HealthInsurance.help: 2027 ACA subsidy, Medicaid and COBRA math

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2027 ACA subsidy estimates, Medicaid/CHIP limits, COBRA vs marketplace math.

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compare_cobra_vs_marketplace Read-only

Compares the total cost of staying on COBRA with switching to a marketplace plan for the months you need coverage: premiums plus expected out-of-pocket costs, including the deductible reset when switching mid-year. Give the marketplace premium, or state, county, ages and income to estimate it as the benchmark silver plan after the 2027 credit.

cobra_monthlynumber, required

COBRA premium per month from the election notice.

agesarray

Ages of everyone on the plan, for the estimate.

statestring

Two-letter state code (e.g. TX, CA, DC) or full state name.

countystring

County name (e.g. "Harris" or "Harris County") or 5-digit county FIPS code.

monthsinteger

Months of coverage needed, e.g. until a new job's plan starts.

annual_incomenumber

Household income for the whole year, including what was earned before the job ended, for the estimate.

expected_carenumber

Medical bills expected in that time, before insurance.

deductible_metnumber

How much of that deductible is already met this year.

cobra_deductiblenumber

Deductible of the current (COBRA) plan.

marketplace_monthlynumber

Marketplace premium per month after the credit, if known. Otherwise give state, county, ages and annual_income.

marketplace_deductiblenumber

Deductible of the marketplace plan you would pick.

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compare_cobra_vs_marketplace Read-only

cobra_monthlynumber, required

COBRA premium per month from the election notice.

agesarray

Ages of everyone on the plan, for the estimate.

statestring

Two-letter state code (e.g. TX, CA, DC) or full state name.

countystring

County name (e.g. "Harris" or "Harris County") or 5-digit county FIPS code.

monthsinteger

Months of coverage needed, e.g. until a new job's plan starts.

annual_incomenumber

Household income for the whole year, including what was earned before the job ended, for the estimate.

expected_carenumber

Medical bills expected in that time, before insurance.

deductible_metnumber

How much of that deductible is already met this year.

cobra_deductiblenumber

Deductible of the current (COBRA) plan.

marketplace_monthlynumber

Marketplace premium per month after the credit, if known. Otherwise give state, county, ages and annual_income.

marketplace_deductiblenumber

Deductible of the marketplace plan you would pick.

Tools (6)

compare_cobra_vs_marketplace

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Argument	Type	Description
ages	array	Ages of everyone on the plan, for the estimate.
state	string	Two-letter state code (e.g. TX, CA, DC) or full state name.
county	string	County name (e.g. "Harris" or "Harris County") or 5-digit county FIPS code.
months	integer	Months of coverage needed, e.g. until a new job's plan starts.
annual_income	number	Household income for the whole year, including what was earned before the job ended, for the estimate.
cobra_monthly*	number	COBRA premium per month from the election notice.
expected_care	number	Medical bills expected in that time, before insurance.
deductible_met	number	How much of that deductible is already met this year.
cobra_deductible	number	Deductible of the current (COBRA) plan.
marketplace_monthly	number	Marketplace premium per month after the credit, if known. Otherwise give state, county, ages and annual_income.
marketplace_deductible	number	Deductible of the marketplace plan you would pick.

Input schema (JSON)

