Healthcare Coverage Eligibility Estimator
ANA›Life Services Authority›National Calculator Authority›Healthcare Coverage Eligibility Estimator
.calc-container { max-width: 640px; margin: 2rem 0; padding: 1.5rem; background: #fff; border: 1px solid #ddd; border-radius: 8px; box-shadow: 0 1px 3px rgba(0,0,0,0.06); font-family: system-ui, -apple-system, sans-serif; } .calc-container h3 { font-family: Georgia, serif; font-size: 1.15rem; color: #1a1a1a; margin-bottom: 1rem; padding-bottom: 0.5rem; border-bottom: 2px solid var(--ac, #3d5a80); } .calc-row { display: flex; align-items: center; gap: 0.75rem; margin-bottom: 0.75rem; flex-wrap: wrap; } .calc-row label { min-width: 160px; font-size: 0.9rem; color: #333; font-weight: 500; } .calc-row input[type="number"], .calc-row select { flex: 1; min-width: 120px; max-width: 200px; padding: 0.5rem 0.6rem; border: 1px solid #ccc; border-radius: 4px; font-size: 0.9rem; font-family: system-ui, sans-serif; color: #1a1a1a; background: #fafaf8; } .calc-row input:focus, .calc-row select:focus { outline: none; border-color: var(--ac, #3d5a80); box-shadow: 0 0 0 2px rgba(26,74,138,0.12); } .calc-row .unit { font-size: 0.82rem; color: #888; min-width: 30px; } .calc-btn { display: inline-block; margin-top: 0.5rem; padding: 0.55rem 1.5rem; background: var(--ac, #3d5a80); color: #fff; border: none; border-radius: 4px; font-size: 0.9rem; font-weight: 600; cursor: pointer; font-family: system-ui, sans-serif; } .calc-btn:hover { opacity: 0.9; } .calc-result { margin-top: 1.25rem; padding: 1rem 1.25rem; background: #f0f6fc; border-left: 3px solid var(--ac, #3d5a80); border-radius: 0 6px 6px 0; display: none; } .calc-result.visible { display: block; } .calc-result-label { font-size: 0.78rem; text-transform: uppercase; letter-spacing: 0.06em; color: #666; margin-bottom: 0.25rem; } .calc-result-value { font-size: 1.6rem; font-weight: 700; color: var(--ac, #3d5a80); } .calc-result-detail { font-size: 0.85rem; color: #555; margin-top: 0.5rem; line-height: 1.5; } .calc-note { margin-top: 1rem; font-size: 0.8rem; color: #888; font-style: italic; } .calc-grid { display: grid; grid-template-columns: 1fr 1fr; gap: 0.75rem; margin-top: 0.75rem; } .calc-grid-item { padding: 0.6rem 0.8rem; background: #f8f9fa; border-radius: 4px; border: 1px solid #eee; } .calc-grid-item .label { font-size: 0.75rem; color: #888; text-transform: uppercase; letter-spacing: 0.04em; } .calc-grid-item .value { font-size: 1.1rem; font-weight: 600; color: #1a1a1a; } @media (max-width: 720px) { .calc-row { flex-direction: column; align-items: flex-start; gap: 0.3rem; } .calc-row label { min-width: auto; } .calc-row input[type="number"], .calc-row select { max-width: 100%; width: 100%; } .calc-grid { grid-template-columns: 1fr; } } .calc-chart { margin: 1rem 0; text-align: center; } .calc-chart svg { max-width: 100%; height: auto; } .calc-chart-legend { display: flex; flex-wrap: wrap; justify-content: center; gap: 0.6rem 1.2rem; margin-top: 0.6rem; font-size: 0.8rem; color: #555; } .calc-chart-legend span { display: inline-flex; align-items: center; gap: 0.3rem; } .calc-chart-legend i { display: inline-block; width: 10px; height: 10px; border-radius: 2px; font-style: normal; } .calc-related { max-width: 640px; margin: 2rem 0 1rem; padding: 1.25rem 1.5rem; background: #f8f9fa; border: 1px solid #e8e8e8; border-radius: 8px; } .calc-related h3 { font-family: Georgia, serif; font-size: 1rem; color: #1a1a1a; margin: 0 0 0.75rem; padding-bottom: 0.4rem; border-bottom: 2px solid var(--ac, #3d5a80); } .calc-related-list { list-style: none; padding: 0; margin: 0 0 0.75rem; display: grid; grid-template-columns: 1fr 1fr; gap: 0.4rem 1.5rem; } .calc-related-list li a { font-size: 0.88rem; color: var(--ac, #3d5a80); text-decoration: none; } .calc-related-list li a:hover { text-decoration: underline; } .calc-browse-all { margin: 0.5rem 0 0; font-size: 0.9rem; font-weight: 600; } .calc-browse-all a { color: var(--ac, #3d5a80); text-decoration: none; } .calc-browse-all a:hover { text-decoration: underline; } @media (max-width: 720px) { .calc-related-list { grid-template-columns: 1fr; } }
Healthcare Coverage Eligibility Estimator
Estimate your eligibility for Medicaid, CHIP, and ACA Marketplace subsidies based on your household size, annual income, age, and state of residence.
