Your Household
Single · Age 40 · OHPrimary Insured
Spouse / Partner
Children (Dependents)
Dependents stay on your plan until 26. ACA caps premiums at 3 children.
Location & Plan
Advanced Assumptions
$
2026 Estimate
Unsubsidized · Non-TobaccoAnnual Household Premium
Monthly
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Annual
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At age 50
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At age 60
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| Member | Age | Monthly | Annual |
|---|---|---|---|
| Total household | — | — | |
The Healthcare Hump
Real (today's) dollars · +1.5% annual premium trend above CPIExcess above today's baseline
Projected annual premium
Today's annual premium (baseline)
How to read this: The shaded area is the extra cost above today's premium your portfolio needs to cover before Medicare at 65. Drops happen when dependents age off your plan at 26.
The Buffer Calculation
Additional FIRE portfolio neededPresent-Value Buffer (above your 4% Rule number)
—
at a 2% real return assumption
Educational estimate only - not financial advice. Verify rates at healthcare.gov.
2.0%
1.5%
Nominal Buffer
—
Raw sum of excess costs, undiscounted
Years to Medicare
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Years of unsubsidized ACA exposure
Peak Annual Cost
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Highest year before Medicare
Peak Year
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Your age at peak premium
How this works: The present value of every dollar your projected premiums exceed today's, discounted at your chosen real return. Add it to your 4% Rule FIRE number. The younger you retire and the leaner your target, the more this matters. Read the full analysis →
Methodology & Sources
Show your workData Sources
- Rate PUF (2026): Individual plan premiums by age, state, and rating area. CMS CCIIO, updated April 2026.
- Plan Attributes PUF (2026): Metal level classification (Silver, Bronze, Expanded Bronze). CMS CCIIO.
- SBE State Estimates: State-level average benchmark premiums for the 21 state-based exchange states not in the federal PUF, from KFF's 2026 Marketplace Average Benchmark Premiums analysis (enrollment-weighted SLCSP for a 40-year-old).
- OOP Costs: Mean annual out-of-pocket spending per privately insured person by age band. AHRQ Medical Expenditure Panel Survey (MEPS) 2023 Household Component. Includes deductibles, copays, coinsurance, and prescription drugs; excludes premiums.
- Coverage: 30 FFE/SBE-FP states with exact rating-area data; 21 SBE states with state-level estimates.
Calculation Methodology
- SLCSP: Second-lowest-cost silver plan premium at each rating area — the federal benchmark rate used for subsidy calculations.
- Bronze: Lowest-cost bronze or expanded bronze plan per rating area.
- Age projection: Uses actual plan rates at ages 21, 30, 40, 50, 60, and 64 from the Rate PUF, with linear interpolation for intermediate ages.
- Children: Child (under-21) rate from SLCSP; ACA caps family premium at 3 children's rates maximum. Dependents remain on plan to age 26.
- Tobacco: Surcharge derived from the IndividualTobaccoRate field in the Rate PUF. Not all states allow tobacco rating.
- State averages: Rating-area rates weighted by silver plan count as an enrollment proxy. Validated within ~1–3% (median) of KFF's published enrollment-weighted state benchmarks.
- Age rules: NY and VT are community rated (no age variation — flat projection). MA uses a 2:1 compressed age curve. All other states follow the federal 3:1 age band.
- OOP estimate: Population-average OOP spending by age from MEPS, interpolated across 12 age-band midpoints. Individual OOP varies widely by health status - healthy adults may spend near $0 while those with chronic conditions can hit the ACA max-OOP ($10,600/individual in 2026). The MEPS average is a planning midpoint, not a prediction.
- Premium growth: User-adjustable real growth above CPI (default 1.5%/yr). Applied as (1+g)^t to premiums only, not OOP. The 2026 plan year saw benchmark premiums rise ~26% nationally, driven by enhanced subsidy expiration and GLP-1 drug costs.
- MOOP stress test: Replaces the N highest-OOP years with the ACA max out-of-pocket limit ($10,600 individual / $21,200 family for 2026, per 45 CFR 156.130), inflated by the premium growth rate. A planning hedge for high-cost medical years, not a probability model.
- Bronze OOP factor: OOP estimates multiplied by 1.30x for bronze plans. Bronze carries higher deductibles and cost-sharing; the 30% uplift is a planning approximation.
- Premium tax credits: Optional toggle using current-law PTC rules (post-2025, with 400% FPL cliff). Applicable percentages from Rev. Proc. 2025-25. FPL from 2025 HHS guidelines. MAGI and FPL held constant in real terms across the projection. Credits are not the default - relying on income management to stay under the cliff is a strategy with real execution risk.
- Buffer: PV of (projected annual cost − today's baseline) from current age to 65, discounted at your chosen real return rate.
What this tool does not model: Medicare costs after 65 or cost-sharing reductions beyond the OOP estimates. Premium tax credits are off by default but can be toggled on for comparison (see the article for why relying on subsidies is a risky planning assumption). Premium growth above CPI is user-adjustable, defaulting to +1.5%/yr based on the ~26% national benchmark increase for the 2026 plan year. The 30 FFE states in the CMS Public Use File do not include CA, CO, CT, MA, MD, MN, NJ, NY, PA, WA, and others that operate their own state exchanges.
Rating areas are the geographic pricing unit for ACA premiums — each state divides into 1–67 rating areas. If you don't know yours, the state average gives a reasonable planning estimate. Differences within a state are typically 10–35%.
This tool is for educational and planning purposes only. It is not financial, legal, or insurance advice. Premiums shown are unsubsidized. Actual plan costs vary by specific plan, provider network, and enrollment date. Always verify current rates at healthcare.gov or your state exchange before making coverage decisions. BiggerPockets Money is not a licensed insurance agent or financial advisor.