Methodology

Q: Where does the premium data come from?

Each row in our database is sourced from primary regulator-published rate filings: CMS QHP Landscape, CMS FFM Exchange Rate PUF (30 FFM states), CMS SBE Rate PUF (20 SBM states when published), Georgia Access Rate PUF, Illinois DOI SERFF-mirror XLS filings, NJ DOBI Individual Health Coverage rate filings, and direct SERFF URRT extracts where the PUF path is unavailable. We never use third-party aggregators as the cheapest-plan source of truth.

Q: How do you compute premiums for ages other than 21?

Premiums are stored at the age-21 rate in our database (the federally-required base age). To price any age 14-64 we multiply by the HHS standardized age-rating factor (45 CFR 147.102 Table). Per the regulation, only the three oldest children under 21 are charged premiums; the 4th+ are free. Tobacco-rated plans use the carrier's per-filing tobacco factor (typically 1.075-1.50x) when the user toggles tobacco-user on.

Q: What is the "benchmark Silver" plan and why does it matter?

The benchmark Silver is the second-lowest-cost Silver plan available in the user's county (rated for their household). The IRS uses the benchmark Silver to compute Advance Premium Tax Credit (APTC) under 26 CFR §1.36B. APTC = max(0, benchmarkSilverAnnual − income × applicablePct), where applicablePct comes from the IRS contribution-percentage table (Rev. Proc. 2025-25 for PY2026). APTC then applies to the plan the user actually picks, capped at gross premium (and per-plan EHB%, see below).

Q: What is the EHB% cap?

Plans with non-Essential-Health-Benefit components — most commonly the §1303 abortion-coverage rider, adult dental, or vision — carry a fraction <1.0 in their EHB-percent attribute. Per 26 CFR §1.36B-3(c)(3)(iii), the non-EHB portion of premium is NOT APTC-eligible. So applied APTC = min(monthlyAptc, grossPremium × ehbPercent). The user pays any non-EHB residual out of pocket. We model this exactly the way HealthCare.gov does (verified against probe plan 48286IA0020012).

Q: How does the 2026 APTC contribution curve work?

The ARPA/IRA enhanced subsidies expired 2025-12-31 and Congress has not extended them, so PY2026 reverts to the pre-ARPA contribution-percentage table. The curve is piecewise-linear over six FPL brackets (100-133, 133-150, 150-200, 200-250, 250-300, 300-400) per Rev. Proc. 2025-25. Above 400% FPL: ineligible (the cliff returns). Below 100% FPL in expansion states: Medicaid-eligible (no APTC). Below 100% in non-expansion states: coverage gap (no Medicaid, no APTC). 100-138% FPL adults in expansion states are also Medicaid-eligible per 26 USC §36B(c)(2)(B), so APTC = $0.

Q: How do you resolve a ZIP code to a county?

ZIP codes can span multiple counties. We use the HUD USPS ZIP-to-FIPS crosswalk (residential ratios). When any non-top candidate has a residential ratio above 0.20, we surface a county picker so the user can pick their actual county. Multi-county ZIPs are tagged in the API response so the results page renders a 'Not this county? Pick a different one' affordance. FIPS codes are always zero-padded to 5 characters in our database — a bare integer FIPS would silently break county joins.

Q: Why does the same plan have different prices in different counties?

Carriers file rates at the rating-area level (a state-defined geographic unit, typically a group of counties). One plan can have different filed rates across rating areas within the same state. AK, MA, and CA-LA have multi-rating-area resolutions inside a single FIPS — for those we use ZIP-aware rating-area resolution to pick the correct filed rate.

Q: How do state premium subsidies stack on federal APTC?

Seven states publish their own premium subsidy programs for PY2026: California, Colorado, Connecticut, Maryland, New Jersey, Vermont, Washington. Each program has its own eligibility gates and formulas. Stacking is always federal APTC first, then state subsidy on top. CA/CT/MD subtract federal APTC inside their formulas; CO/NJ/VT/WA add on top of whatever federal APTC returned. Net premium = max(0, gross − federalAptc − stateSubsidy), with the EHB% cap applied to the federal APTC component.

