral is required).
• HSA Eligibility: Being able to put money into an HSA account to pay for medical expenses saves you on taxes which, depending on your income tax tier, can be significant. Look to see if the plan you are interested in qualifies you to make HSA contributions. In general, to qualify as HSA eligible in 2027, the plan must have a minimum deductible of $1,750 and a max out-of-pocket off $8,700 for an individual, $3,500 and $17,400 respectively for a family plan.