Healthcare Open Enrollment should be simple and easy. Understanding the relationship between Income, Health Insurance Premiums, and ACA subsidies is important in navigating the insurance marketplace and making wise and beneficial choices. This calculator is a helpful start.
Throughout the country, for every household with income less than 400% of the Federal Poverty Level (FPL), the maximum health insurance premium will be the same (Alaska and Hawaii with minor differences.)
A 3 person household in San Francisco making $50,000/year will pay the same maximum amount for premiums as a downtown Detroit household or a family in rural Kansas. Age, zip code, and pre-existing conditions are not a factor.
Health Insurance Premium Calculator
Usage
Inputs:
Coverage Year: Which year is the coverage active? e.g. 2021 => Jan 1, 2021 - Dec 31, 2021State: In which State do you live, Alaska, Hawaii, or the lower 48 / DC?
Household size: Household size = taxpayer + spouse (if applicable) + tax dependents (max: 10)
MAGI: What is your estimated MAGI (Modified Adjusted Gross Income) for the coverage year?
MAGI is often the same as your Adjusted Gross Income (AGI, Line 7 on the 1040) but could be different if you have tax-exempt interest, Social Security income, or excluded foreign earned income. See this excellent primer for more.
Outputs:
Household FPL: FPL level for the input household size and incomeFor a detailed understanding of FPL for your household size, see Federal Poverty Levels for ACA / Obamacare.
Max Contribution percentage: the maximum percentage of MAGI that a household will need to pay for the Second-Lowest Cost Silver Plan (SLCSP.) e.g. in 2020, for 300%-400% FPL the maximum contribution is 9.78%.
Data sourced from HHS poverty guidelines.The actual subsidy value is equal to the full cost of the SLSCP minus the expected household contribution.
If you select a more expensive Silver Plan or Gold Plan, actual premiums may be higher. If you select a lower cost Silver Plan or Bronze Plan, actual premiums may be lower, but the subsidy amount can be applied to any marketplace plan.
If this isn't clear, please review Obamacare Optimization in Early Retirement.
Annual Premium: Max contribution percentage * MAGIMonthly Premium: Annual Premium / 12
Comments:
Households with income below 138% FPL (or 100% FPL in non-Medicare expansion states) will not qualify for ACA subsidies and will instead enroll in Medicaid.
Households with income greater than 400% FPL are not eligible for subsidies and will pay full/unsubsidized premiums.
For a deeper level of understanding for the complex tradeoffs between income, taxes, and ACA subsidies, please review:
- Obamacare Optimization in Early Retirement
- Obamacare Optimization vs Tax Minimization
- Obamacare Advanced Premium Tax Credit Repayment Limitation
Call to Action
For quotes on 2020 ACA health insurance policies, head to HealthCare.gov 
Hi,
Very timely post. Keep up the great work! There is no coverage when travelling overseas, correct?
Some plans might allow for emergency coverage overseas, but most likely not. Even out of State coverage is sketchy… how a policy defines “emergency” can be the difference between being reimbursed and not. Travel insurance is cheap “insurance” (ahem) if it isn’t clear from reading your policy fine print.
Hi. Ordinary dividends and capital gains, (among others), must be included in the MAGI calculation for the ACA. What are some income-reducing options for those in the ER community, especially single retirees, with portfolios spinning off a decent amount of dividends, and perhaps having to sell a portion of their portfolio to fund annual living expenses, therefore realizing a capital gain? I’m single with zero dependents and am inching dangerously close to the “subsidy cliff”. Thanks.
There aren’t really many options… even giving away money (charitable contributions) doesn’t help. HSA contributions are maybe the only real way to reduce MAGI besides earning less.
More out of the box thinking: You could potentially go abroad for a year, and use that time to step-up basis (even if it results in taxes paid.) You could also do this domestically and just pay full price for insurance for the year.
Dan- hold cefs like ETV in a taxable account and due to high ROC due to option writing you will only pay your tax rate on about 10% of the monthly/annual distro….currently etv yields 8% and pays monthly…thus monthly income that aca does not car about >>>ROC….fyi this reduces your cost basis over time until you ever sell which you will pay the tax man accordingly. Otherwise I plan to never sell and no tax due on the roc amount until cost basis reaches zero…other cefs like ETV are EXG,ETJ and EXD
Thank you for this!! We kept our income down this year to do some Roth converting and it was a challenge to figure how much to convert and without triggering buku health premium payback/penalty. This calculator definitely helps us to plan for 2020!! Thank you!!
Please be careful… even $1 over, and BOOM!
Triple check your math and don’t rely completely on this (or any) online calculator.
Exactly right! I was glad to come across that info because at 12%, we thought about converting up to the next bracket! I left a good cushion in there for any error or forgetting something. Thank you for you helpful info!!
I’m going to put in $19K IRA contribution for 2019. Is the MAGI before or after the IRA contribution?
After. See MAGI definition.
Note that some states have other FPL qualification limits – for example, MN requires MAGI >200% FPL to qualify for ACA, because it has another healthcare option between Medicaid and ACA.
NY also I believe (the BHP option.) Or many states with Medicaid or similar covering children at higher FPL levels.
Household size is described as people that will be covered by the policy – is that definitely correct? I have a household of 2, my son and myself. I claim him as a tax dependent, but his health insurance is covered by his father, my ex-husband. Thanks for this work!
No, I phrased that poorly (I updated it, thanks!) Household size is taxpayer + spouse (if applicable) + tax dependents (with some exceptions.)
Nice work! Wish I had this calculator when the ACA was first introduced.
Thanks!
Seems to match both my back of envelope guestimate and the conversation I had earlier this year with an Obamacare Broker. Like a lot things to do with Government/IRS you never REALLY know what the outcome will really be until the following year. Having a nice easy to use calculator like this helps with planning/projections. Thanks!
(13 work days and counting until retirement!)
13 days?! Congratulations!
Thanks for checking the numbers
Do Roth IRA withdrawals count toward MAGI?
Qualified Roth IRA withdrawals do not.
I have a question. My husband will be on Medicare. I will be on Aca. For Aca purposes, what magi should u use? Will it be Magi for both my husband and I? If so, that will include his SS, pension, and our dividends, etc.. so, even though I will Aca just for myself, I will have to consider his income, too?
MAGI is for the household (your combined income.)
Although your combined MAGI will be higher than yours alone, subsidies are also based on household size – the federal poverty level will be higher for household size of 2 vs 1.
Does the long term cap gain count towards MAGI even if you have capital loses from a different account in the current or prior years to offset? I understand the overall tax liability will be zero but just not sure if the difference between gains and loses is considered as MAGI or will the total gain be considered as MAGI. Sorry for this basic question but just cant seem to figure this out.
Thank you so much for your valuable posts that have made early retirement possible for us in mid 30s!
Taxable gains / MAGI is what remains after you sum all realized gains and losses in taxable accounts
Thanks!
Have you looked at the new Secure Act 2.0 rules as they relate to “catch-up” contributions? I’m wondering about the relative value of putting those catch-up contributions in a Roth account vs making them as deductible contributions (if allowed) that might qualify one for better insurance subsidies. I’m not sure where to start to assess these options, though. Any thoughts?
Regular contribution or catch-up contribution, the analysis is the same.
If the marginal tax rate on the contribution is higher than the marginal rate on withdrawal, then a normal / Traditional / pre-tax contribution makes sense. If the opposite, then Roth is better.
Figuring out the marginal rate from the ACA takes some getting used to, but you can start here:
Obamacare Optimization in Early Retirement
Obamacare Optimization vs Tax Minimization