Q: How often is the data refreshed?

Annually, on the OEP cycle (typically October-November for the next plan year). Plan year 2026 data was last refreshed 2026-04-19T08:08:55.462Z. Mid-year corrections happen when CMS publishes errata or when a state DOI publishes amended filings.

Plan year 2026, last refreshed 2026-04-19T08:08:55.462Z.

Every dollar figure on this site comes from regulator-published primary sources. This page documents the data pipeline and the formulas, so you can verify our work against the underlying regulations.

Data sources

CMS QHP Landscape file (federal facilitated marketplace, 30 FFM states): on-exchange QHP per-county per-plan rates, refreshed annually for OEP.
CMS FFM Exchange Rate PUF: per-plan × per-rating-area × per-age × tobacco rates for the 30 FFM states. Fills the non-cheapest-Silver lookup needed for benchmark Silver math.
CMS SBE Rate PUF: same shape as the FFM Rate PUF, scoped to the 20 state-based marketplaces. Published annually after PY-N OEP open. Replaces HIX Compare as the source of truth for SBM jurisdictions.
Georgia Access Rate PUF: GA's state-specific rate filings since GA exited the FFM in 2024.
Illinois DOI SERFF-mirror XLS filings: per-carrier individual-market rate tables published by the IL Department of Insurance.
NJ DOBI Individual Health Coverage rate filings: ihcrates2026.pdf parsed into per-plan rates via fuzzy plan-name matching.
SERFF URRT extracts: when none of the above is available for a given carrier × state × plan-year, we extract the Unified Rate Review Template directly from SERFF filings.

Computation pipeline

User enters ZIP + age (+ optional income, household size, tobacco).
ZIP → FIPS via the HUD USPS crosswalk. Multi-county ZIPs surface a picker when the runner-up county has >20% residential ratio.
For the resolved FIPS, load every plan in the per-state shard that matches the rating area (AK / MA / CA-LA use ZIP-aware rating-area resolution).
Compute household premium per plan: HHS age-rating curve (45 CFR 147.102) applied to age-21 base, with the 3-child rule (only the three oldest children <21 charged) and tobacco surcharge (per-filing tobacco factor) when applicable.
If income provided: compute FPL %, classify subsidy state (Medicaid-likely, coverage-gap, APTC-eligible, ineligible-over-400), compute monthly APTC against the second-lowest-cost Silver, compute state subsidy if applicable, apply EHB% cap on APTC component.
Sort by net premium (income provided) or gross premium (no income). Return the cheapest single plan plus a fallback if the cheapest is a Catastrophic for someone 30+ without a hardship exemption.

Frequently asked questions

Where does the premium data come from?

Each row in our database is sourced from primary regulator-published rate filings: CMS QHP Landscape, CMS FFM Exchange Rate PUF (30 FFM states), CMS SBE Rate PUF (20 SBM states when published), Georgia Access Rate PUF, Illinois DOI SERFF-mirror XLS filings, NJ DOBI Individual Health Coverage rate filings, and direct SERFF URRT extracts where the PUF path is unavailable. We never use third-party aggregators as the cheapest-plan source of truth.

How do you compute premiums for ages other than 21?

Premiums are stored at the age-21 rate in our database (the federally-required base age). To price any age 14-64 we multiply by the HHS standardized age-rating factor (45 CFR 147.102 Table). Per the regulation, only the three oldest children under 21 are charged premiums; the 4th+ are free. Tobacco-rated plans use the carrier's per-filing tobacco factor (typically 1.075-1.50x) when the user toggles tobacco-user on.

What is the "benchmark Silver" plan and why does it matter?