Household Size (number of people)
Annual Household Income ($)
Your Age (primary applicant)
State of Residence
-- Select State -- Medicaid Expansion State Non-Expansion State
Number of Children Under 19 in Household
Does your employer offer health insurance?
No Yes
Estimate Eligibility
function heaCalc() { var resultDiv = document.getElementById('hea-result'); resultDiv.style.display = 'none'; resultDiv.innerHTML = '';
// --- Inputs --- var householdSize = parseInt(document.getElementById('hea-household-size').value); var annualIncome = parseFloat(document.getElementById('hea-annual-income').value); var age = parseInt(document.getElementById('hea-age').value); var stateType = document.getElementById('hea-state').value; var children = parseInt(document.getElementById('hea-children').value); var employerOffer = document.getElementById('hea-employer-offer').value;
// --- Validation --- var errors = []; if (isNaN(householdSize) || householdSize 20) errors.push("Household size must be between 1 and 20."); if (isNaN(annualIncome) || annualIncome 120) errors.push("Age must be between 0 and 120."); if (!stateType) errors.push("Please select your state type."); if (isNaN(children) || children 20) errors.push("Number of children must be between 0 and 20."); if (children >= householdSize && children > 0) errors.push("Number of children cannot exceed or equal household size.");
if (errors.length > 0) { resultDiv.style.display = 'block'; resultDiv.innerHTML = 'Please fix the following:' + errors.map(function(e){ return ''; }).join('') + ''; return; }
// --- 2024 Federal Poverty Level (FPL) Base Values --- // FPL = $15,060 for household of 1 + $5,380 per additional person var FPL_BASE = 15060; var FPL_ADDL = 5380; var fpl = FPL_BASE + (householdSize - 1) * FPL_ADDL; var fplPercent = (annualIncome / fpl) * 100;
// --- Program Thresholds --- // Medicare: age >= 65 var medicareEligible = (age >= 65);
// Medicaid (expansion states): 0 && fplPercent 0) { chipEligible = false; }
// ACA Marketplace Subsidy (Premium Tax Credit): // Eligible if: 100%-400% FPL (or up to any % under ARP extension through 2025) // Not eligible if: Medicaid/Medicare eligible, or employer offers affordable coverage // ARP 2021-2025: No upper income cap; anyone paying > 8.5% of income qualifies var acaEligible = false; var acaSubsidyLevel = ''; var estimatedSubsidy = 0; var benchmarkPremium = 0;
if (!medicareEligible && !medicaidEligible && employerOffer === 'no') { // 2024 benchmark (second-lowest-cost Silver plan) national average approximation // Approx $500/month per adult, adjusted by age factor var ageFactor = 1.0; if (age 400% FPL: 8.5% (ARP cap) var requiredContribPct = 0; if (fplPercent 0) { acaEligible = true; if (fplPercent = 100 && fplPercent '; html += 'Household Size' + householdSize + ' person(s)'; html += 'Annual Income' + fmt(annualIncome) + ''; html += '2024 Federal Poverty Level (FPL)' + fmt(fpl) + ''; html += 'Income as % of FPL' + pct(fplPercent) + ''; html += '';
html += '#### Program Eligibility '; html += '';
// Medicare html += ''; html += 'Medicare'; if (medicareEligible) { html += '✓ Likely Eligible'; html += 'Age 65+. Enroll during Initial Enrollment Period (IEP).'; } else { html += '✗ Not Eligible'; html += 'Medicare is for age 65+ or certain disabilities.'; } html += '';
