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Health Insurance Cost Calculator

Estimate marketplace premiums with subsidies, value employer coverage, or compare your options side by side

Estimate what you would pay for health insurance on the Affordable Care Act (ACA) marketplace, including any premium tax credit subsidy you may qualify for.

Your Modified Adjusted Gross Income (MAGI): start with your gross income (wages, self-employment, investments), then subtract student loan interest and IRA contributions. For most people, MAGI is the same as adjusted gross income on line 11 of your tax return.

Include yourself, spouse, and tax dependents

Premiums are age-rated under the Affordable Care Act (ACA)

Premiums vary significantly by state

Bronze has lower premiums but higher out-of-pocket costs. Silver is the benchmark tier and qualifies for extra cost-sharing reductions at lower incomes. Gold has higher premiums but lower costs when you use care.

⚠️ This calculator provides estimates for educational purposes only. It is not financial, tax, or legal advice. Your actual results may vary.

How This Calculator Works

This calculator estimates health insurance costs using three approaches:

Marketplace Estimate

Uses the Affordable Care Act (ACA) premium tax credit formula: your subsidy equals the Second Lowest Cost Silver Plan (SLCSP) premium minus your expected contribution. Your expected contribution is your household income multiplied by an "applicable percentage" from the IRS table, which ranges from 2.10% to 9.96% based on your income as a percentage of the Federal Poverty Level (FPL).

For 2026, subsidies are available for incomes between 100% and 400% of FPL. Above 400% FPL ($63,840 for a single person), the subsidy drops to zero. This is often called the "subsidy cliff."

Employer Value

Calculates the total compensation value of employer-provided health insurance, including the employer's premium contribution and the tax advantage of pre-tax payroll deductions (you avoid both income tax and FICA on your premium payments).

Coverage Comparison

Combines both calculations to show a side-by-side cost comparison, helping you decide between marketplace coverage and employer-sponsored insurance.

Key Considerations

  • Premiums shown are state-level averages. Your actual cost depends on your county, the specific plans available, and the insurers in your area.
  • The ACA age curve uses a 3:1 ratio. New York and Vermont use community rating (same price regardless of age).
  • If your income falls below 100% FPL in a state that has not expanded Medicaid, you may fall into the "coverage gap" where neither Medicaid nor marketplace subsidies are available.
  • Cost-Sharing Reductions (CSRs) are available only with Silver plans for incomes between 100% and 250% FPL. These reduce your deductible and copays without increasing your premium.
  • Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage continues your employer plan at 102% of the full premium (employer share plus employee share plus a 2% administrative fee) for up to 18 months.
  • Five states (California, Massachusetts, New Jersey, Rhode Island) plus the District of Columbia impose penalties for being uninsured.

