Estimate your premium and ACA subsidy eligibility
Estimates based on 2025 ACA marketplace averages. Actual premiums vary significantly by insurer, exact location, and plan. Visit HealthCare.gov for official quotes during open enrollment (Nov 1 – Jan 15).
The Affordable Care Act provides Premium Tax Credits (Advanced Premium Tax Credits, or APTC) to households with income between 100% and 400% of the Federal Poverty Level (FPL). Under the American Rescue Plan extension (through 2025), subsidies are also available above 400% FPL if premiums would exceed 8.5% of income.
Open Enrollment runs November 1 – January 15 each year. Special enrollment periods are available for qualifying life events (job loss, marriage, birth of child). Visit HealthCare.gov for official estimates and to enroll.
This is an estimate only and not a guarantee of actual subsidy amounts. Always verify through HealthCare.gov or a licensed insurance broker.
The ACA (also known as Obamacare) established health insurance marketplaces where individuals can buy coverage and receive Premium Tax Credits to reduce their monthly premiums. It also expanded Medicaid eligibility and required all plans to cover essential health benefits. If you buy insurance through the marketplace and your income is between 100% and 400% of the Federal Poverty Level (or above 400% if premiums exceed 8.5% of income), you may qualify for subsidies.
Your premium is the monthly amount you pay for coverage regardless of whether you use healthcare. Your deductible is the amount you pay out of pocket before insurance kicks in (e.g. the first £1,000 of medical bills). Your out-of-pocket maximum is the most you'll ever pay in a year — after reaching it, insurance covers 100% of covered services. Lower premiums usually mean higher deductibles and vice versa.
An HMO (Health Maintenance Organisation) requires you to use in-network doctors and get referrals to see specialists. It's typically the cheapest option. A PPO (Preferred Provider Organisation) lets you see any doctor without referrals, including out-of-network (at higher cost) — more flexible but more expensive. An EPO (Exclusive Provider Organisation) is like an HMO without referral requirements but with no out-of-network coverage.
Open Enrollment for ACA marketplace plans runs November 1 – January 15 each year. Outside this period, you can only enrol if you have a qualifying life event — losing employer coverage, getting married, having a baby, moving to a new state, or losing Medicaid eligibility. Employer-sponsored plans typically have their own open enrollment period once per year.
If your income is below 138% of the Federal Poverty Level, you may qualify for Medicaid (a free or very low-cost government programme) in states that expanded Medicaid under the ACA. If you're between 100–400% FPL, Premium Tax Credits can significantly reduce your marketplace premiums. Use this calculator to estimate your subsidy eligibility before shopping for plans.
ACA calculations based on Healthcare.gov FPL guidelines and IRS Premium Tax Credit guidance.
Figures are estimates for guidance only. See about this site — how we source data and what these tools can and cannot do.
The Affordable Care Act subsidy system works by capping how much of your income you spend on health insurance. The ACA sets a benchmark — the second-lowest-cost Silver plan in your area — and limits your required contribution to a percentage of your Modified Adjusted Gross Income (MAGI). The government pays the rest as a Premium Tax Credit.
The income thresholds are expressed as percentages of the Federal Poverty Level (FPL), which changes each year. For 2025, the FPL for a single adult is $15,060. A single person earning $30,120 (200% FPL) would have their required premium contribution capped at approximately 6–7% of income. The American Rescue Plan extension, in effect through 2025, means those above 400% FPL can also qualify if benchmark premiums exceed 8.5% of their income.
Subsidies are reconciled at tax time. If your income ends up higher than estimated, you may owe back some of the credit. If it ends up lower, you receive the difference as a tax refund. This is why it's important to report income changes to the marketplace during the year.
ACA plans are categorised by their actuarial value — the percentage of average covered healthcare costs the plan pays. Bronze covers 60%, Silver 70%, Gold 80%, Platinum 90%.
Bronze makes sense if you are young, healthy, and rarely use healthcare — you'll pay less in monthly premiums and can absorb occasional out-of-pocket costs. The risk is a high deductible (often $5,000–$7,000) if something major happens.
Silver is the only tier eligible for Cost-Sharing Reductions (CSRs), which reduce your deductible and out-of-pocket maximum if your income is below 250% FPL. For people who qualify, a Silver plan with CSR can offer better value than a Bronze plan with a lower premium.
Gold and Platinum suit people with chronic conditions, regular prescriptions, or planned procedures — the higher premium is offset by lower costs each time you use healthcare.
This calculator estimates your premium before and after subsidy, but health insurance costs extend beyond the monthly premium. Out-of-pocket costs — deductibles, copays, and coinsurance — can add thousands of dollars in a year if you use significant healthcare. When comparing plans, the total cost of ownership matters more than the premium alone.
Also not included: dental and vision insurance (sold separately in the ACA marketplace), employer-sponsored plan costs (which use a different affordability test), and Medicaid eligibility (which in most states kicks in below 138% FPL for adults). If you earn below the Medicaid threshold in your state and your state has expanded Medicaid, you may pay nothing at all — check your state's Medicaid eligibility directly.
Premium estimates use national benchmark data from the Kaiser Family Foundation's Subsidy Calculator methodology. Federal Poverty Level figures are the 2025 HHS published guidelines. ACA subsidy rules follow the American Rescue Plan Act extension provisions applicable through 2025. Always verify current figures at HealthCare.gov before enrolling.
Researched and maintained by Iulian, founder of Flux Media Systems. General information, not professional advice — about this site & our sources →