Health Insurance Marketplace Calculator | KFF (2024)

<% if ( c.p.expanding_medicaid || !c.c.employer_coverage ) { %>

Estimated financial help:

<%= c._cur( c.silver_tax_credit / 12 ) %> per month (<%= c._cur( c.silver_tax_credit ) %> per year) as a premium tax credit. This covers <%= c._pct( c.silver_tax_credit / c.actual_silver_premium, 0 ) %> of the monthly costs. <% if ( c.silver_tax_credit == 0 && c.income_fpl > 1 && c.income_fpl <= 4 ) { %> (Although your income would qualify you for help, insurance premiums in your area may not be expensive enough for this help to kick in. For more information, see the FAQ). <% } %>

Your cost for a silver plan:

<%= c._cur( ( c.actual_silver_premium - c.silver_tax_credit ) / 12 ) %> per month (<%= c._cur( c.actual_silver_premium - c.silver_tax_credit ) %> per year) in premiums (which equals <%= c._pct( ( c.actual_silver_premium - c.silver_tax_credit ) / c.income_dollars, 2 ) %> of your household income).

The most you have to pay for a silver plan:

<% if ( c.income_fpl >= c.p.subsidy_min && c.income_fpl <= c.p.subsidy_max ) { %> <%= c._pct( c.percent_income_silver, 2 ) %> of income for the second-lowest cost silver plan <% } else { %> No maximum <% } %> <% if ( c.any_smokers ) { %>

(before accounting for a tobacco surcharge, if applicable) <% } %>

Without financial help, your silver plan would cost:

<%= c._cur( c.actual_silver_premium / 12 ) %> per month (<%= c._cur( c.actual_silver_premium ) %> per year) <% if ( c.any_smokers ) { %>

You may pay more if your insurer charges a higher rate for tobacco use. In most states, insurers can charge a tobacco surcharge of up to 50% of your total premium before the tax credit. The tax credit cannot be applied to the tobacco surcharge. <% } %>

<% } %> <% if ( c.show_additional_assistance ) { %>

Additional Help

<% if ( c.c.state == 'vt' && c.income_fpl <= 3 ) { %>

The state of Vermont provides additional help to Vermont residents at your income level. After accounting for this additional help, the amount you pay would likely be lower than the amount shown above. You are also likely eligible for additional help that would lower your out-of-pocket costs when you get medical care. For more information, click here.

<% } else if ( c.c.state == 'ma' && c.income_fpl <= 3 ) { %>

The state of Massachusetts provides additional help to Massachusetts residents at your income level. After accounting for this additional help, the amount you pay would be lower than the amount shown above. For more information, click here.

<% } else if ( c.c.state == 'mn' && c.income_fpl <= 2 ) { %>

Based on the information you provided, you may be eligible for MinnesotaCare, which is a program for Minnesota residents who do not have access to affordable health coverage. If you are eligible for MinnesotaCare, the amount you pay may be lower than the amount shown above. For more information, click here.

<% } else if ( c.c.state == 'ny' && c.income_fpl <= 2 ) { %>

Based on the information you provided, you may be eligible for the Essential Health Plan, which is a program for New York residents who do not have access to affordable health coverage. If you are eligible for the Essential Health Plan, the amount you pay may be lower than the amount shown above. For more information, click here.

<% } %> <% if ( c.income_fpl <= 6 && c.c.state == 'ca' ) { %>

The state of California provides additional help to California residents at your income level. After accounting for this additional help, the amount you pay would be lower than the amount shown above. For more information, click here.

<% } %> <% if ( c.income_fpl <= 4 && c.c.state == 'nj' ) { %>

The state of New Jersey provides additional help to New Jersey residents at your income level. After accounting for this additional help, the amount you pay would be lower than the amount shown above. For more information, click here.

<% } %> <% if ( c.c.child_count > 0 && c.income_fpl <= c.p.chip_threshold ) { %>

If your children are under the age of 19, they are likely eligible for coverage through the Children's Health Insurance Program (CHIP) or Medicaid, based on the information you provided. If your children are eligible for one of these programs, they would not be eligible for financial help through the Marketplace and should instead enroll in CHIP or Medicaid. To get the best estimate of your family’s financial assistance, please check your family information above to make sure you do not include children who are eligible for CHIP or Medicaid in the number of children enrolling in Marketplace coverage.

<% } %> <% } %> <% if ( c.c.state == 'mn' ) { %>

Additional Info

Depending on your area and family size, the amount you pay may differ from the estimatedamounts shown above. For more information, visit MNsure.

