Most quote tools hold the number hostage until you hand over your phone. This one does not. Enter four things and see the maximum you could be asked to pay for benchmark marketplace coverage, calculated straight from the published federal tables. Then decide whether you want to talk to anyone.
An estimator is only as honest as the assumptions under it. These are the national figures the 2026 market actually produced, cited so you can check them yourself, and so you have something real to sanity-check any estimate against.
They are national averages published by KFF and CMS.[1][2] They are not a quote, and your own figure will differ, possibly by a lot. Individual health coverage is priced on age, county, household size, tobacco use and plan richness, and for medically underwritten products on your health history as well.
What an average is good for is catching a number that cannot be right. If an estimate you have been given sits far below the national average net premium of $178 a month, it is worth asking what is not in it — a subsidy assumption you may not qualify for, or a product that is not ACA-compliant.
Household income, and not in the way most people assume. It is not a rating factor — insurers do not price on it — but it decides whether a premium tax credit applies, and that is usually a larger swing than any plan choice you could make.
The threshold is 400% of the federal poverty level: $62,600 for one person and $128,600 for a family of four for 2026 coverage, moving to $63,840 and $132,000 for 2027.[4] Below it, a credit; above it, none at all. That single line explains most of the distance between two households with identical plans and very different bills.
Estimates are a starting point, not an answer. Once you have a range, the useful next step is a real comparison against your actual age, county and providers — including the marketplace option, which we do not sell. If that is the better answer for you, we will say so.
The enhanced premium tax credits expired, and the effect was not spread evenly. Households above the subsidy cliff made up about 7% of 2025 enrollment but nearly 48% of the decline; the 400–500% band alone lost 44% of its sign-ups, more than 321,000 people.[1] Any estimate built on 2025 assumptions understates the 2026 reality for exactly those households.
Four inputs. The result updates as you type and nothing is sent anywhere.
Use modified adjusted gross income. For a self-employed household that is your net profit after legitimate business expenses, not your gross receipts. This is the single input that moves the answer most, and it is the one people most often get wrong by entering the wrong figure.
This is an estimate of a legal cap, not a quote. It shows the most you could be asked to pay for the benchmark second lowest cost silver plan in your rating area after any premium tax credit, using the published federal poverty guidelines and the IRS applicable percentage table for the coverage year selected. Your actual premium depends on the specific plan, your age, your county and tobacco use. Nothing here is an offer of coverage or tax advice.
Figures and rules on this page last verified against the primary sources on August 13, 2026
Scotty Jaymes Insurance is a private, independent insurance agency. We are not affiliated with, endorsed by, or connected to any government agency, the federal Medicare or Medicaid programs, or any state or federal health insurance marketplace including Healthcare.gov. Regulatory summaries are general information, current as at the verification date shown, and are not legal or tax advice. Rules change and vary by state and by plan. Plan availability, benefits and pricing vary by state and by applicant.
Almost every health insurance calculator on the internet is doing one of two things. Either it is showing you an advertisement, a low figure that exists for somebody somewhere but almost certainly not for you, or it is showing you nothing at all until you surrender a phone number that then gets sold to six agencies. This tool does neither, and the reason it can afford to be honest is structural rather than generous.
The premium tax credit is not a discount a carrier decides to give you. It is defined in federal law as the amount required to reduce your cost for one specific benchmark plan, the second lowest cost silver plan available in your rating area, down to a fixed percentage of your household income. That percentage is published every year by the IRS. The income thresholds it applies to are published every year by the Department of Health and Human Services. Put those two published tables together with your household size and your projected income and the arithmetic produces a genuine dollar figure without anyone needing to know a single carrier rate.
That is the whole trick. This calculator does not have secret pricing data and it is not pretending to. It tells you what the law caps your benchmark cost at, which is a real, defensible number that no quote form on the internet can talk you out of.
The enhanced premium tax credits expired at the end of 2025 and the four hundred percent cliff came back. A household one dollar over the line now receives no credit at all.
Two things followed from the expiration. First, the applicable percentages went back up, meaning enrollees at every income level below the threshold are asked to contribute a larger share of income than the year before. Second, and far more consequentially, the cliff returned. Under the enhanced structure nobody paid more than a set share of income no matter how much they earned. That protection is gone.
