The comparison ladder
Five questions, in the order they actually matter
Everyone starts at the premium, because the premium is the only number anyone prints in large type. It is the fifth most important number on the page. This is the order a competent desk works in.
Rungs 01 - 05
The ladder
Each rung is a real table, and the section narrows as you descend, because that is what a decision does. Open any rung; they are all closed by default only so the page fits on a screen.
Who is buying Measure Single, 40 Couple, 38 & 41 Family of four Self-employed, 52 Household income $38,400 $61,200 $74,800 $96,000 Percent of FPL 245% 285% 239% 613% Benchmark Silver $448 $911 $1,344 $704 Expected contribution $128 $374 $249 $680 Advance credit $320 $537 $1,095 $24 CSR eligible Yes, 73 AV No Yes, 73 AV No Expected contribution is the applicable percentage of household modified adjusted gross income under the current schedule.
Which metal tier Measure Bronze Silver Gold Platinum Actuarial value 60% 70% 80% 90% Gross premium $312 $448 $529 $638 After a $352 credit $41 $96 $177 $286 Deductible $7,500 $4,200 $1,600 $400 Maximum out-of-pocket $10,600 $8,900 $6,800 $3,400 Primary care visit 40% after ded. $35 $25 $15 Carries CSR No Yes No No The credit is fixed to the benchmark Silver plan, so it does not grow when you move up a tier. Every dollar above Silver is yours.
Which network Measure HMO EPO PPO Referral to a specialist Required Not required Not required Out-of-network Emergency only Emergency only Covered, higher share Typical Silver premium $412 $448 $566 Provider count, metro 18,400 22,100 41,600 Provider count, rural 2,900 3,400 9,800 Annual premium delta -$432 Baseline +$1,416 Provider counts are illustrative. Verify your own physicians against the carrier's live directory before the effective date.
Which subsidy applies Measure Premium tax credit only Premium tax credit + CSR Income band 250 - 400% FPL 100 - 250% FPL Tier required Any metal tier Silver only Effective actuarial value 70% 73, 87 or 94% Silver deductible $4,200 $800 at 94 AV Silver MOOP $8,900 $3,150 at 94 AV Reconciled at tax time Yes, Form 8962 Credit only, CSR is not reconciled Cost-sharing reductions attach to the Silver tier by statute. Choosing Bronze to save premium forfeits them entirely.
The answer Measure Recommendation Plan Keystone Mutual Silver 73 EPO Gross premium $448 per month Advance premium tax credit -$352 per month Net premium $96 per month Deductible $2,900 after CSR Maximum out-of-pocket $6,400 after CSR Why this one Both listed physicians in network, and the CSR variant beats Gold on total cost at expected utilisation. Illustrative only. A real recommendation is produced against your actual ZIP code, providers, prescriptions and household income.
Form LC-1
Run the same five questions against your own county
The ladder is set with illustrative figures, because it has to be set with something. Form LC-1 asks for a ZIP code and a household and then prices the real market: live plan data from the CMS Marketplace API, a real subsidy estimate, and the two documents an enrolment actually requires.
| Sheet | What it asks | Where the answer comes from |
|---|---|---|
| 1 Location | ZIP code, county, coverage year and start date | Marketplace county service, with a bundled Census 2020 table behind it |
| 2 Household | Everyone on the tax household, and the expected income | Your answers, checked against the federal poverty guidelines for your state |
| 3 Care | Prescriptions and the providers you will not leave | The Marketplace drug and provider indexes, with free text where they miss |
| 4 Plans | Which plan, at what net premium | Live plan search, filtered on facets the response itself returns |
| 5 Instrument A | Consent for an agent to assist | The CMS model consent language, unamended |
| 6 Instrument B | A read-back of everything, then an attestation | Your own record, with an amend link on every section |
| 7 Record | Nothing | The edge assembles what it observed, prints it, and stores none of it |
A demonstration. Nothing entered on Form LC-1 is transmitted to the Marketplace, to CMS or to any carrier.
Rung 04, expanded
Where your income lands, and what it buys
Two subsidies with two different rules. The premium tax credit lowers the monthly bill. Cost-sharing reductions lower what you pay at the counter, and they only exist on Silver.
| Band | Household of one | Expected contribution | Premium tax credit | CSR variant |
|---|---|---|---|---|
| Under 100% | Under $15,650 | - | Medicaid or coverage gap | - |
| 100 - 150% | $15,650 - $23,475 | 0% of income | Full benchmark | 94 AV |
| 150 - 200% | $23,475 - $31,300 | 0 - 2.0% | Large | 87 AV |
| 200 - 250% | $31,300 - $39,125 | 2.0 - 4.0% | Moderate | 73 AV |
| 250 - 400% | $39,125 - $62,600 | 4.0 - 8.5% | Tapering | None |
| Over 400% | Over $62,600 | 8.5% of income | Capped at 8.5% | None |
Illustrative 2026 figures for the contiguous 48 states. The expected contribution is a percentage of household modified adjusted gross income, applied to the benchmark Silver premium.
A household at 140% of the federal poverty level that buys Bronze to save $55 a month walks away from a Silver plan worth roughly 94% actuarial value.1 Over a year with one hospital admission, that trade costs several thousand dollars.
Rung 03, expanded
Network shape is invisible until the month it is not
A plan's network is set independently of its metal tier. Two Silver plans from the same carrier can have entirely different physician lists.
| Network | Referrals | Out of network | Typical Silver | Premium |
|---|---|---|---|---|
| HMO | Required | Emergency only | $412 | Lowest |
| EPO | Not required | Emergency only | $448 | Middle |
| PPO | Not required | Covered, higher share | $566 | Highest |
HMO
You have no strong provider attachment and want the lowest premium.
EPO
You want direct specialist access but will stay in network.
PPO
You have an out-of-area specialist you will not leave.
Rung 02, expanded
What each tier costs at the point of care
Actuarial value describes how a plan behaves across a standard population. This is what it looks like at the desk, for one person, on an ordinary Tuesday.
| Tier | Primary care visit | Generic drug | Deductible | MOOP |
|---|---|---|---|---|
| Bronze | Deductible, then 40% | $25 after deductible | $7,500 | $10,600 |
| Silver | $35 copay | $15 copay | $4,200 | $8,900 |
| Gold | $25 copay | $10 copay | $1,600 | $6,800 |
| Platinum | $15 copay | $5 copay | $400 | $3,400 |
The premium tax credit is fixed to the benchmark Silver plan, so it does not grow when you move up a tier. Every dollar above Silver is paid by you.
This is the single most useful thing to understand about the Marketplace: the credit is a fixed dollar amount, not a percentage.2 It is computed once, from the second-lowest-cost Silver plan in your rating area, and then applied to whatever you buy.
Method
How the answer on rung five is produced
Illustrative 2026 federal poverty level figures for the contiguous 48 states.3
- 01
Every plan in the rating area is loaded
On-exchange plans only, from the current landscape file, refreshed within 48 hours of each CMS release.
- 02
Network and formulary filters run first
Your physicians and your prescriptions. Anything that fails is removed before price is looked at.
- 03
Subsidy is applied to each survivor
Benchmark premium, expected contribution, advance credit, and the CSR variant if the household qualifies.
- 04
Total annual cost is modelled three ways
Low, expected and bad-year utilisation. Premium plus expected cost share, twelve months, one number per plan.
- 05
One recommendation, with the runner-up
And the reason it lost, so you can disagree with the reasoning rather than with the conclusion.
Next
Run the ladder against your own household.
Bring a ZIP code, a household, a list of physicians and a list of prescriptions. The comparison takes about forty minutes and costs nothing.