Health Insurance Premium Estimator

From 2021 through 2025, enhanced premium tax credits removed the income cap entirely, capping premium contributions at 8.5% of income no matter how high that income was. Those enhancements expired at the end of 2025, and Congress did not act to extend them, so 2026 marketplace coverage reverts to the original ACA rules: a real income cliff at 400% of the federal poverty level, above which no subsidy is available at all, regardless of how high your premium is relative to your income.

Your subsidy is based on your income as a percentage of the federal poverty level (FPL) for your household size, using the 2025 poverty guidelines, the guideline year that applies to 2026 coverage under the standard lookback used for open enrollment.

Your subsidy dollar amount is the gap between your local benchmark second-lowest-cost Silver plan's real annual premium and your expected contribution at your applicable percentage. That dollar amount then applies as a flat credit toward whichever metal tier you actually choose, which is why a cheaper Bronze plan can sometimes end up fully covered by a subsidy calculated against the pricier Silver benchmark. Whatever your net premium ends up being, weighing it against real income, not just the sticker price, is worth doing with a Take-Home Pay Calculator.

The benchmark second-lowest-cost Silver plan premium varies enormously by state, county, and your own age, since real ACA premiums are individually rated. There is no single accurate national figure to default to, so this calculator asks for your own real benchmark premium, which you can look up for free by browsing plans at Healthcare.gov or your state's own exchange without enrolling. Entering your real local figure, rather than a generic national average, is what makes the subsidy estimate here accurate instead of a rough guess.

This calculator estimates a subsidy based on income alone, but a real ACA eligibility rule sits outside that formula: if you or your spouse have access to employer-sponsored insurance (ESI) that counts as affordable, you are not eligible for a marketplace subsidy at all, regardless of how the income-based math above works out.

If your employer's offered family coverage costs less than 9.96% of your household income, it is considered affordable, and you are expected to use it rather than qualify for marketplace subsidies, even if you decline the offer. This calculator does not check employer coverage availability, since that is a real eligibility gate the subsidy formula itself does not capture, so a genuinely accurate answer requires checking your own employer's offer against this real threshold, not just running the numbers here.

This calculator's formula was checked directly against the Kaiser Family Foundation's own live 2026 ACA subsidy calculator, using a real test scenario, an income of $45,000 for a household of two. KFF's real result: 213% of the federal poverty level, a 7.07% applicable percentage, and a $265 monthly expected contribution. This calculator's formula, computed independently on the same inputs, returns the same figures exactly.

A health insurance premium is one piece of a broader coverage decision. These related calculators cover other real parts of it:

• Life Insurance Coverage Calculator - estimate how much life insurance coverage your household actually needs
• COBRA Continuation Cost Estimator - compare the real cost of continuing employer coverage against a marketplace plan
• Take-Home Pay Calculator (US) - see what a monthly premium actually costs against your real paycheck