The benchmark Silver is the second-lowest-cost Silver plan available in the user's county (rated for their household). The IRS uses the benchmark Silver to compute Advance Premium Tax Credit (APTC) under 26 CFR §1.36B. APTC = max(0, benchmarkSilverAnnual − income × applicablePct), where applicablePct comes from the IRS contribution-percentage table (Rev. Proc. 2025-25 for PY2026). APTC then applies to the plan the user actually picks, capped at gross premium (and per-plan EHB%, see below).

What is the EHB% cap?

Plans with non-Essential-Health-Benefit components — most commonly the §1303 abortion-coverage rider, adult dental, or vision — carry a fraction <1.0 in their EHB-percent attribute. Per 26 CFR §1.36B-3(c)(3)(iii), the non-EHB portion of premium is NOT APTC-eligible. So applied APTC = min(monthlyAptc, grossPremium × ehbPercent). The user pays any non-EHB residual out of pocket. We model this exactly the way HealthCare.gov does (verified against probe plan 48286IA0020012).

How does the 2026 APTC contribution curve work?

The ARPA/IRA enhanced subsidies expired 2025-12-31 and Congress has not extended them, so PY2026 reverts to the pre-ARPA contribution-percentage table. The curve is piecewise-linear over six FPL brackets (100-133, 133-150, 150-200, 200-250, 250-300, 300-400) per Rev. Proc. 2025-25. Above 400% FPL: ineligible (the cliff returns). Below 100% FPL in expansion states: Medicaid-eligible (no APTC). Below 100% in non-expansion states: coverage gap (no Medicaid, no APTC). 100-138% FPL adults in expansion states are also Medicaid-eligible per 26 USC §36B(c)(2)(B), so APTC = $0.

How do you resolve a ZIP code to a county?

ZIP codes can span multiple counties. We use the HUD USPS ZIP-to-FIPS crosswalk (residential ratios). When any non-top candidate has a residential ratio above 0.20, we surface a county picker so the user can pick their actual county. Multi-county ZIPs are tagged in the API response so the results page renders a 'Not this county? Pick a different one' affordance. FIPS codes are always zero-padded to 5 characters in our database — a bare integer FIPS would silently break county joins.

Why does the same plan have different prices in different counties?

Carriers file rates at the rating-area level (a state-defined geographic unit, typically a group of counties). One plan can have different filed rates across rating areas within the same state. AK, MA, and CA-LA have multi-rating-area resolutions inside a single FIPS — for those we use ZIP-aware rating-area resolution to pick the correct filed rate.

How do state premium subsidies stack on federal APTC?

Seven states publish their own premium subsidy programs for PY2026: California, Colorado, Connecticut, Maryland, New Jersey, Vermont, Washington. Each program has its own eligibility gates and formulas. Stacking is always federal APTC first, then state subsidy on top. CA/CT/MD subtract federal APTC inside their formulas; CO/NJ/VT/WA add on top of whatever federal APTC returned. Net premium = max(0, gross − federalAptc − stateSubsidy), with the EHB% cap applied to the federal APTC component.

How often is the data refreshed?

Annually, on the OEP cycle (typically October-November for the next plan year). Plan year 2026 data was last refreshed 2026-04-19T08:08:55.462Z. Mid-year corrections happen when CMS publishes errata or when a state DOI publishes amended filings.

Primary regulatory sources

45 CFR § 147.102 — age-rating curve
26 USC § 36B — Refundable credit for coverage under a qualified health plan (APTC statute)
26 CFR § 1.36B-3 — APTC computation regulations (including EHB% cap subsection (c)(3)(iii))
Rev. Proc. 2025-25 — PY2026 Applicable Percentage Table (IRB 2025-32)
45 CFR § 156.155 — Catastrophic plan eligibility
HHS Poverty Guidelines — 2025 FPL table used for PY2026 coverage
CMS Marketplace Data Resources — QHP Landscape, Rate PUFs, Plan Attributes PUFs

Read more in our ACA glossary and our about page.