Plan your coverage budget with clear premium estimates. Adjust benefits, family size, and location today. Download a report to share with your advisor securely.
This tool estimates a monthly premium using a multiplicative rating model, then subtracts credits. The model is designed for planning and comparison across scenarios.
This calculator models a premium using a baseline age rate and pricing multipliers. It is built for budgeting and comparisons, not underwriting. The output shows gross premium, administrative load, discount, and then credits, so you can see the steps clearly.
Age sets the starting adult rate by band. For example, ages 36–40 use a 410 monthly baseline, while ages 41–45 use 470. Family cost is translated into “member units”: each adult counts as 1.00, and up to three children count as 0.60 each. Two adults and two children equals 2.20 units. A local cost index scales results; 0.85 mimics lower cost areas, 1.00 is average, and 1.25 reflects higher cost markets.
Plan level shifts premiums using factors: Catastrophic 0.75, Bronze 0.85, Silver 1.00, Gold 1.15, Platinum 1.30. Network choice adds another factor, such as HMO 0.95, EPO 1.00, POS 1.03, and PPO 1.08. Lower copays and lower coinsurance increase the benefit factor because the plan pays more. A 20% coinsurance and 30 copay behave like the baseline.
Deductible and out of pocket maximum adjust the estimate around baselines of 2,000 and 8,500. Increasing the deductible trends the deductible factor downward, while lowering the out of pocket maximum trends the OOP factor upward. Tobacco use applies a 1.20 surcharge factor. Administrative load is applied as a percentage multiplier, such as 8% turning 1,000 into 1,080. A wellness discount is then applied, such as 5% reducing 1,080 to 1,026.
Run a baseline scenario first, then vary one input at a time to isolate impact. Compare monthly premium and annual cost, and use the deductible sensitivity chart to visualize how premiums move. Finally, enter employer contributions and tax credits to estimate your payment, and export CSV or PDF for review.
These scenarios illustrate how changing plan design and credits can shift the estimate.
| Scenario | Age | Adults | Children | Index | Level | Network | Deductible | OOP Max | Credits | Estimated Monthly |
|---|---|---|---|---|---|---|---|---|---|---|
| Average single | 35 | 1 | 0 | 1.00 | Silver | EPO | USD 2,000.00 | USD 8,500.00 | None | USD 369.36 |
| High cost, richer | 50 | 1 | 0 | 1.25 | Gold | PPO | USD 1,000.00 | USD 6,000.00 | None | USD 879.70 |
| Family with credit | 42 | 2 | 2 | 1.00 | Silver | HMO | USD 3,000.00 | USD 9,000.00 | Tax USD 350.00/mo | USD 1,108.18 |
| Lower cost market | 29 | 1 | 0 | 0.85 | Bronze | EPO | USD 6,000.00 | USD 12,000.00 | None | USD 231.98 |
| Employer helps | 44 | 2 | 1 | 1.10 | Silver | POS | USD 2,500.00 | USD 8,500.00 | Employer USD 300.00/mo | USD 1,116.97 |
It scales the estimate for your market. Use 1.00 for average pricing, 0.85 for lower cost areas, and 1.25 for higher cost areas. It affects the premium before discounts and credits.
Children are converted into member units. Each adult counts as 1.00 unit, and up to three children count as 0.60 each. Additional children are not charged in the unit calculation.
Lower deductibles shift more early costs to the plan. The deductible factor increases when the deductible is lower than the baseline, which raises the estimated premium. Higher deductibles reduce that factor within set limits.
Lower copays and lower coinsurance imply richer benefits. The benefit factor increases when those values drop below the baseline. Higher copays or coinsurance slightly reduce the benefit factor in this planning model.
They are subtracted from the post-discount premium as monthly amounts. The calculator prevents negative results, so net premium cannot go below zero. Enter zeros if you are unsure about credits.
No. It is an illustrative estimate to compare scenarios and plan a budget. Actual prices depend on insurer filings, plan rules, underwriting limits where allowed, and enrollment timing.
Important Note: All the Calculators listed in this site are for educational purpose only and we do not guarentee the accuracy of results. Please do consult with other sources as well.