Subsidy Cliff
See what your ACA marketplace plan actually costs once the enhanced subsidy is gone, compared plan by plan instead of premium by premium.
Subsidy Cliff
See what your ACA marketplace plan actually costs once the enhanced subsidy is gone, compared plan by plan instead of premium by premium.
Date: 2026-09-17 Form factor: web app Status: Prototype
What it is
Subsidy Cliff is a calculator for people shopping the ACA marketplace for 2027 coverage. You enter your state, household size, income, and age, and it shows what each plan will really cost for the year — premium after your tax credit, plus a rough estimate of out-of-pocket spending — instead of just the sticker premium healthcare.gov leads with. It also flags plainly if your income puts you over 400% of the federal poverty line, where the subsidy stops covering anything at all.
Who it serves
Marketplace shoppers renewing or picking a plan for the first time during the open enrollment window that starts November 1, 2026, especially anyone near the 400% FPL line who doesn't yet know whether they're about to lose their subsidy outright, or anyone comparing a cheap bronze premium against a pricier silver plan without a way to see which one actually costs less once medical bills hit.
Why it could be profitable
The monetization model is referral. A free calculator that, once someone sees their real cost and decides to switch plans, hands them to a licensed enrollment partner for a per-enrollment fee, the same model eHealth affiliates and HealthSherpa's broker network already run on. A paid tier is a second option: year-over-year cost tracking and a renewal reminder before the December 15 deadline, for people who want to be told when it's worth re-shopping instead of checking manually.
The timing is the pitch. The enhanced premium tax credits that capped everyone's contribution at 8.5% of income expired, and KFF reports insurers are raising pre-subsidy premiums by a weighted average of more than 23% nationwide for 2026, with people over 400% of the poverty line losing their subsidy entirely. That is the "cliff" this app is named for (KFF, kff.org). Open enrollment for 2027 coverage opens November 1, 2026, and the out-of-pocket maximum consumers face is rising too, to $10,600 for an individual, up from $9,200 (healthinsurance.org). None of the existing marketplace comparison tools I could find show total annual cost, premium plus expected out-of-pocket, side by side across plans. They mostly show the premium alone, which is the number this whole situation makes misleading.
The honest caveat: I haven't validated actual conversion rates for a lead-gen referral flow in this space, and insurance-adjacent lead gen is a competitive, CPL-driven market where established players like eHealth and HealthSherpa already have distribution. The wedge here is narrower than "no competition." It's total-cost math the big comparison sites don't surface.
Form factor & scope
This lives as a single web page, no login, no account, nothing that touches real personal data. It's not a filing tool and it doesn't submit anything to healthcare.gov. The prototype demonstrates the core calculation (subsidy math, cliff detection, total-cost comparison across metal tiers) using a sample plan catalog rather than a live marketplace feed, which a production version would need to pull from the CMS Marketplace API or state exchange data per state.
How to run it
- Open
index.htmldirectly in any modern browser — no local server needed. The sample plan catalog is embedded in the page as an inline JSON block (sample-data.jsonis also included in this folder as the same data, for reference and reuse) so it works from a plainfile://path. - Set your state, household size, income, and age in the left panel. The subsidy summary and plan table update as you type.
- Toggle "typical" vs "high" usage year to see how the total-cost estimate shifts once a plan's deductible actually gets used.
What's in this prototype
- A subsidy calculator using a simplified version of the ACA's sliding-scale contribution table, with an explicit "cliff" warning above 400% of the federal poverty line
- A countdown to the November 1, 2026 open enrollment start (and the December 15 deadline for January 1 coverage), computed from the browser's actual date
- A 20-plan sample catalog across five states and three metal tiers (two silver options per state), each with a premium, deductible, and out-of-pocket maximum
- A comparison table sortable by sticker premium or total estimated annual cost, so a cheaper premium and a cheaper year aren't assumed to be the same plan
- A disabled "connect with a licensed broker" button standing in for the referral flow a real version would wire up
Roadmap
- Pull live plan data from the CMS Marketplace API instead of the sample catalog
- Replace the simplified age-rating curve with the real 3:1 actuarial age table
- Add a real broker referral integration and track which plan comparisons convert
- Support multiple applicants on one household plan (kids, spouse) with individual ages
- Send a renewal-window reminder email before the December 15 deadline
Sources
- https://www.kff.org/affordable-care-act/what-we-know-so-far-about-2026-aca-marketplace-enrollment-premiums-and-deductibles/ — enhanced subsidy expiration, the 23%+ pre-subsidy premium increase, and enrollee counts
- https://www.healthinsurance.org/blog/2026-aca-open-enrollment-period-preview/ — 2026 out-of-pocket maximum increase to $10,600/$21,200
- https://www.healthcare.gov/quick-guide/dates-and-deadlines/ — open enrollment and coverage-start deadlines
- https://www.healthcare.gov/sep-list/ — special enrollment period rules referenced for the subsidy-eligibility-change case
Requirements
Subsidy Cliff — Requirements
Goals
- Show a marketplace shopper the total annual cost of a plan (premium after subsidy, plus expected out-of-pocket spending), not just the sticker premium
- Make the subsidy cliff visible and specific: if household income crosses 400% of the federal poverty line, say so plainly and show the subsidy dropping to zero
- Let a shopper compare plans across metal tiers on equal footing without doing the math by hand
Primary user
A household shopping the ACA marketplace for 2027 coverage during the open enrollment window that starts November 1, 2026 — renewing an existing plan or picking one for the first time. They know their rough income and household size but not how the sliding-scale subsidy formula works, and they've been told premiums are going up without a way to see what that means for their specific numbers.
