KFF Health Insurance Marketplace Calculator
Understanding your health insurance costs under the Affordable Care Act (ACA) can be complicated. Premium tax credits, Medicaid eligibility, cost-sharing reductions, and plan comparisons all depend on income, age, household size, and state rules.
Our KFF Health Insurance Marketplace Calculator helps you quickly estimate:
- Income as a percentage of the Federal Poverty Level (FPL)
- Premium tax credit (monthly subsidy)
- Bronze, Silver, and Gold plan premiums
- Annual subsidy amount
- Cost-Sharing Reduction (CSR) eligibility
- Medicaid eligibility indicators
- Employer coverage impact
Inspired by data modeling approaches from KFF (formerly Kaiser Family Foundation), this tool provides a fast, user-friendly way to preview your 2024 Marketplace costs before enrolling.
What Is the Health Insurance Marketplace?
The Health Insurance Marketplace allows individuals and families to buy coverage if they do not have affordable employer-sponsored insurance. Most states use HealthCare.gov, while some operate their own exchanges.
Under the ACA, financial assistance is available to reduce both:
- Monthly premiums (Premium Tax Credits)
- Out-of-pocket costs (Cost-Sharing Reductions for eligible Silver plan members)
This calculator helps you estimate both.
How the KFF Marketplace Calculator Works
The tool calculates subsidy eligibility and premium estimates using several factors:
1. State Selection
Premiums and Medicaid expansion rules vary by state. The calculator allows selection from states such as:
- California
- Texas
- Florida
- New York
- Georgia
- Washington
- Illinois
- Colorado
- Alabama
- Alaska
- Arizona
- Arkansas
- Connecticut
Your state impacts eligibility thresholds and base premium estimates.
2. County (Optional)
Entering your county can help refine premium estimates, as insurance pricing differs by rating area.
3. Annual Income (Before Taxes)
Your total projected yearly income determines your percentage of the Federal Poverty Level (FPL). This percentage determines:
- Whether you qualify for Medicaid
- Whether you qualify for subsidies
- How large your tax credit will be
4. Family Size & Adults Enrolling
Larger households have higher FPL thresholds. The calculator adjusts poverty percentages and premium estimates accordingly.
5. Oldest Adult Age
Premiums increase with age under ACA rules. The calculator applies age-rating factors, meaning older adults typically see higher base premiums.
6. Employer Coverage
If you are offered affordable employer-sponsored coverage, you generally cannot qualify for Marketplace subsidies. The tool checks this condition before calculating tax credits.
7. Tobacco Use
Insurance companies may charge higher premiums for tobacco users. The calculator increases premium estimates when tobacco use is selected.
How to Use the KFF Health Insurance Marketplace Calculator
Using the tool is simple:
- Select your state.
- (Optional) Enter your county.
- Input your annual income before taxes.
- Select the number of people enrolling.
- Choose the number of adults.
- Enter the oldest adult’s age.
- Indicate if employer coverage is offered.
- Select tobacco usage status.
- Click Calculate.
The results section will instantly display:
- Income as % of Poverty Level
- Subsidy eligibility status
- Monthly premium tax credit
- Estimated Bronze, Silver, and Gold premiums
- Annual subsidy amount
- CSR eligibility level
- Medicaid eligibility indicator
You can reset the calculator anytime to test different income or plan scenarios.
Example Scenario
Let’s walk through a sample case:
- State: Texas
- Family Size: 4
- Adults: 2
- Oldest Adult Age: 47
- Income: $65,000
- Employer Coverage: No
- Tobacco Use: No
Step 1: Poverty Level Percentage
The tool calculates income relative to the FPL for a 4-person household.
Step 2: Determine Eligibility
If income falls between 100%–400% of FPL, the household may qualify for premium tax credits.
If income is below 138% of FPL in expansion states, Medicaid eligibility may apply.
Step 3: Calculate Benchmark Premium
The Silver plan acts as the benchmark for calculating subsidies.
Step 4: Apply Contribution Cap
The ACA limits how much of your income you must pay toward premiums.
Step 5: Calculate Premium Tax Credit
If the benchmark premium exceeds your capped contribution, the difference becomes your monthly tax credit.
The calculator then adjusts Bronze, Silver, and Gold premiums accordingly.
Understanding Marketplace Plan Levels
Bronze Plans
- Lowest monthly premiums
- Highest deductibles
- Good for healthy individuals with minimal care needs
Silver Plans (Benchmark)
- Moderate premiums
- Balanced cost-sharing
- Required to qualify for Cost-Sharing Reductions
Gold Plans
- Higher premiums
- Lower deductibles
- Ideal for frequent healthcare use
Medicaid Eligibility Explained
If your income falls below 138% of FPL in states that expanded Medicaid, you may qualify for Medicaid instead of Marketplace subsidies.
The calculator shows:
- “May Qualify for Medicaid”
- “Yes (if state expanded Medicaid)”
This helps you understand whether Marketplace coverage is your best option.
What Are Cost-Sharing Reductions (CSR)?
CSR benefits lower:
- Deductibles
- Copayments
- Out-of-pocket maximums
To qualify:
- Income must generally be between 100%–250% of FPL
- You must enroll in a Silver plan
The calculator displays CSR levels such as:
- Highest Level
- High Level
- Moderate Level
Why Use This Marketplace Calculator?
✔ Fast subsidy estimates
✔ Compare Bronze, Silver & Gold plans
✔ Identify Medicaid eligibility
✔ Check employer coverage impact
✔ Estimate annual subsidy savings
✔ Plan your healthcare budget
Important Disclaimer
- Estimates are based on 2024 Marketplace modeling.
- Actual premiums vary by insurer and county.
- Medicaid eligibility depends on state expansion status.
- Always confirm final eligibility at HealthCare.gov or your state Marketplace.
15 Frequently Asked Questions (FAQs)
1. What is the Federal Poverty Level (FPL)?
A federal income guideline used to determine eligibility for subsidies and Medicaid.
2. How is the premium tax credit calculated?
It’s the difference between the benchmark Silver premium and your capped income contribution.
3. Why is the Silver plan used as a benchmark?
The ACA uses the second-lowest-cost Silver plan to determine subsidies.
4. Does employer coverage affect eligibility?
Yes. If affordable employer coverage is offered, you typically cannot receive Marketplace subsidies.
5. What happens if my income is below 138% of FPL?
You may qualify for Medicaid in expansion states.
6. Do tobacco users pay more?
Yes. Tobacco use may increase premiums.
7. Can I get subsidies above 400% of FPL?
Enhanced ACA rules may still limit your premium contribution.
8. What is CSR?
Cost-Sharing Reduction lowers deductibles and copays for eligible Silver plan members.
9. Does age increase premiums?
Yes. ACA rules allow higher premiums for older adults.
10. Is this calculator official?
No. It provides estimates for planning purposes only.
11. Can I compare multiple income scenarios?
Yes. Simply reset and enter new values.
12. Are Gold plans eligible for CSR?
No. CSR benefits apply only to Silver plans.
13. Are subsidies paid monthly?
Yes. Premium tax credits reduce your monthly premium.
14. What if my income changes mid-year?
You should report changes to avoid tax reconciliation issues.
15. Is this tool free to use?
Yes. It’s completely free with no registration required.
Final Thoughts
Choosing the right health insurance plan requires understanding your eligibility for subsidies, Medicaid, and cost-sharing reductions. Our KFF Health Insurance Marketplace Calculator makes it easier to estimate your costs, compare plan tiers, and make informed decisions.
Use the calculator today to see how much you could save under the Affordable Care Act and confidently plan your 2024 health coverage.