ACA Marketplace Plan Cost Calculator
2026 update: the ACA enhanced premium tax credits (ARPA/IRA) expired at the end of 2025. For 2026 the pre-enhancement rules are back — most importantly, households with income above 400% of the Federal Poverty Level (FPL) no longer qualify for a Premium Tax Credit, and applicable percentages are higher than during the enhanced years. Confirm your current-year eligibility and figures at HealthCare.gov. This is a plan-cost COMPARATOR: enter the NET monthly premium you already see on HealthCare.gov (after whatever subsidy applies to you) for two plans you're considering, plus each plan's deductible, coinsurance, out-of-pocket maximum, and routine co-pays, and the calculator computes each plan's total annual cost (premium + expected out-of-pocket) at three usage levels — low, typical, and high annual claims. We do NOT compute your Premium Tax Credit or reproduce the IRC §36B applicable-percentage table (that table changed for 2026; get your subsidy at HealthCare.gov). The subsidy is an OPTIONAL informational input only. This calculator does NOT recommend a plan or carrier — it produces the side-by-side math so you can compare with your licensed broker. Cited to 45 CFR §156.130 (annual limitation on cost sharing), HHS/CMS marketplace rules, and HealthCare.gov glossary definitions. NOT insurance advice — for plan selection consult a credentialed health insurance specialist (CHC, RHU, or licensed broker).
| Scenario | Plan A total | Plan B total | Cheaper |
|---|---|---|---|
| Low usage | $4,700 | $7,400 | Plan A |
| Typical usage | $9,300 | $8,600 | Plan B |
| High usage | $11,400 | $10,900 | Plan B |
Blue = Plan A. Orange = Plan B. Lower bar wins at that usage level. The crossover below tells you the claims level where the winner flips.
Below this much medical usage one plan is cheaper; above it, the other is.
View the TypeScript implementation on GitHub: packages/calc/src/marketplace-health-plan.ts · view tests
What this means
Most people pick a health plan on premium alone, because premium is the one number the marketplace puts in big type. But the premium is only half of what a plan costs you. The other half is what you pay when you actually use care — the deductible, then coinsurance, then nothing once you hit the out-of-pocket maximum. A plan with a $250/month lower premium that has a $4,500-higher deductible is not cheaper; it’s a bet that you won’t need much care this year.
This calculator settles that bet with arithmetic. It computes each plan’s total annual cost — premium plus expected out-of-pocket — at a low, typical, and high usage level, and it finds the exact claims level where the cheaper plan flips. Below the crossover, the low-premium plan wins; above it, the low-deductible plan wins. Knowing that number turns “which plan is cheaper?” into “how much care do I expect this year?”, which is a question you can actually answer.
Two things this calculator deliberately will not do. It will not compute your subsidy: the Premium Tax Credit rules changed for the 2026 plan year, and a stale subsidy table would hand you a wrong number on a YMYL decision — so you get your net premium from HealthCare.gov and enter it here. And it will not pick a plan for you. When I’ve compared plans for my own household, the arithmetic narrowed the field to two, but the final call came down to whether my doctors were in-network and my prescriptions were on the formulary — neither of which is in these numbers. That part belongs to a licensed broker, who can verify both before you enroll and costs you nothing because the carrier pays the commission.
Worked example
Plan A is a bronze-style plan: $200/month net premium ($2,400/year), $6,000 deductible, 30% coinsurance, $9,000 OOP max, $300 routine co-pays, HSA-eligible. Plan B is a gold-style plan: $450/month net premium ($5,400/year), $1,500 deductible, 20% coinsurance, $5,500 OOP max, $400 routine co-pays.
Low year ($2,000 claims):Plan A — under the deductible, so OOP is $2,000 + $300 = $2,300; total $2,400 + $2,300 = $4,700. Plan B — over its $1,500 deductible, OOP is $1,500 + 20% × $500 + $400 = $2,000; total $5,400 + $2,000 = $7,400. Plan A wins by $2,700.
Typical year ($8,000 claims): Plan A OOP is $6,000 + 30% × $2,000 + $300 = $6,900; total $9,300. Plan B OOP is $1,500 + 20% × $6,500 + $400 = $2,200; total $8,600. Plan B wins by $700.
High year ($30,000 claims): both plans hit their OOP max. Plan A total is $2,400 + $9,000 = $11,400; Plan B total is $5,400 + $5,500 = $10,900. Plan B wins by $500.
Break-even: the two plans cost the same at about $5,375of annual claims ($8,075 total each). Below ~$5,375 of medical usage, the low-premium Plan A is cheaper; above it, the low-deductible Plan B is. So the whole decision reduces to one honest question: in a normal year, do you expect more or less than about $5,375 of covered care? The arithmetic is settled; the plan choice — network, formulary, service — still belongs with your broker.
Frequently asked questions
The information and tools on this website are for general educational purposes only and do not constitute financial, investment, legal, or tax advice. Consult a licensed professional for decisions specific to your situation.