How are ACA premiums calculated?
ACA plan premiums are calculated using only five allowed factors — age, ZIP code (rating area), tobacco use, individual vs family enrollment, and plan category — with no rating for gender or pre-existing conditions, per HealthCare.gov (2026).
More on this topic: subsidies and costs
What the government has said, on the record
Here's how a federal official described it, on the record:
“Five factors can affect a plan's monthly premium: location, age, tobacco use, plan category, and whether the plan covers dependents.”
— Centers for Medicare & Medicaid Services (HealthCare.gov), Centers for Medicare & Medicaid Services (U.S. Department of Health & Human Services), HealthCare.gov, How insurance companies set your premiums (source)
Editor's note: From official HealthCare.gov (CMS) consumer guidance. Rules and figures can change by plan year — confirm current details at HealthCare.gov.
Who said this
Centers for Medicare & Medicaid Services (HealthCare.gov) · Centers for Medicare & Medicaid Services (U.S. Department of Health & Human Services)
Also asked as
- What factors affect ACA premiums?
Sources
Last verified: 2026-07-19