How pricing really works

What it costs and why quotes differ

Nobody can quote you a real number from a web page, and any site that shows you one before knowing seven specific things about you is showing you an advertisement. Here is exactly what drives your premium, so you can tell a real quote from a hook.

A real quote takes about ten minutes

Age, county, household size, tobacco use, projected income, health history and which door you are eligible for. That is the whole list. Once we have it, you get actual plan names and actual numbers, not a range.

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What happens next

Four steps. No runaround.

This is the exact sequence we run. No portal maze, no call-center roulette, no quote and vanish.

01

Nail down age and county first

Rates are set by age band and by rating area, which is usually your county rather than your state. Two neighbors on either side of a county line can see meaningfully different pricing for the same plan design.

02

Project income for the coverage year

On the marketplace this determines whether you receive a premium tax credit and how large it is. It is the single largest swing factor in what you personally pay, and it is based on the year you are covered, not last year.

03

Decide guaranteed issue or medically underwritten

Guaranteed issue plans price everyone the same regardless of health. Medically underwritten plans price you on your health history. For a healthy household these produce very different numbers, and both should be quoted.

04

Compare on total annual cost

Premium times twelve, plus the deductible you realistically expect to hit, capped by the out of pocket maximum. The cheapest monthly premium is regularly the most expensive plan by December.

What actually drives the price, and the published numbers we can point at

Any site that quotes you a monthly figure before knowing your age, location and health history is guessing. What we can do honestly is show you the eight things that move the number, and cite the published market data rather than inventing our own.

What moves the priceWhich direction, and how much it matters
Your ageThe single largest rating factor in most individual coverage. It moves the premium more than almost anything else you can control, and you cannot control it.
Where you liveRating areas are drawn by county, and neighbouring counties can differ meaningfully because the local hospital market differs.
Household incomeNot a rating factor, but the largest single determinant of what you actually pay for marketplace coverage. Below 400% of the federal poverty level a premium tax credit applies; above it, none does.[4]
Your health historyIrrelevant on ACA-compliant coverage, by law. Decisive on medically underwritten policies, where it determines whether you are approved at all and at what price.
Tobacco usePermitted as a rating factor on ACA plans and commonly applied. It is one of the few large levers genuinely within your control.
Metal level or plan richnessYou are choosing where to pay: premium now, or deductible and coinsurance later. Neither is free, and the cheapest premium is rarely the cheapest year.
How many people are on the policyFamily pricing is not a flat multiple. Adding a spouse and adding a child do very different things to the total.
The year you are buying inMarket-wide. For 2026, insurers filed a median increase of 18% across 312 filings, and about 40% requested 20% or more.[3]

This table describes how these categories of coverage generally work and, where indicated, quotes the regulator cited in the sources below. It is not a quote for coverage, it is not specific to any one company, and rules and benefits vary by state and change over time. Confirm the details against the actual plan documents before you buy anything.

The published numbers, so you have a reference point

These are national figures from KFF and CMS, not quotes, and not ours. They are here so you have something real to anchor on rather than a made-up range.

The average monthly premium actually paid, net of tax credits and including people who received no credit, was $178 in 2026, up 58% from $113. The average deductible was $3,786, up 37% from $2,759.[1] In Florida, 4,538,772 people selected a marketplace plan for 2026, down 196,643 from 4,735,415 the year before.[2]

Why we will not put a price on this page. Individual health coverage is priced on your age, your county, your household and, for underwritten products, your medical history. A headline figure that ignores all four is a marketing device, not information — and the number you would actually be offered could be double it or half it.

What we will do is run the real comparison, including the marketplace option we do not sell, and tell you plainly which one wins for your situation. That costs you nothing.

The cheapest premium and the cheapest year are different questions

Sorting by monthly premium is the default and it is usually wrong. The number that decides what a bad year costs is the annual out-of-pocket maximum, and the number that decides whether an ordinary year is affordable is the deductible plus your realistic usage. A plan that is $40 cheaper each month and $3,000 worse on the deductible is not a saving; it is a bet, and it is worth knowing that you are placing one.

If you are self-employed, remember that premiums you pay yourself may be deductible on Schedule 1 (Form 1040), line 17, which changes the real cost and can also move your income relative to the subsidy cliff.[9] Confirm with a CPA; we are licensed insurance producers, not tax advisers.

Seven inputs decide your number

Your premium is a function of your age, your rating area which is usually your county, how many people are on the plan and their ages, whether anyone uses tobacco, the plan design you select, whether you are being medically underwritten, and on the marketplace, your projected income for the coverage year. That is genuinely the list. Nothing else moves the number in a meaningful way. This is why a site can display a low figure in large type without lying outright, because somewhere there exists a person for whom that figure is real. It is almost certainly not you, and the honest version of that number takes a short conversation to produce.