The scale is not subtle. The Kaiser Family Foundation reports the average net premium paid by marketplace enrollees rose from roughly one hundred thirteen dollars a month to roughly one hundred seventy eight, an increase of about fifty eight percent, while the average deductible rose from roughly two thousand seven hundred fifty nine dollars to roughly three thousand seven hundred eighty six. Bronze plans reached a record share of selections, which is what happens when people start optimizing for the premium line instead of for the coverage.
If the estimator tells you that you are over the cliff, that is not a dead end. It is precisely the situation where a medically underwritten plan is most likely to beat the marketplace outright, because underwriting prices a healthy household on its own health history rather than on the pool average. That door deserves to be priced before you accept a full list price premium as your only option.
Your actual premium depends on age, county, tobacco use and plan design. Those combine in ways no calculator can guess, which is why the figure above is a ceiling rather than a quote.
Network is the question that decides whether a plan is useful or merely inexpensive. Directories go stale. Verifying your hospital and specialists by name is a phone call, and it happens before you enroll.
Medically underwritten coverage requires your health history and an actual underwriting decision. Above the subsidy cliff this is frequently the plan that wins, and no calculator can produce it.
For a self-employed household the projection is the whole game, and it is the input most worth a real conversation and sometimes a call to your tax preparer.
If the estimator put you inside the credit range, treat the figure as your ceiling for benchmark coverage and start comparing on total annual cost rather than on the monthly premium. That means premium times twelve, plus the deductible you realistically expect to reach, bounded by the out of pocket maximum. The plan with the lowest monthly number is regularly the most expensive plan by December, and the arithmetic that proves it takes about five minutes.
If it placed you under the poverty line in a state that has not expanded Medicaid, you have landed in the coverage gap, which is a genuine policy problem and not a mistake you made. Options still exist, they are just narrower, and the right move is a conversation rather than a form. If it put you over four hundred percent, price the underwritten door before you do anything else.
Closing those gaps costs you nothing. Plan pricing is filed with and approved by state regulators, so the identical plan costs the identical amount whether you buy it alone online or with a licensed producer helping you. There is no agent markup and no fee to you. What changes is whether every door got priced and whether anyone verified your doctors before you enrolled.
No, and nothing on this page should be treated as one. It is an estimate of a statutory cap. It shows the most you could be asked to pay for the benchmark second lowest cost silver plan in your rating area after any premium tax credit is applied, based on published federal tables. A quote requires your age, your county, tobacco use and a specific plan, and it comes from a licensed producer rather than a web page.
Because gating a number that comes from published federal tables would be a sales tactic rather than a service. The calculation is public information. If the result is useful and you want the parts a calculator cannot do, the network verification, the underwritten comparison, the income projection, you can reach out. If it is not, you got what you came for and you owe nobody anything.
Modified adjusted gross income for the year you will be covered, for everyone in your tax household. For self-employment that generally starts from net profit after ordinary and necessary business expenses, not gross receipts. It also includes other countable household income, and certain items such as tax exempt interest and untaxed Social Security get added back. This is why many people who assume they earn too much to qualify actually do qualify.
Two tables change every year. The federal poverty guidelines shift, and the IRS applicable percentage table that converts your position relative to those guidelines into a required contribution shifts as well. A coverage year is also measured against the poverty guidelines published in the prior calendar year, which is why the 2026 and 2027 results rest on different underlying figures.
For 2026 and 2027 there is no premium tax credit above that line, because the enhanced subsidies that removed the cliff expired at the end of 2025. You would pay the full list price on the marketplace. That is the situation where a medically underwritten plan most often wins, since it prices a healthy household on its own health history rather than on the pool. Both doors should be priced before you accept a number.
In states that did not expand Medicaid, adults below the poverty line can earn too little to qualify for marketplace premium tax credits and simultaneously too much to qualify for that state's Medicaid program. That leaves a band of income with no affordable option, which is what the coverage gap describes. Ten of the states this agency is licensed in have not expanded. If the estimator places you there, options exist but they are narrow and worth talking through.
No. Health plan rates are filed with and approved by state regulators, so the same plan costs the same amount either way. There is no markup and no fee to you. The difference is whether every door you are eligible for actually got priced and whether your doctors were verified against the network before enrollment rather than after.
Tell us your age, your county, who is on the plan and roughly what the year looks like. We price the marketplace with and without a credit, we price the medically underwritten door alongside it, and we verify your doctors by name. Licensed producer, no fee to you, and your information does not get resold.