// Medicaid html += ''; html += 'Medicaid'; if (medicaidEligible) { html += '✓ Likely Eligible'; html += 'Income (' + pct(fplPercent) + ') is at or below ' + medicaidAdultThreshold + '% FPL threshold for your state type.'; } else { html += '✗ Not Eligible'; html += 'Income (' + pct(fplPercent) + ') exceeds ' + medicaidAdultThreshold + '% FPL threshold for your state type.'; } html += '';
// CHIP html += ''; html += 'CHIP (Children)'; if (children === 0) { html += 'N/A'; html += 'No children under 19 in household.'; } else if (chipEligible) { html += '✓ Likely Eligible'; html += '' + children + ' child(ren) under 19; income at ' + pct(fplPercent) + ' FPL (≤200% threshold).'; } else if (medicaidEligible) { html += 'Covered via Medicaid'; html += 'Children covered under Medicaid at this income level.'; } else { html += '✗ Not Eligible'; html += 'Income (' + pct(fplPercent) + ') exceeds 200% FPL federal floor for CHIP.'; } html += '';
// ACA Marketplace html += ''; html += 'ACA Marketplace Subsidy'; if (medicareEligible || medicaidEligible) { html += 'N/A'; html += 'Not applicable — covered by Medicare/Medicaid.'; } else if (employerOffer === 'yes') { html += '⚠ Check Affordability'; html += 'Employer coverage offered. Subsidy only available if employer plan is unaffordable (>9.12% of household income for self-only coverage in 2024).'; } else if (acaEligible) { html += '✓ Likely Eligible'; html += 'Subsidy Level: ' + acaSubsidyLevel + ''; } else { html += '✗ Likely Not Eligible'; html += '' + acaSubsidyLevel + ''; } html += '';
// CSR html += ''; html += 'Cost-Sharing Reductions (CSR)'; if (csrEligible) { html += '✓ Likely Eligible'; html += '' + csrLevel + '. Must enroll in Silver plan to receive CSR.'; } else { html += '✗ Not Eligible'; html += 'CSR requires ACA enrollment and income between 100%–250% FPL.'; } html += '';
html += '';
// Subsidy estimate if (acaEligible && estimatedSubsidy > 0) { html += ''; html += 'Estimated Annual Premium Tax Credit: ' + fmt(estimatedSubsidy) + ''; html += ' | Monthly: ' + fmt(estimatedSubsidy / 12); html += 'Based on estimated benchmark Silver plan premium of ' + fmt(benchmarkPremium) + '/year for your household.'; html += ''; }
html += 'ⓘ This is an estimate only. Actual eligibility is determined by your state Medicaid agency or Healthcare.gov. Consult a certified navigator or broker for personalized guidance.
';
resultDiv.style.display = 'block'; resultDiv.innerHTML = html; }
#### Formulas Used
Federal Poverty Level (2024): FPL = $15,060 + ($5,380 × (Household Size − 1))
Income as % of FPL: FPL% = (Annual Income ÷ FPL) × 100
Medicaid Eligibility: Expansion states: FPL% ≤ 138% | Non-expansion states: FPL% ≤ 100% (conservative estimate)
CHIP Eligibility: Children under 19 with household FPL% ≤ 200% (federal floor; many states extend to 300%+)
ACA Premium Tax Credit (ARP 2021–2025 extension): Required Contribution = Annual Income × Required Contribution % (sliding scale by FPL%) Subsidy = max(0, Benchmark Premium − Required Contribution) No upper income cap while ARP is in effect (anyone paying >8.5% of income qualifies)
Required Contribution % Sliding Scale: ≤150% FPL: 0% | 150–200%: 0–2% | 200–250%: 2–4% | 250–300%: 4–6% | 300–400%: 6–8.5% | >400%: 8.5%
Cost-Sharing Reductions (CSR): Available to ACA enrollees in Silver plans with FPL% between 100%–250%. 100–150% FPL → 94% AV | 150–200% FPL → 87% AV | 200–250% FPL → 73% AV
#### Assumptions & References
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