Estimate a health plan’s annual cost
A lower premium can mean higher costs when you need care. Enter your ZIP, ages, income, and expected covered care costs. We estimate a year of after-subsidy premiums plus care costs using reported deductibles and out-of-pocket limits with assumed coinsurance by metal tier. These are simplified 2026 comparisons, not 2027 prices, quotes, or predictions of your medical bills.
Not sure which metal tier fits your year? The metal tier recommender walks you through it in four questions and shows the real numbers.
How we estimate this
The model applies expected covered, in-network spending to the medical deductible, then the assumed coinsurance, capped at the reported out-of-pocket maximum. A missing medical deductible is treated as zero; a non-positive reported out-of-pocket limit leaves modeled care costs uncapped. Plans with no reported out-of-pocket maximum are omitted. Separate drug deductibles, copays, services covered before the deductible, family deductible rules, networks, and formularies are not modeled. Premiums, non-covered care, and out-of-network charges are not included in the modeled care-cost cap. Check plan documents before choosing.
Worked example: with a $4,000 deductible, 30% assumed coinsurance, a $9,000 out-of-pocket limit, and $7,000 of covered spending, modeled care cost is $4,000 + 30% of $3,000 = $4,900. At $200 per month after subsidy, the estimated annual total is $2,400 + $4,900 = $7,300. This is a synthetic example, not a plan quote.
Premiums, deductibles, and out-of-pocket maximums come from the official CMS Marketplace public use files for plan year 2026, the same plan and rate data behind HealthCare.gov. The after-subsidy price subtracts your estimated premium tax credit, computed per the IRS formula in Rev. Proc. 2025-25 from the second-lowest-cost Silver plan in your area, except Catastrophic plans, which cannot use the credit and are shown at full price.
To turn your expected care into a dollar figure, we estimate what you’d pay after the deductible using a representative coinsurance rate for each metal level: 40% for Bronze and Catastrophic, 35% for Expanded Bronze, 30% for Silver, 20% for Gold, and 10% for Platinum. These are model assumptions, not plan-specific coinsurance rates. A metal tier’s actuarial value does not determine what you personally pay for a given service. Real plans set their own copays and coinsurance by service, so your actual share will differ; this is a planning estimate, not a quote. Under the Affordable Care Act, in-network preventive care is free even before the deductible, so a healthy year is mostly premiums; the expected-care figure is meant to capture the care beyond those preventive visits. Your real usage will differ from any scenario you pick, which is exactly why it’s worth seeing how the ranking shifts as you change it. This now covers the federal marketplace and most state-run exchanges; a couple of state exchanges (Colorado and Maryland) aren’t in the public files yet, so plan-level cost detail isn’t available there; we say so instead of faking a table.
Sources: CMS Marketplace public use files and HealthCare.gov plan categories. The data is for plan year 2026, not the upcoming 2027 enrollment year.
Inspect the full calculation method and source roles
Download the descriptive rate-row snapshot. This related dataset is not the live plan lookup or a substitute for your household estimate.
Frequently asked questions
Why isn’t the monthly premium the full cost of a health plan?
- Because the premium is only the part you pay whether or not you use any care. The rest of the cost shows up when you actually get care: the deductible you pay before the plan starts sharing costs, the coinsurance you pay after it, up to the out-of-pocket maximum. A plan with a low premium often has a high deductible, so in a year you use care it can cost more in total than a pricier plan with a lower deductible. The real cost is a year of premiums plus what you pay toward care, which this tool estimates under simplified assumptions.
What does this calculator include in the estimated annual cost?
- Two things: twelve months of the premium after your estimated subsidy, plus an estimate of what you would pay toward your expected care using plan deductibles and out-of-pocket maximums with assumed coinsurance by metal tier. You choose how much care you expect (a healthy year, a typical year, a heavy year, or your own dollar figure), and we estimate annual costs for the available plans with reported out-of-pocket limits and sort by that estimate. This is not a service-by-service benefit comparison or a guarantee of the cheapest plan for you.
Is preventive care free under these plans?
- Yes. Under the Affordable Care Act, in-network preventive services (annual checkups, recommended vaccines, many screenings) are covered with no cost sharing, even before you meet the deductible. So a healthy year is mostly just premiums. The expected-care figure in this tool is meant to capture the care beyond preventive visits: the tests, treatments, prescriptions, and procedures that run through the deductible and coinsurance.
Can a more expensive plan actually be cheaper?
- It can be, depending on your care and the plan benefits. In a year where you use a lot of care, a plan with a higher monthly premium but a lower deductible and out-of-pocket maximum can cost you less in total than the cheapest-premium plan, because you pay far less toward the care itself. This tool shows the modeled difference under simplified cost-sharing assumptions. In a healthy year the cheaper-premium plan usually wins. Actual service benefits, networks, and prescriptions can change the result.
The Insurance Guide is not an insurance company, agency, or licensed advisor, and this tool does not provide insurance, tax, or financial advice. All figures are educational estimates based on public data and the usage you enter, not quotes, and not a prediction of your medical costs. Confirm final prices and benefits with the marketplace or a licensed agent before you enroll.