{
  "type": "object",
  "required": [
    "cobra_monthly"
  ],
  "properties": {
    "ages": {
      "type": "array",
      "items": {
        "type": "integer",
        "maximum": 120,
        "minimum": 0
      },
      "maxItems": 12,
      "minItems": 1,
      "description": "Ages of everyone on the plan, for the estimate."
    },
    "state": {
      "type": "string",
      "maxLength": 30,
      "minLength": 2,
      "description": "Two-letter state code (e.g. TX, CA, DC) or full state name."
    },
    "county": {
      "type": "string",
      "maxLength": 60,
      "minLength": 2,
      "description": "County name (e.g. \"Harris\" or \"Harris County\") or 5-digit county FIPS code."
    },
    "months": {
      "type": "integer",
      "default": 6,
      "maximum": 36,
      "minimum": 1,
      "description": "Months of coverage needed, e.g. until a new job's plan starts."
    },
    "annual_income": {
      "type": "number",
      "maximum": 10000000,
      "minimum": 0,
      "description": "Household income for the whole year, including what was earned before the job ended, for the estimate."
    },
    "cobra_monthly": {
      "type": "number",
      "maximum": 50000,
      "minimum": 1,
      "description": "COBRA premium per month from the election notice."
    },
    "expected_care": {
      "type": "number",
      "default": 0,
      "maximum": 10000000,
      "minimum": 0,
      "description": "Medical bills expected in that time, before insurance."
    },
    "deductible_met": {
      "type": "number",
      "default": 0,
      "maximum": 100000,
      "minimum": 0,
      "description": "How much of that deductible is already met this year."
    },
    "cobra_deductible": {
      "type": "number",
      "default": 0,
      "maximum": 100000,
      "minimum": 0,
      "description": "Deductible of the current (COBRA) plan."
    },
    "marketplace_monthly": {
      "type": "number",
      "maximum": 50000,
      "minimum": 0,
      "description": "Marketplace premium per month after the credit, if known. Otherwise give state, county, ages and annual_income."
    },
    "marketplace_deductible": {
      "type": "number",
      "default": 5000,
      "maximum": 100000,
      "minimum": 0,
      "description": "Deductible of the marketplace plan you would pick."
    }
  },
  "additionalProperties": false
}

estimate_premium_tax_credit

Estimates a household's 2027 ACA premium tax credit the way the site's subsidy calculator does: poverty-line percentage, IRS applicable percentage (Rev. Proc. 2026-26), expected monthly contribution, the age-rated benchmark silver premium for the county, the monthly credit, net cost of the lowest bronze, silver and gold plans, the 400% cliff, and a per-person income screen for Medicaid, CHIP or a Basic Health Program. An estimate, not an eligibility decision.

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Argument	Type	Description
state*	string	Two-letter state code (e.g. TX, CA, DC) or full state name.
county	string	County name (e.g. "Harris" or "Harris County") or 5-digit county FIPS code.
members*	array	Each person applying for coverage, e.g. [{"age":45},{"age":43,"pregnant":true},{"age":10}].
annual_income*	number	Expected 2027 household income (modified adjusted gross income) in dollars per year.
benchmark_monthly	number	Optional. The monthly price of the second-lowest-cost silver plan for the people applying, from HealthCare.gov or the state exchange. Replaces the county estimate; required for a credit in states that run their own exchange.
others_in_household

estimate_tax_credit_repayment

Form 8962 in miniature for tax year 2026 (returns filed in 2027), for a full year with the same household and plan: the premium tax credit allowed on final income versus the advance payments on Form 1095-A, and the excess to repay (no repayment cap from 2026) or the extra credit to claim.

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Argument	Type	Description
state*	string	Two-letter state code (e.g. TX, CA, DC) or full state name.
annual_income*	number	Final 2026 household income (modified AGI) in dollars.
advance_annual	number	Form 1095-A column C (advance payments), summed for the year.
household_size*	integer	People in the tax household.
benchmark_annual*	number	Form 1095-A column B (benchmark plan premium), summed for the year.
enrolled_premium_annual	number	Form 1095-A column A (your plan's premiums), summed. Defaults to the benchmark amount.

Input schema (JSON)

{
  "type": "object",
  "required": [
    "state",
    "household_size",
    "annual_income",
    "benchmark_annual"
  ],
  "properties": {
    "state": {
      "type": "string",
      "maxLength": 30,
      "minLength": 2,
      "description": "Two-letter state code (e.g. TX, CA, DC) or full state name."
    },
    "annual_income": {
      "type": "number",
      "maximum": 10000000,
      "minimum": 0,
      "description": "Final 2026 household income (modified AGI) in dollars."
    },
    "advance_annual": {
      "type": "number",
      "default": 0,
      "maximum": 1000000,
      "minimum": 0,
      "description": "Form 1095-A column C (advance payments), summed for the year."
    },
    "household_size": {
      "type": "integer",
      "maximum": 12,
      "minimum": 1,
      "description": "People in the tax household."
    },
    "benchmark_annual": {
      "type": "number",
      "maximum": 1000000,
      "minimum": 1,
      "description": "Form 1095-A column B (benchmark plan premium), summed for the year."
    },
    "enrolled_premium_annual": {
      "type": "number",
      "maximum": 1000000,
      "minimum": 0,
      "description": "Form 1095-A column A (your plan's premiums), summed. Defaults to the benchmark amount."
    }
  },
  "additionalProperties": false
}