<% } %> <% if ( c.p.expanding_medicaid || !c.c.employer_coverage ) { %>

Other Levels of Coverage

<% if (c.c.no_bronze_plans) { %>

The costs above are for a silver plan in your area. Gold plans offer more financial protection if you get sick, but these plans have higher monthly costs. You can receive financial help to purchase any of these levels of coverage. There are no bronze plans available in your area.

<% } else { %> <% if ( c.income_fpl >= c.p.subsidy_min && c.income_fpl <= c.p.subsidy_max && c.bronze_premium_before_tobacco < c.silver_tax_credit && c.actual_silver_premium - c.silver_premium_before_tobacco > 0 ) { %>

The costs above are for a silver plan in your area. Silver plans are one of four levels of coverage that you can buy with financial help. These levels – bronze, silver, gold, and platinum – tell you about how much financial protection the plan will offer you if you get sick. Bronze plans have the lowest monthly costs, but when you need medical care, you will pay more for your care. Gold and platinum plans offer more financial protection if you get sick, but these plans have higher monthly costs. You can receive financial help to purchase any of these levels of coverage.

For example, you could enroll in a bronze plan for about <%= c._cur( c.actual_bronze_premium - c.bronze_tax_credit ) %> per year (which is <%= c._pct( c.percent_income_bronze, 2 ) %> of your household income). By enrolling in a bronze plan, you would receive <%= c._cur( c.bronze_tax_credit ) %> in subsidies, which would cover the entire amount of your bronze premium, but you may pay more for using tobacco. For most people, the bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a bronze plan, you will face higher out-of-pocket costs than if you enrolled in a silver plan.

<% } else if ( c.income_fpl >= c.p.subsidy_min && c.income_fpl <= c.p.subsidy_max ) { %>

The costs above are for a silver plan in your area. Silver plans are one of four levels of coverage that you can buy with financial help. These levels – bronze, silver, gold, and platinum – tell you about how much financial protection the plan will offer you if you get sick. Bronze plans have the lowest monthly costs, but when you need medical care, you will pay more for your care. Gold and platinum plans offer more financial protection if you get sick, but these plans have higher monthly costs. You can receive financial help to purchase any of these levels of coverage.

<% if ( c.bronze_premium_before_tobacco < c.silver_tax_credit && c.actual_silver_premium - c.silver_premium_before_tobacco == 0 ) { %>

For example, you could enroll in a bronze plan for about <%= c._cur( ( c.actual_bronze_premium - c.bronze_tax_credit ) / 12 ) %> per month (<%= c._cur( c.actual_bronze_premium - c.bronze_tax_credit ) %> per year), which is <%= c._pct( c.percent_income_bronze, 2 ) %> of your household income). By enrolling in a bronze plan, you would receive <%= c._cur( c.bronze_tax_credit ) %> in subsidies, which would cover the entire amount of your bronze premium. For most people, the bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a bronze plan, you will face higher out-of-pocket costs than if you enrolled in a silver plan.

<% } else { %>

For example, you could enroll in a bronze plan for about <%= c._cur( ( c.actual_bronze_premium - c.bronze_tax_credit ) / 12 ) %> per month (<%= c._cur( c.actual_bronze_premium - c.bronze_tax_credit ) %> per year), which is <%= c._pct( c.percent_income_bronze, 2 ) %> of your household income, after taking into account <%= c._cur( c.bronze_tax_credit ) %> in subsidies). For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a silver plan.

<% } %> <% } else { %>

The costs above are for a silver plan in your area. The level of coverage – bronze, silver, gold, or platinum – tells you about how much financial protection the plan will offer you if you get sick. Bronze plans have the lowest monthly costs, but when you need medical care, you will pay more for your care. Gold and platinum plans offer more financial protection if you get sick, but these plans have higher monthly costs.

For example, you could enroll in a Bronze plan for about <%= c._cur( c.actual_bronze_premium / 12 ) %> per month (<%= c._cur( c.actual_bronze_premium ) %> per year), which is <%= c._pct( c.percent_income_bronze, 2 ) %> of your household income). For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a bronze plan, you will face higher out-of-pocket costs than if you enrolled in a silver plan.

