The premium is not the price of a health plan

Health plans are sold on the premium because the premium is the number that fits on a card. It is also the number least likely to decide what the year actually costs.

The real figure has three parts: what you pay in premiums, minus whatever subsidy applies, plus what you pay when you use the plan. Compare only the first part and you are comparing a third of the price.

The subsidy does not move when you change plans

This is the piece that surprises people, and it is the reason plan comparison is simpler than it looks. The Affordable Care Act premium tax credit is calculated from the benchmark plan — the second-lowest-cost silver plan for your household in your area — and from an expected contribution set as a percentage of income under the IRS applicable-percentage schedule. It is not calculated from the plan you pick.

So the credit is the same dollar amount whichever plan on the marketplace you buy. Choosing a cheaper plan does not shrink the credit; it reduces your net premium dollar for dollar. Choosing a dearer one raises it the same way.

A worked example, entirely hypothetical

Take a hypothetical household of three. Marketplace subsidies use the prior year's poverty guideline, so 2026 coverage uses the 2025 table, where three people is $26,650 (90 FR 5917). Put this hypothetical household at $53,300, which is exactly 200% of it. Under the 2026 applicable-percentage schedule, 200% carries an expected contribution of 6.60% of income: $53,300 × 6.60% = $3,517.80 a year.

Say the benchmark silver premium in this hypothetical area is $600 a month, so $600 × 12 = $7,200 a year. The credit is the benchmark minus the expected contribution: $7,200 − $3,517.80 = $3,682.20. That $3,682.20 is now fixed for this household, whichever plan it buys.

Two hypothetical plans:

• The hypothetical silver plan, at the benchmark price of $7,200 a year. Net premium $7,200 − $3,682.20 = $3,517.80.
• A hypothetical bronze plan at $430 a month, so $430 × 12 = $5,160 a year. Net premium $5,160 − $3,682.20 = $1,477.80.

On premium alone the bronze plan wins by $2,040 a year. Now add usage. In a light hypothetical year, say the silver plan costs $1,500 out of pocket and the bronze plan, with its higher deductible, costs $600:

• Hypothetical silver: $3,517.80 + $1,500 = $5,017.80.
• Hypothetical bronze: $1,477.80 + $600 = $2,077.80.

Bronze is $2,940 cheaper. Now a heavy hypothetical year — a surgery, a birth, a chronic condition — where both plans run to their out-of-pocket maximums, say $4,000 on the silver plan and $9,200 on the bronze:

• Hypothetical silver: $3,517.80 + $4,000 = $7,517.80.
• Hypothetical bronze: $1,477.80 + $9,200 = $10,677.80.

The hypothetical silver plan is now $3,160 cheaper. Same household, same subsidy, same two plans, opposite answer. The premium never told you which year you were going to have.

The number worth looking up first

Not the deductible — the out-of-pocket maximum. The deductible is where the plan starts sharing; the out-of-pocket maximum is the worst the year can get, and it is the number that makes a bad year survivable or not. Two plans with similar deductibles can have very different maximums.

One thing this arithmetic deliberately leaves out: silver plans at lower incomes can carry cost-sharing reductions that lower the deductible and the maximum, and the marketplace shows those on the plan itself. Read what your own marketplace prints rather than assuming the sticker figures.

The tool

PlanTrueCost asks for income, household size, region, the benchmark silver premium in your area, your chosen plan's premium and the out-of-pocket you expect, then prints your income as a percentage of the poverty line, the applicable percentage, the estimated credit, your net premium and the true annual cost. Run it once per plan and rank the results.

It uses the 2026 schedule with the 400% cliff as current law, and a toggle for the enhanced 8.5%-cap schedule if that is ever restored. Benchmark premiums are area-specific, so it asks rather than guesses. It is an estimate for comparing plans, not a determination and not advice about which plan to buy.