get_county_plan_prices

Monthly premiums before any credit from CMS's plan file for a county in a HealthCare.gov state: the benchmark (second-lowest-cost silver) and the lowest bronze, silver and gold plan for a 40-year-old non-smoker, number of insurers and plans, and the same prices age-rated for the ages you give. Omit county for the state's range (median, lowest and highest benchmark).

read-only

Argument	Type	Description
ages	array	Optional ages of everyone on the plan, e.g. [62, 60], to price the household instead of one 40-year-old.
state*	string	Two-letter state code (e.g. TX, CA, DC) or full state name.
county	string	County name (e.g. "Harris" or "Harris County") or 5-digit county FIPS code.

Input schema (JSON)

{
  "type": "object",
  "required": [
    "state"
  ],
  "properties": {
    "ages": {
      "type": "array",
      "items": {
        "type": "integer",
        "maximum": 120,
        "minimum": 0
      },
      "maxItems": 12,
      "minItems": 1,
      "description": "Optional ages of everyone on the plan, e.g. [62, 60], to price the household instead of one 40-year-old."
    },
    "state": {
      "type": "string",
      "maxLength": 30,
      "minLength": 2,
      "description": "Two-letter state code (e.g. TX, CA, DC) or full state name."
    },
    "county": {
      "type": "string",
      "maxLength": 60,
      "minLength": 2,
      "description": "County name (e.g. \"Harris\" or \"Harris County\") or 5-digit county FIPS code."
    }
  },
  "additionalProperties": false
}

get_medicaid_chip_limits

A state's Medicaid, CHIP and Basic Health Program income limits as a percent of the poverty line and in 2026 dollars per month and per year for a household size, by group (adults, parents, pregnancy, children by age, CHIP). With an income, also says which limits it is under. A screen of published limits, not an eligibility decision.

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Argument	Type	Description
state*	string	Two-letter state code (e.g. TX, CA, DC) or full state name.
annual_income	number	Optional household income per year, to compare with each limit.
household_size	integer	People in the household, usually everyone on the tax return. A pregnant woman counts as two or more.

Input schema (JSON)

{
  "type": "object",
  "required": [
    "state"
  ],
  "properties": {
    "state": {
      "type": "string",
      "maxLength": 30,
      "minLength": 2,
      "description": "Two-letter state code (e.g. TX, CA, DC) or full state name."
    },
    "annual_income": {
      "type": "number",
      "maximum": 10000000,
      "minimum": 0,
      "description": "Optional household income per year, to compare with each limit."
    },
    "household_size": {
      "type": "integer",
      "default": 1,
      "maximum": 12,
      "minimum": 1,
      "description": "People in the household, usually everyone on the tax return. A pregnant woman counts as two or more."
    }
  },
  "additionalProperties": false
}

get_state_marketplace_facts

For one state: where to enroll (HealthCare.gov or the state exchange, with its URL), 2027 open enrollment start and end dates and the last day for January 1 coverage, Medicaid expansion status, any state coverage mandate and penalty, state premium help programs, the 2027 average rate change where the regulator published one, and short-term plan rules.

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Argument	Type	Description
state*	string	Two-letter state code (e.g. TX, CA, DC) or full state name.

Input schema (JSON)

{
  "type": "object",
  "required": [
    "state"
  ],
  "properties": {
    "state": {
      "type": "string",
      "maxLength": 30,
      "minLength": 2,
      "description": "Two-letter state code (e.g. TX, CA, DC) or full state name."
    }
  },
  "additionalProperties": false
}

HealthInsurance.help: 2027 ACA subsidy, Medicaid and COBRA math

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compare_cobra_vs_marketplace Read-only

HealthInsurance.help: 2027 ACA subsidy, Medicaid and COBRA math

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compare_cobra_vs_marketplace Read-only

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