# How our health insurance estimates work

2026 planning estimates, not 2027 prices, enrollment decisions or plan quotes.

## What we add

We combine reported plan data with transparent calculations and decision checklists. We are a secondary explanation and calculation source, not the authority for insurance law. Cite the primary source for the rule and this method for the calculation.

## Reported data versus assumptions

Premiums, deductibles and out-of-pocket limits use reported plan data where available. Some estimates use state-average benchmark fallbacks, not a specific plan quote. Expected covered spending is your scenario. Tier-level coinsurance is our simplified assumption, not a service-specific plan benefit. Networks, formularies, excluded services and out-of-network bills are not resolved by this model.

## Reproduce this synthetic example

Inputs: $200 monthly premium after estimated subsidy; $7,000 covered spending; $4,000 deductible; $9,000 out-of-pocket limit; Silver model coinsurance 30%.

Modeled care cost: $4,000 + 30% × ($7,000 - $4,000) = $4,900. Annual premiums: $2,400. Estimated annual total: $7,300. These are invented inputs, not a real plan or a measured saving.

Formula: min(out-of-pocket limit, spending up to deductible + assumed coinsurance × spending above deductible), then add twelve months of net premiums. Compare multiple spending scenarios; a different scenario can change the ranking.

## Freshness and verification

The calculation examples describe the current model, not a new data refresh. Data year, source publication date, import date and editorial update are different facts. We do not claim a new import date where one is not recorded. 2026 data must not be treated as 2027 prices. Confirm enrollment dates and eligibility with the relevant marketplace, and benefits and prices with the plan. State guides are not a completed 50-state policy audit.

## Sources

- [CMS Marketplace public use files](https://www.cms.gov/marketplace/resources/data/public-use-files): Filed plan rates and attributes where available. A historical file is not proof that a plan is currently accepting enrollment.
- [IRS Revenue Procedure 2025-25](https://www.irs.gov/pub/irs-drop/rp-25-25.pdf): 2026 applicable percentages used in the premium-tax-credit estimate. Final eligibility and reconciliation depend on your circumstances.
- [HealthCare.gov plan categories](https://www.healthcare.gov/choose-a-plan/plans-categories/): What metal categories mean. Actuarial value is not your personal coinsurance for a particular service.