Health Insurance Cost Estimator

How is the full premium calculated?

This tool starts from a benchmark silver premium of $450 a month and multiplies it by an age factor, then by a tier factor. The tier factors are bronze ×0.72, silver ×1.00, gold ×1.18 and platinum ×1.32. At age 35 the age factor is 1.00, so silver is $450 and platinum is $594; the table further down lists the other age bands.

How does the subsidy estimate work?

Income is compared with the poverty figure built into the tool ($14,580 for one person plus $5,140 for each additional person). The result sets a share of income the household is expected to pay toward the benchmark plan: 0% up to 150% of that figure, 2% up to 200%, 4% up to 250%, 6% up to 300% and 8.5% above. The subsidy is the benchmark premium minus that monthly share, floored at zero and capped at the selected plan’s full premium.

Does it use a sliding scale?

No. Each band uses a single flat percentage, so moving from just under 250% to just over it changes the assumed share from 4% to 6% all at once. The tool also applies 8.5% to every income above 300%, including incomes above 400% of the figure. Whether any credit exists for a given year and income is decided by marketplace rules, not by this tool.

Is tobacco use included?

Yes, as a flat surcharge of 50% of the selected plan’s full premium. In this model the surcharge is added after the subsidy is determined, so it is not reduced by the credit. For a 28-year-old on bronze at 137% of the figure, the surcharge is $133 and the net premium equals it exactly.

What does it show when income is under 100% of the poverty figure, or zero?

No subsidy is calculated, so the net premium equals the full premium. At $12,000 for one person the tool shows 82% of the figure, a $450 premium and a $0 subsidy. It makes no statement on other programs you might qualify for, which the marketplace or your state would assess.

Which costs are not included?

Deductibles, copayments, coinsurance, out-of-pocket maximums, cost-sharing reductions, dental and employer contributions are all outside the model. The tier selector only changes the monthly premium multiplier. The estimate also does not vary by state, county, insurer or number of covered people; household size affects only the income percentage.

Does it estimate premiums for the whole household?

No. The age you enter is one person’s, and the premium shown is for that single person. Household size is used only to compute the income percentage, so other members’ premiums are not added.

Can I rely on it for enrollment decisions?

No. It is an estimate from fixed factors and 2024 figures. Actual premiums, credits and eligibility come from the marketplace, the insurer and tax rules for the year in question, and a licensed agent, navigator or healthcare.gov quote governs.