What is the healthcare hump?

ACA premiums rise steeply with age — federal rules allow a 64-year-old to be charged three times what a 21-year-old pays. For early retirees, that creates a growing annual cost between retirement and Medicare at 65 that the standard 4% Rule does not capture. This tool sizes that gap and the extra portfolio buffer needed to fund it.

What plan year does the estimator use?

The 2026 ACA plan year. Premiums come from the CMS 2026 Health Insurance Exchange Public Use Files for the 30 federal-exchange states, with state-level 2026 benchmark estimates for the 21 state-based-exchange states. Out-of-pocket estimates come from the AHRQ Medical Expenditure Panel Survey.

Does it include premium tax credits (subsidies)?

By default, no — it shows worst-case unsubsidized costs, because relying on subsidies is a risky long-horizon planning assumption. You can toggle on a premium tax credit scenario that applies the post-2025 rules, including the 400% of federal poverty level eligibility cliff that returned when the enhanced credits expired at the end of 2025.

Is the estimator free, and where does my data go?

It is free and runs entirely in your browser. All inputs are calculated locally and are not sent anywhere.

Can I use it to choose or buy a health plan?

No. It is a planning estimate, not insurance advice and not an enrollment tool. Actual plan costs vary by specific plan, network, and county — always verify current rates at healthcare.gov or your state exchange before making coverage decisions.

BiggerPockets Money · Healthcare Lab · 2026 CMS Rate Data

The Healthcare Cost Projection

Model your ACA unsubsidized premiums from today to Medicare and see the full cost of the bridge your FIRE plan needs to fund.

Your Household

+ partner age 35 · 2 kids · Colorado

Primary Insured

Your current age

Tobacco user?

Spouse / Partner

Include a second adult?

Spouse / partner age

Spouse tobacco user?

Children (Dependents)

Children on this plan

Child 1 age

Child 2 age

Child 3 age

Child 4 age

Dependents stay on your plan until 26. ACA caps premiums at 3 children.

Location & Plan

Any ZIP, city, or state resolves to a statewide average. Rates within a state vary by rating area (often 10–35%); this tool doesn't price an individual ZIP or county.

Plan type

Include estimated OOP costs?Deductibles, copays, Rx - MEPS-informed estimates

Advanced Assumptions

Know your actual quote?Monthly premium from healthcare.gov - leave blank to use modeled rates

Subsidy scenario

Planned annual MAGIModified adjusted gross income for the coverage year

2026 Estimate

Unsubsidized · Non-Tobacco

Annual Household Cost

Monthly premium

—

Annual premium

—

At age 50

—

At age 60

—

Member	Monthly	Annual
Total premium	—	—
Total household	—	—
Est. premium tax credit	—	—
Net with credits	—	—

The Healthcare Hump

Unsubsidized · Real (today's) dollars · +1.5% annual premium trend above CPI

Excess above today's baseline

Projected annual premium — unsubsidized

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 needed

Present-Value Buffer (above your 4% Rule number)

—

at a 2% real return assumption

Educational estimate only - not financial advice. Verify rates at healthcare.gov.

Real return assumption 2.0%

Premium growth above CPI 1.5%

Stress test: years hitting plan max OOP

Undiscounted Buffer

—

Raw sum of excess costs in real (today's) dollars, no discounting

Years to Medicare

—

Years of unsubsidized ACA exposure

Peak Annual Cost

—

Highest year before Medicare

Peak Year

—

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 work

Data 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: MEPS-informed planning estimates of annual out-of-pocket spending by age band, adjusted upward from AHRQ MEPS 2023 population means to reflect individual-market cost sharing (higher deductibles than the employer plans that dominate MEPS). Includes deductibles, copays, coinsurance, and prescription drugs; excludes premiums. These are planning figures, not published MEPS means.
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: MEPS-informed OOP figures by age, adjusted upward for individual-market cost sharing and 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 figure is a planning midpoint, not a prediction or a published survey mean.
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 the 2025 HHS poverty guidelines ($32,150 for a family of four), which govern premium tax credits for the 2026 coverage year; the 2026 guidelines published in January 2026 ($33,000 for a family of four) apply to 2027 coverage. Household size for the FPL test is approximated by plan household each year (kids drop out at 26). 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%.

Data notes: A few states carry less intra-state detail than the rest. Arkansas currently shows a single statewide figure across all rating areas; Oregon and Montana have whole-dollar (rounded) rates in several areas; Mississippi's bronze plans price unusually close to silver; and one Michigan rating area's lowest bronze prices slightly above its silver benchmark (several others sit just below it). These reflect the source extract and are being reconciled against the CMS 2026 Rate PUF — treat those states' figures as approximate.

BiggerPockets Money

Citations: Centers for Medicare & Medicaid Services. (2025). 2026 Health Insurance Exchange Public Use Files. cms.gov. | KFF. (2025). Marketplace Average Benchmark Premiums, 2026. kff.org. | AHRQ MEPS 2023 Household Component (OOP figures are MEPS-informed planning adjustments, not published means). meps.ahrq.gov. | IRS Rev. Proc. 2025-25 (PTC applicable percentages). | HHS 2025 Poverty Guidelines. | Tool built by BiggerPockets Money.
© 2026 Early Retirement Group, LLC d/b/a BiggerPockets Money. All rights reserved.

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.