About the ACA Age Rating Calculator
Under the Affordable Care Act, individual and small-group health insurers may charge older adults no more than three times what they charge a 21-year-old for the same plan, and the exact steps between ages follow an age curve. Most states use the federal default curve set by CMS: children 14 and under pay 0.765 times the age-21 rate, a 40-year-old pays 1.278 times, and anyone 64 or older pays 3.0 times. A few states use their own curve, and New York and Vermont do not vary premiums by age at all.
This calculator takes a premium quoted for any age, backs out the age-21 base rate, and rebuilds the premium for every person you list — useful for estimating what a plan will cost a family, how much a premium will rise on your next birthday, or what a parent’s benchmark plan costs compared with your own quote.
Family premiums are the sum of each member’s individual rate, but federal rules count no more than the three oldest children under age 21. In New York and Vermont, families instead pay a fixed multiple of the single rate set by family tier. Tobacco surcharges, plan-year rate increases and subsidies are not included; the state curves shown are the ones CMS published for plan years beginning in 2018, so confirm your state has not changed its curve since.
With the default inputs, the total monthly premium is $2,076.00. Change any value above to recalculate instantly.
How to use the aca age rating calculator
- 1Choose the federal default curve unless your state uses its own.
- 2Enter a premium you know and the age it was quoted for.
- 3List the ages of everyone who will be on the policy.
- 4Read the total premium and the per-person breakdown.
- 5Use the chart to see how the premium changes with age.
Formula and method
Every ACA-compliant individual and small-group premium is the plan’s base rate for a 21-year-old multiplied by an age factor F. Dividing any known premium by its age factor recovers that base rate, which can then be multiplied by the factor for any other age. Age bands are single years from 15 to 63, one band for ages 0–14 and one for 64 and older.
The federal default curve runs from 0.765 for children to 3.000 at 64+, keeping the oldest-to-youngest adult ratio at the legal maximum of 3:1. Family coverage is priced member by member and added up, except that only the three oldest covered children under 21 are counted. Under community rating (New York, Vermont) every age has a factor of 1 and families pay a fixed tier multiple of the single rate instead: New York 2.0 for two adults, 1.7 for one adult with children and 2.85 for two adults with children; Vermont 2.0, 1.93 and 2.81.
- F(age)
- Age rating factor from the chosen curve
- Base₂₁
- Monthly premium for a 21-year-old on the same plan
- Quote
- A known monthly premium at a known age
Worked examples
Family of six on the federal curve, $400 age-21 rate
The adults’ factors are 1.444 (45) and 1.357 (43). Only the three oldest children count: 0.859 (16), 0.765 (12) and 0.765 (9); the 6-year-old is free. The factors add to 5.19, so the family pays 5.19 × $400 = $2,076 a month.
Converting a 40-year-old’s quote to age 60
Dividing $520 by the age-40 factor of 1.278 gives an age-21 rate of $406.89. At 60 the factor is 2.714, so the same plan costs about $1,104 a month.
Family of four in New York
New York does not rate by age, so the single rate is the quoted $700 at any age. Two adults with children fall in the 2.85 family tier, so the family pays 2.85 × $700 = $1,995 a month however many children are covered.
Utah curve, two 30-year-olds and a toddler
Utah’s curve rises faster in the twenties: age 30 has a factor of 1.390 and children 0.793. The total factor is 1.39 + 1.39 + 0.793 = 3.573, or $1,786.50 a month at a $500 age-21 rate.
Frequently asked questions
How much more can older people be charged under the ACA?+
Insurers may charge adults 64 and older no more than three times the premium for a 21-year-old on the same plan (a 3:1 ratio). States can set a narrower ratio; New York and Vermont use pure community rating with no age variation.
What is the federal default age curve?+
It is the table of age factors CMS sets for states that do not adopt their own. It assigns 0.765 to ages 0–14, rises from 0.833 at 15 to 1.000 at 21–24, reaches 1.278 at 40 and 1.786 at 50, and caps at 3.000 at age 64 and older.
Do I pay for every child on a family health plan?+
No. Under 45 CFR 147.102, only the three oldest covered children under age 21 are counted when adding up a family premium. A fourth or later child under 21 is covered at no additional premium.
Does my premium go up on my birthday?+
Usually your age is set when the policy starts or renews, so your premium changes at the next plan year rather than on your birthday. Rate changes from the insurer and your new age both take effect at renewal.
Do premium tax credits depend on age?+
The credit is based on the age-rated price of the benchmark silver plan for your household and the share of income you are expected to pay. Because older people face higher benchmark premiums, their credits are usually larger at the same income.
How are family premiums set in New York and Vermont?+
Both states use community rating with uniform family tiers. In New York a couple pays 2 times the single rate, one adult with children 1.7 times and two adults with children 2.85 times; Vermont uses 2, 1.93 and 2.81. The number of children does not change the premium.
Results are estimates for educational purposes and are not financial advice. Rates, fees and terms vary — confirm with your lender or a licensed advisor before making decisions.