What a health plan really costs you in a year

How we estimate this

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 — from about 40% at the Bronze level down to 10% at Platinum (Silver around 30%, Gold around 20%), with Expanded Bronze and Catastrophic plans near the Bronze rate, drawn from each tier’s actuarial value. 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. States that run their own exchanges aren’t in the federal files, so plan-level cost detail isn’t available there yet — we say so instead of faking a table.

Frequently asked questions

Why isn’t the monthly premium the real 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 is what this tool adds up.

What does this calculator include in the true 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 under each plan’s deductible, coinsurance, and out-of-pocket maximum. You choose how much care you expect — a healthy year, a typical year, a heavy year, or your own dollar figure — and we compute the true annual cost for every plan in your area and sort them cheapest first.

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?

Often, yes — and that is the whole point of this tool. 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. When that happens here, we say so directly and show the dollar difference. In a healthy year the cheaper-premium plan usually wins. Your expected usage is what decides it.