Data Sources

Frequently Asked Questions

Do I have to pay a penalty for being uninsured?
State-level penalties vary. California charges the greater of 2.5% of income above the filing threshold or a flat amount ($900 per adult, $450 per child, maximum $2,700). Massachusetts uses a monthly penalty schedule tied to income and the cost of the lowest available plan. New Jersey and Rhode Island follow a structure similar to the old federal penalty (greater of 2.5% of income or a flat per-person amount). The District of Columbia charges the greater of 2.5% of income above the filing threshold or $695 per adult ($347.50 per child). Vermont has a mandate requiring coverage but imposes no financial penalty. If you live in one of these states and choose to go without coverage, the penalty is collected through your state tax return.
How does the calculator estimate my health insurance savings as an employee?
Employer-sponsored health plans cost approximately $9,325 per year total for single coverage. Employers pay about 79% ($7,400) and you pay about 21% ($1,925). If you currently pay $5,400 per year on the marketplace, your savings as an employee would be $5,400 minus $1,925 = $3,475 per year. This savings is built into the Benefits Value shown in your results. Note that actual employer plans vary in cost and contribution percentage, so your real savings may be higher or lower than this estimate.
How is my health insurance subsidy calculated?
The Affordable Care Act (ACA) subsidy formula works in three steps. First, your household income is measured as a percentage of the Federal Poverty Level (FPL). For 2026, a single person at 100% FPL earns $15,960. Second, the IRS Applicable Percentage Table determines what share of income you are expected to pay toward insurance, ranging from 2.1% (under 133% FPL) to 9.96% (300-400% FPL). Third, the subsidy equals the benchmark plan cost minus your expected contribution. You can apply the credit to any metal tier plan, not just Silver. If you choose a cheaper Bronze plan, the same dollar subsidy applies and your net premium drops further.
How much does COBRA cost compared to marketplace coverage?
COBRA lets you keep your employer's group health plan for up to 18 months after leaving a job, but at 102% of the total premium. For example, if your employer was paying $667/month and you paid $167/month, COBRA costs ($667 + $167) times 1.02 = $850/month. Meanwhile, a marketplace plan with subsidies could cost $128 to $500/month depending on your income and location. The key factor is income: if your income drops after a job loss, you may qualify for a substantial subsidy on the marketplace. Losing employer coverage is a qualifying life event that allows you to enroll in a marketplace plan outside of open enrollment. You have 60 days to elect COBRA, so you can compare options before deciding.
How much does health insurance cost as an independent contractor?
The calculator estimates your marketplace health insurance cost using the Affordable Care Act (ACA) subsidy formula based on your projected contractor income. Bronze plans with Health Savings Account (HSA) eligibility are a common strategy for healthy contractors who want lower premiums and tax-advantaged savings. Health insurance is often the single largest new expense when leaving employment, because employer plans typically cover 79% of the premium cost that you must now pay in full.
How much is my employer's health insurance worth?
Employer health insurance value has three components. First, the premium contribution: your employer pays 79% of single coverage (averaging $7,400/year) or 75% of family coverage (averaging $20,143/year). Second, the tax advantage: your payroll deduction is pre-tax, saving you roughly 30% (federal income tax plus FICA) compared to buying the same plan with after-tax dollars on the marketplace. Third, group pricing: employer plans negotiate rates based on the entire workforce, often getting better coverage per dollar than individual market plans. When evaluating a job offer or considering self-employment, add the employer's health insurance contribution to the salary for an accurate total compensation comparison.
Should I use my employer's plan or buy marketplace coverage?
The IRS "affordability" test for 2026 says employer coverage is considered affordable if your required contribution for self-only coverage does not exceed 9.96% of your household income. If your employer plan fails this test, you can buy marketplace coverage with subsidies instead. Even when the employer plan is technically affordable, compare total costs: employer plan premium plus deductible plus typical copays versus marketplace plan premium (after subsidy) plus deductible plus copays. Also consider that employer premiums are pre-tax while marketplace premiums are after-tax (unless you are self-employed). One important rule: if your employer offers affordable coverage, you generally cannot receive marketplace subsidies, even if the marketplace plan would cost less.
What happens if my income goes above 400% of the Federal Poverty Level?
The subsidy cliff creates an extreme marginal cost at the 400% Federal Poverty Level (FPL) threshold. A single person earning $63,840 might receive $3,000 or more in annual subsidies, while someone earning $63,841 receives nothing. This effective marginal tax rate can exceed 17% on the additional dollar of income. Strategies to manage the cliff include maximizing traditional 401(k) or IRA contributions (which reduce Modified Adjusted Gross Income), timing capital gains realizations, and using Health Savings Account (HSA) contributions if enrolled in a qualifying plan. The enhanced credits (2021-2025) eliminated this cliff by extending subsidies above 400% FPL, but they expired after 2025.
What is the Second Lowest Cost Silver Plan (SLCSP)?
The SLCSP varies by geographic area (county and rating area) and age. For 2026, the national average SLCSP for a 40-year-old is approximately $625 per month, but state averages range from $401 in New Hampshire to $1,299 in Vermont. The second-lowest cost plan (rather than the cheapest) is used because it provides a stable benchmark: if one insurer offers an unusually cheap plan or exits the market, it does not dramatically shift everyone's subsidies. You are not required to enroll in the SLCSP. If you choose a Bronze plan that costs less than the SLCSP, the full subsidy still applies, potentially reducing your premium to near zero.
What is the difference between Bronze, Silver, Gold, and Platinum plans?
The actuarial value (percentage the plan pays) determines the tier. Bronze plans have the lowest premiums but the highest deductibles (typically $7,000 to $9,000 in 2026). Silver plans are the benchmark tier for subsidy calculations and the only tier that offers Cost-Sharing Reductions (lower deductibles and copays) for incomes between 100% and 250% of the Federal Poverty Level. Gold plans have higher premiums but deductibles of $1,000 to $2,500, making them better for people who use care regularly. Platinum plans are rare on the marketplace and have the highest premiums with the lowest out-of-pocket costs. A Catastrophic plan (below 60% actuarial value) is available only to people under 30 or those with a hardship exemption. For 2026, the average marketplace deductible across all tiers is $3,786, up 37% from 2025.

Related Resources

Explore HealthCare.gov marketplace plan options and enrollment

The federal health insurance marketplace for comparing plans, estimating subsidies, and enrolling in coverage if you do not have employer-sponsored insurance.

Read IRS questions and answers on the Premium Tax Credit

Official IRS guidance on how the premium tax credit works, including eligibility, calculation, and how to claim it on your tax return.

Review the KFF 2025 Employer Health Benefits Survey

Annual survey of employer-sponsored health coverage costs. Reports average premiums ($9,325 single, $26,993 family), employer contributions, deductibles, and trends by plan type and firm size.

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Income Tax Calculator

Estimate your federal and state income tax to understand how health insurance subsidies interact with your tax situation.