Functional requirements
- FR1: Accept household size (1–6), annual household income, state, and primary applicant age as inputs
- FR2: Calculate household income as a percentage of the federal poverty line for the given household size
- FR3: Apply a sliding-scale expected-contribution percentage based on FPL band, using the bundled contribution schedule
- FR4: Calculate the monthly subsidy as the benchmark (second-lowest-cost silver) plan premium minus the expected monthly contribution, floored at zero
- FR5: Set subsidy to zero and display an explicit cliff warning when income exceeds 400% FPL
- FR6: Apply a simplified age-rating factor to each plan's listed premium before subsidy is applied
- FR7: Filter the plan catalog to the selected state and list every plan for that state with metal tier, insurer, and plan type
- FR8: Show, per plan: sticker monthly premium, monthly premium after subsidy, and estimated annual out-of-pocket spending
- FR9: Estimate annual out-of-pocket spending using a "typical usage year" assumption (a fraction of the deductible) and a "high usage year" assumption (the full out-of-pocket maximum), user-toggleable
- FR10: Compute and display total estimated annual cost per plan (12 × net premium + estimated out-of-pocket) under the selected usage assumption
- FR11: Let the user sort the plan comparison table by sticker premium or by total estimated annual cost
- FR12: Show a live countdown to the November 1, 2026 open enrollment start date and the December 15, 2026 deadline for January 1 coverage, computed from the browser's current date
- FR13: Recalculate all displayed values immediately when any input changes, with no page reload
- FR14: Include a disabled "connect with a licensed broker" button labeled as a placeholder for a referral integration
User stories
- As a marketplace shopper near the 400% FPL line, I want to see whether I'm about to lose my subsidy entirely, so that I'm not surprised by the December bill.
- As someone comparing a cheap bronze plan to a pricier silver plan, I want to see total annual cost instead of just premium, so that I don't pick the plan that's actually more expensive once I get sick.
- As a shopper who doesn't know the subsidy formula, I want the app to show my expected contribution percentage and the math behind it, so that I trust the number instead of taking it on faith.
- As someone renewing an existing plan, I want to see the open enrollment countdown, so that I know how much time I have before the December 15 deadline for January 1 coverage.
- As a shopper with a family, I want to enter my actual household size and see the FPL calculation change, so that the subsidy estimate reflects my situation, not a single filer's.
- As someone deciding between a typical and a bad health year, I want to toggle the usage assumption, so that I can see the cost range instead of one optimistic number.
Non-functional requirements
- No personal data leaves the browser — the prototype makes no network calls and stores nothing outside the page's own memory
- The plan catalog and FPL/contribution tables are clearly labeled as illustrative sample data, not live marketplace rates
- All dollar figures are rounded to the nearest whole dollar in the UI
- The page is usable on a phone-width viewport (single-column layout below 640px)
- Every subsidy and cost figure is a simplified estimate; the UI states this is not tax or insurance advice and points the user to healthcare.gov or a licensed broker for an authoritative quote
Out of scope (for the prototype)
- Live plan data from the CMS Marketplace API or a state exchange
- The real IRS 3:1 actuarial age-rating table (this prototype uses a simplified linear approximation)
- Multiple applicants with independent ages on one household plan
- Any actual broker referral integration or lead capture
- Medicaid/CHIP eligibility determination for incomes below 100% FPL
- State-based exchanges with enrollment windows that differ from the federal Nov 1–Jan 15 schedule
Open questions
- Is a flat referral fee per completed enrollment enough margin to cover the CPL cost of the traffic needed to reach shoppers before they land on healthcare.gov directly?
- Would a paid renewal-tracking tier hold up on its own, or does it only make sense bundled with the free calculator as a retention hook?
- How much does the simplified age-rating curve diverge from real quotes at the extremes (21 vs. 64), and does that gap undermine trust in the tool?
