Healthcare Decision Tool

1What your employer contributes

Your HR team usually fills this in. Change it only if your employer gave you different numbers.

You onlyYou + 1Family

Healthshare monthly cost

$
$
$

Employer pays this % of it

Employer’s monthly maximumLeave blank if there’s no cap

Healthshare amount you pay per incidentWorks like a per-event deductible

My employer also offers a group health insurance planTurn on to check the family-coverage glitch and the “employee-only” strategy

2Your household

Include everyone you claim on your tax return, even people who won’t need coverage.

State

ZIP code

Expected 2027 household income Use taxable income: W-2 box 1 for you and your spouse, plus any other income. Pre-tax payroll deductions lower this number, which can raise your subsidy.

You

Date of birth I have something on the health checklist below

I’m marriedYou’ll need to file a joint tax return to get marketplace subsidies Dependents you claim (children or others)

3Health checklist

A healthshare is not insurance. Conditions you already have are limited for several years, and some care isn’t shared at all. If any line below fits someone, that person is usually better off on marketplace insurance, even if the rest of the family uses the healthshare.

A surgery, procedure or major test is recommended or scheduled
Seen, treated, had symptoms or took medication for a condition in the past 24 months that will need care this year
Has, or is being evaluated for, cancer or a tumor (any history in the past 36 months)
Pregnant now, or planning to conceive soon
Ongoing mental health treatment or medication
Relies on medication or supplies a healthshare typically excludes, such as diabetic supplies or asthma maintenance medication
Needs substance use treatment or fertility care
Turning 65 within the coming year

Well-controlled high blood pressure, cholesterol, thyroid conditions or type 2 diabetes may still be fine if there was no hospital stay for them in the past 12 months. Check the guidelines of your specific healthshare.

Your options side by side

Monthly cost to you after employer help and estimated subsidies. Marketplace figures use the benchmark silver plan, the plan subsidies are based on.

Your marketplace subsidy estimate

The decision tree

Work down from the top. Each person stops at the first box that fits them. Your household’s path lights up as you fill in the form.

Two strategies families miss

The family glitch: employee-only can beat family coverage

If your employer offers group insurance, the government checks whether it’s “affordable.” Since 2023, your spouse and kids are judged on what family coverage would cost you. If family coverage costs more than 10.22% of household income in 2027, your family can get marketplace subsidies even while you stay on the employer plan.

That means it’s often smarter to take employee-only coverage and waive family coverage, so your spouse and children can qualify for subsidized marketplace plans, sometimes with a $0 premium, or for free coverage through CHIP or Medicaid.

CHIP: free or low-cost coverage for kids

Every state covers children through CHIP or Medicaid up to an income limit, ranging from about 175% to 405% of the poverty level depending on the state. In many states that reaches families earning $90,000 to $100,000 or more.

A common split: kids on CHIP, healthy parents on the healthshare, and anyone with an ongoing condition on a marketplace plan. Each person ends up in the cheapest option that still protects them.