Notice what is not on the list. There is no negotiation, no insider rate, and no discount for using one agent over another. Plan pricing is filed with and approved by state regulators. The identical plan costs the identical amount whether you buy it yourself online or with a licensed producer helping you. What changes is whether you end up on the right plan, and that difference is usually far larger than anything a discount could produce.

Want the real number for your household?

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Why identical people see wildly different quotes online

Three reasons, and all of them are structural. First, many quote engines only show one door. A marketplace calculator cannot price a medically underwritten plan and a private quote engine cannot apply a subsidy, so each shows you a partial picture and calls it the answer. Second, some sites display the lowest available plan in your area regardless of whether it is a plan any sensible person would buy, including plans with very narrow networks or extremely high deductibles. Third, some quote forms exist primarily to collect your phone number, and the figure on screen is the bait rather than the product. If a number appeared before you entered your county and your age, it was not a quote.

The monthly premium is the wrong thing to optimize

The number that matters is what you will actually spend across the whole year, which is your premium times twelve, plus whatever you pay toward the deductible and coinsurance, with the out of pocket maximum acting as your worst case ceiling. A plan with a low premium and a very high deductible can be the correct choice for a household that rarely uses care and has savings to absorb a bad month. The same plan is a poor choice for a household with a chronic prescription or a planned procedure, because they will hit that deductible every single year and pay it on top of twelve premiums. Run both plans through your realistic year before you decide. It is arithmetic, and it takes minutes.

What actually happens when you call

We take the seven inputs, we price every door you are eligible for, and we show you actual plan names with actual annual totals rather than a range. If a subsidy applies, we calculate it. If a medically underwritten plan beats it, we show you that too, along with what is excluded. You get a licensed producer, there is no fee to you, and your phone number does not get resold to six agencies the moment you hang up.

Sources

Figures and rules on this page last verified against the primary sources on August 13, 2026

  1. KFF, “What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles.” Published May 19, 2026; updated July 15, 2026. kff.org
  2. KFF State Health Facts, “Marketplace Enrollment Snapshot for Open Enrollment 2026,” from the CMS Marketplace 2026 Open Enrollment Period Report: National Snapshot, January 28, 2026. kff.org
  3. Peterson-KFF Health System Tracker, “How much and why ACA Marketplace premiums are going up in 2026.” Updated January 15, 2026. healthsystemtracker.org
  4. U.S. Department of Health and Human Services, annual update of the HHS poverty guidelines. aspe.hhs.gov
  5. Florida Department of Financial Services, Short-term Limited Duration Insurance (STLDI) consumer information. myfloridacfo.com
  6. Centers for Medicare & Medicaid Services, “Short-Term, Limited-Duration Insurance and Independent, Noncoordinated Excepted Benefits Coverage (CMS-9904-F)” fact sheet. Final rule issued April 3, 2024, applicable to policies sold or issued on or after September 1, 2024. cms.gov
  7. U.S. Departments of Labor, Health and Human Services, and the Treasury, statement regarding short-term, limited-duration insurance, August 7, 2025. The Departments stated they do not intend to prioritise enforcement of the 2024 final rule’s definition until future rulemaking. dol.gov
  8. National Association of Insurance Commissioners, “Not All Products are Health Insurance: Health Care Sharing Ministries, Discount Plans and Risk-Sharing Plans.” naic.org
  9. Internal Revenue Service, Instructions for Form 7206, Self-Employed Health Insurance Deduction. irs.gov

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 above are provided for general information, are current as at the verification date shown, and are not legal or tax advice. Rules change and vary by state. Plan availability, benefits and pricing vary by state and by applicant.

Straight answers

The questions people actually ask.

Why can nobody quote me a price online?

Because a real premium depends on your age, your county, your household, tobacco use, plan design, your health history if you are being underwritten, and your projected income if you are using the marketplace. Any figure shown before those are known is an advertisement, not a quote.

Is it cheaper to buy directly instead of through an agent?

No. Health plan pricing is filed with state regulators, so the same plan costs the same either way. There is no agent markup and no fee to you. What changes is whether every door got priced and whether your doctors were verified before you enrolled.

What is the biggest factor in what I pay?

For most households it is whether you qualify for a marketplace premium tax credit, which is driven by projected income and household size. After that, age and county do most of the remaining work.

Should I just take the cheapest premium?

Only if you have run the whole year. Compare premium times twelve plus your realistic out of pocket spending, bounded by the out of pocket maximum. Low premium plans with very high deductibles are excellent for some households and costly for others.

Do prices change during the year?

Plan rates are generally set for the plan year, but your subsidy can change if your income or household changes, and you should report those changes when they happen rather than at filing. New plan years bring new rates and new plan designs, which is why an annual review is worth the twenty minutes.

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