Calculator inputs
Enter a common care scenario first, then fill each plan block. Results appear below the header and above this form after submission.
Example data table
The table below shows a sample comparison scenario you can mirror inside the calculator.
| Variable | Bronze Saver | Silver Balance | Gold Shield |
|---|---|---|---|
| Monthly premium | $410.00 | $560.00 | $720.00 |
| Deductible | $6,500.00 | $3,200.00 | $1,000.00 |
| Coinsurance | 40% | 25% | 15% |
| Out-of-pocket maximum | $9,100.00 | $7,200.00 | $4,800.00 |
| Employer contribution | $600.00 | $900.00 | $1,200.00 |
| Common monthly subsidy | $180.00 | ||
| Common other medical bills | $3,500.00 | ||
| Primary / Specialist / Generic fills / Urgent | 4 / 2 / 12 / 1 | ||
Formula used
Annual premium after subsidy = max(0, monthly premium − monthly subsidy) × 12
Annual copays = primary visits × PCP copay + specialist visits × specialist copay + generic fills × generic copay + urgent visits × urgent copay
Deductible paid = minimum(other medical bills, deductible)
Coinsurance paid = max(0, other medical bills − deductible) × coinsurance rate
Member medical cost = minimum(out-of-pocket maximum, annual copays + deductible paid + coinsurance paid)
Estimated annual cost = annual premium after subsidy + member medical cost − employer contribution
Worst-case annual cost = annual premium after subsidy + out-of-pocket maximum − employer contribution
Value score blends normalized annual cost, risk exposure, network score, and metal tier richness into a 0 to 100 planning score.
How to use this calculator
- Enter one expected care scenario that applies to all plans.
- Add the monthly subsidy or tax credit you expect.
- Fill in three marketplace plan structures, including premiums, deductibles, coinsurance, and copays.
- Include any annual employer HRA or similar support in the employer contribution field.
- Click Compare plans to generate the ranked results.
- Review estimated annual cost, worst-case cost, and the graph together before choosing.
- Use the CSV and PDF buttons to save the output for enrollment reviews or internal benefits discussions.
FAQs
1. What does this calculator compare?
It compares three marketplace plans using the same care scenario. The tool estimates annual premiums after subsidy, medical cost exposure, employer support, and worst-case financial risk.
2. Why is subsidy entered once?
A monthly marketplace subsidy usually applies to the household, not to each medical usage line. The calculator subtracts that amount from every plan premium for apples-to-apples comparison.
3. Does the out-of-pocket maximum cap everything?
The tool caps member medical cost at the out-of-pocket maximum. Premiums remain separate because they are paid regardless of how much care is used.
4. What should I enter as other medical bills?
Use the expected allowed charges that would normally flow through deductible and coinsurance rules. This field helps model scans, outpatient procedures, lab work, or other non-copay services.
5. What is the value score?
The value score is a planning metric. It rewards lower estimated annual cost, lower worst-case exposure, stronger networks, and richer metal tiers to highlight balanced options.
6. Can employer money change the best plan?
Yes. An employer HRA, ICHRA, or similar contribution can materially lower effective annual cost. That may make a plan with a higher sticker premium more attractive overall.
7. Is the lowest premium always the best choice?
Not necessarily. Low premiums often come with higher deductibles, coinsurance, and out-of-pocket maximums. A slightly higher premium can produce lower total yearly cost under moderate or heavy usage.
8. Should I rely on this result alone?
Use it as a decision aid, not the only source. Always confirm covered drugs, provider networks, referrals, preauthorization rules, and actual marketplace plan documents before enrolling.