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Out of Pocket Costs

Although your insurance company may cover most of the cost of your medical care, you generally have to pay something when you go to the doctor or have a hospital stay. These costs – which are in addition to the amount you pay each month – are called your “out-of-pocket” costs. The health reform law sets limits on the amount you have to pay out-of-pocket each year. Your out-of-pocket limit for a silver plan can be no more than <%= c._cur( c.oop_max ) %> in 2024. Whether you reach this maximum level will depend on the amount of health care services you use. Keep in mind that this only protects you when you go to doctors and hospitals that are in your insurer’s network. If you go to a doctor or hospital that is not in the network, you could end up paying much more.

<% if ( c.income_fpl >= c.p.subsidy_min && c.income_fpl <= c.p.subsidy_max ) { %> You are guaranteed access to a silver plan with an actuarial value of <%= c._pct( c.av, 0 ) %> . This means that for all enrollees in a typical population, the plan will pay for <%= c._pct( c.av, 0 ) %> of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. <% } else { %> A silver plan has an actuarial value of 70%. This means that for all enrollees in a typical population, the plan will pay for 70% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. <% } %> Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.

<% if ( c.percent_income_bronze > 0.08 || ( c.percent_income_bronze < 0.08 && c.house_under_30 ) ) { %>

Other Coverage Options

<% } %> <% if ( c.percent_income_bronze > 0.08 ) { %>

Because bronze level coverage would cost more than 8% of your household income, you may instead choose to purchase catastrophic coverage. With a catastrophic plan, you would pay for most health services yourself until you reach the annual limit on cost sharing (<%= c._cur( c.p.unsubsidized_oop_max_single ) %> for individual and <%= c._cur( c.p.unsubsidized_oop_max_fam ) %> for family coverage in 2024). However, preventive services are covered with no cost sharing required.

<% } %> <% if ( c.percent_income_bronze < 0.08 && c.house_under_30 ) { %>

Children and young adults under age 30 are eligible to purchase catastrophic coverage. With a catastrophic plan, you would pay out-of-pocket for most health services until you reach the annual limit on cost sharing (<%= c._cur( c.p.unsubsidized_oop_max_single ) %> for individual and <%= c._cur( c.p.unsubsidized_oop_max_fam ) %> for family coverage in 2024). However, preventive services are covered with no cost sharing required.

<% } %> <% if ( c.income_fpl > 1 && c.income_fpl < 1.38 && ( c.c.state === 'ut' || c.c.state === 'ne' || c.c.state === 'id' ) ) { %>

Medicaid Coverage

<% if ( c.c.state === 'ut' ) { %>

Based on the information you provided, you may be eligible for Medicaid. Medicaid is a health coverage program run by states and the Federal government. Under the health law, states have the option to expand Medicaid coverage to everyone under 138% of the poverty level. (The federal government pays nearly all of the costs of Medicaid expansion).

Medicaid coverage varies from state to state, but out-of-pocket costs are generally very low. Tobacco use is not taken into account in Medicaid eligibility.

Keep in mind that these results are estimates based on your income and where you live. For more information and to see if you qualify, visit Healthcare.gov, your state’s Health Insurance Marketplace, or Medicaid program office.

<% } else if ( c.c.state === 'ne' ) { %>

You are currently eligible for financial help on the ACA Health Insurance Marketplace, and you may also be eligible for Medicaid in October 2021. Medicaid is a health coverage program run by states and the Federal government. Under the health law, states have the option to expand Medicaid coverage to everyone under 138% of the poverty level. (The federal government pays nearly all of the costs of Medicaid expansion).

Medicaid coverage varies from state to state, but out-of-pocket costs are generally very low. Tobacco use is not taken into account in Medicaid eligibility.

Keep in mind that these results are estimates based on your income and where you live. For more information and to see if you qualify, visit Healthcare.gov, your state’s Health Insurance Marketplace, or Medicaid program office.

<% } else if ( c.c.state === 'id' ) { %>

Based on the information you provided, you may be eligible for Medicaid in the future. Medicaid is a health coverage program run by states and the Federal government. Under the health law, states have the option to expand Medicaid coverage to everyone under 138% of the poverty level. (The federal government pays nearly all of the costs of Medicaid expansion).

Idaho voters approved a ballot measure in November 2018 that requires the state to submit a state plan amendment to the Centers for Medicare and Medicaid Services (CMS) to implement the Medicaid expansion within 90 days of approval of the measure. Medicaid coverage varies from state to state, but out-of-pocket costs are generally very low. Tobacco use is not taken into account in Medicaid eligibility.

Keep in mind that these results are estimates based on your income and where you live. For more information and to see if you qualify, visit Healthcare.gov, your state’s Health Insurance Marketplace, or Medicaid program office.

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