Estimate your ACA marketplace health insurance premium and check subsidy eligibility. Compare Bronze, Silver, Gold, and Platinum plan costs side by side.
Health insurance through the ACA marketplace is priced primarily based on age, tobacco use, plan tier, and family size — not health status or pre-existing conditions. Premium tax credits (subsidies) are available to individuals and families with incomes between 100% and 400% of the Federal Poverty Level, significantly reducing the monthly premium you actually pay. Choosing the right plan tier involves balancing your monthly premium against your expected healthcare use: a Bronze plan works well if you rarely see a doctor, while a Gold or Platinum plan makes financial sense if you have regular medical needs, prescriptions, or planned procedures. Always check whether your preferred doctors and hospitals are in-network before enrolling in any health insurance plan.
ACA marketplace health insurance plans are categorized by how costs are split between you and the insurer. Bronze: you pay roughly 40% of covered costs; lowest premiums, highest deductibles (~$7,500). Silver: you pay about 30% of costs; moderate premiums and deductibles. Gold: you pay about 20% of costs; higher premiums, lower deductibles (~$1,500). Platinum: you pay about 10% of costs; highest premiums, lowest deductibles (~$250). Silver plans are the only tier eligible for Cost-Sharing Reductions (CSRs) if your income qualifies.
A health insurance deductible is the amount you pay for covered medical services before your insurance begins to pay. For example, with a $4,500 deductible, you pay the first $4,500 in covered costs each plan year. After meeting your deductible, you typically pay a copay or coinsurance for services until you reach your out-of-pocket maximum, at which point your insurance covers 100% of covered costs. Preventive care services are generally covered with no deductible.
You may be eligible for premium tax credits (subsidies) if your income is between 100% and 400% of the Federal Poverty Level (FPL) — though legislation has temporarily extended subsidies above 400% FPL through recent years. For 2026, 100% FPL is approximately $15,060 for an individual and $31,200 for a family of four. To claim the subsidy, you must enroll through your state's marketplace or healthcare.gov during Open Enrollment (November 1 – January 15) or a qualifying Special Enrollment Period.
HMO (Health Maintenance Organization) requires you to choose a primary care physician (PCP) who coordinates your care. You typically need referrals to see specialists, and out-of-network care is not covered except in emergencies. HMOs generally have lower premiums. PPO (Preferred Provider Organization) allows you to see any doctor without a referral, in or out of network (though in-network care costs less). PPOs offer more flexibility but have higher premiums. Other plan types include EPO (like HMO but no referrals needed) and HDHP/HSA-compatible plans with high deductibles and health savings account benefits.
The annual Open Enrollment Period for ACA marketplace plans typically runs from November 1 through January 15, with coverage starting February 1. Outside of Open Enrollment, you can enroll during a Special Enrollment Period (SEP) triggered by qualifying life events: losing job-based coverage, getting married, having a baby, moving to a new area, or other major life changes. Medicaid and CHIP enrollment is available year-round for those who qualify based on income.
This calculator provides estimates for educational purposes only. Actual health insurance premiums and subsidy eligibility vary based on your specific situation, insurer, state marketplace, income, and policy factors. Consult a licensed insurance agent or broker for accurate quotes and coverage recommendations.