Metal tiers, benchmark premiums, and what you actually pay.
Health pricing is the most confusing line in American insurance, and the one where the sticker price is least likely to be the real price. Koala explains the machinery, subsidies included.
Free while in beta · An estimate, never a quote
What Koala prices this from
How this is calculated- Data source
- KFFKFF Health Insurance Marketplace benchmark (2nd-lowest silver) premium
- As of
- 2024The year the underlying figures describe
- Estimate band
- ±15%Around the midpoint, per person, age-rated from 40
- Coverage levels priced
- BronzeSilverGold
The policy, in plain English.
Marketplace health plans are sold in metal tiers that describe actuarial value: the share of covered costs the plan pays across a typical population. Bronze pays roughly 60%, silver 70%, gold 80%. A lower premium almost always means a higher deductible, not less coverage in kind.
- The ten essential health benefits every ACA plan must include
- Preventive care at no cost-sharing, in network
- Prescription drugs, subject to the plan's formulary
- Emergency care, hospitalization, and maternity
- Mental health and substance-use treatment
The levers, and the ones Koala can't see.
An estimate is only as honest as the list of things it ignores. Here is both halves.
Koala models these
Your age
The ACA age curve is explicit and public: a 64-year-old can be charged up to three times what a 21-year-old is charged for the same plan. Koala applies the published curve.
Where you live
Benchmark premiums are set by rating area and vary widely by state. Koala uses the KFF benchmark (second-lowest silver) as its anchor.
Which metal tier you pick
Bronze, silver, or gold, priced against the silver benchmark.
Koala does not model these
Your income, and therefore your subsidy
This is the big one, and Koala does not model it. Premium tax credits are calculated against the benchmark silver plan and your household income, and they can reduce what you actually pay to a fraction of the sticker price, or to nothing. Treat every health number Koala shows as a pre-subsidy figure.
Tobacco use and household composition
Both move real marketplace pricing. Neither is modeled here.
Estimated range based on published state/national rate data for similar profiles. This is not a quote and not an offer of insurance. Actual pricing depends on the specific insurer's underwriting and may differ from this estimate.
The same model, running.
Not a mock-up. This is a live health estimate for a sample household, computed by the engine that will run on yours, with every step it took printed underneath.
Silver
Sample household · Texas · two adults, ages 36 and 34
$7,858 to $10,632
per year · ≈$770/mo at the midpoint
What this assumed
- State
- state-level average for TX
- Household members
- 2 (ages: 36, 34)
- Metal tier
- Silver
The arithmetic
- 1Benchmark silver (age 40, state-level average for TX): $5,400/yr
- 2× household age-factor sum (1.71): $9,245/yr
- 3× Silver tier factor: ×1
- 4= estimated annual mid-point $9,245, shown as a ±15% range (before any premium tax credits)
The range shown is the midpoint ±15%. That band is not a confidence interval; it is the spread published rate data implies, and a real quote can land outside it.
Source: KFF Health Insurance Marketplace benchmark (2nd-lowest silver) premium · data as of 2024
An estimate, never a quoteThat is the whole calculation. There is no second model behind it. Build your profile to run it on your own household, or see the worked sample estimate.
Health questions
The things worth knowing before you compare a single price.
Why is the number Koala shows higher than what I'd actually pay?
Because it's the pre-subsidy premium. Most marketplace enrollees receive a premium tax credit based on income, and it is frequently the difference between an unaffordable number and an affordable one. Koala does not model income, so it shows the sticker price and says so.
Is bronze worse coverage than gold?
Not in what it covers. Every ACA plan covers the same essential health benefits. The difference is who pays: bronze has the lowest premium and the highest deductible, gold the reverse. Bronze is a bet that you won't need much care this year.
What is the benchmark plan?
The second-lowest-cost silver plan in your rating area. It has no special coverage; it exists because subsidies are calculated against it. That's why Koala anchors to it rather than to an average of all plans.
Want to go deeper? Read the guides or see how Koala works.
Already filed a health claim?
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Everything under this health estimate.
This page uses words that cost people money, and numbers that came from somewhere. Both have a page of their own.
- Read it
Reference
The glossary
Deductible, actual cash value, recoverable depreciation: what each means, and where it bites.
- Read it
Methodology
Where this number came from
The dataset behind this line, the exact arithmetic, and the levers Koala can't see.
- Read it
Guides
Playbooks for a live claim
What to document before you file, and how to check a settlement offer line by line.
See what health coverage should cost you.
Build your profile once and Koala estimates every line you carry, with the arithmetic shown, and no one selling you anything at the end of it.