Healthcare Cost Bridge

ACA Window 2028–2051 — Scott & Courtney Miller — Born 1986

Inputs

Full Annual Premium (no subsidy) $/yr before any subsidy

Premium Growth Rate %/yr Historical ~5–7%/yr

Target MAGI (stay under cliff) Roth conversions + income

OOP Max Family/yr (2028 $) Grows 3%/yr automatically

OOP Utilization % % of OOP max actually spent

OOP Growth %/yr Annual OOP inflation

⚠ The enhanced ACA subsidies (ARPA/IRA 8.5% cap, no income cliff) EXPIRED Dec 31, 2025 — this has happened; it is no longer hypothetical. From 2026, premium contributions follow the pre-2021 sliding scale (~2.1%–9.96% of MAGI based on % of Federal Poverty Level) and the hard 400% FPL subsidy cliff is back: above 400% FPL the subsidy is $0. This calculator models the 2026 rules.

Year-by-Year ACA Cost Projection (2028–2051)

Year	Ages	HH	ACA Cliff	Full Premium	Subsidy	Your Premium	Est OOP	Total Cost	Savings vs Full

Summary Metrics (2028–2051)

Total Subsidies Received

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24 years of ACA support

Total OOP Costs

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Deductibles, copays, etc.

Total Healthcare Spend

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Premium + OOP, all years

Average Annual Cost

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Simple average 2028–2051

ACA Cliff Warning

MAGI Level	Annual Premium	Delta vs Target

Supplemental Costs (Not ACA-Covered)

These are not ACA-eligible but are real out-of-pocket retirement costs. Estimates are per couple, not inflation-adjusted.

Dental (est. per couple)

$1,800/yr

~$150/mo · standalone dental plan · not ACA-subsidized

Vision (est. per couple)

$600/yr

~$50/mo · standalone vision plan · not ACA-subsidized

Combined supplemental estimate: $2,400/yr — add this to ACA total healthcare spend above for a complete picture.

Medicare Transition (2051+)

🏥 Medicare Transition Note

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Annual Action Checklist

📅 Key Dates & Actions

Nov 1 – Dec 15 ACA Open Enrollment — compare plans on healthcare.gov. Review benchmark SLCSP and update premium inputs above.
December Finalize MAGI before Dec 31 — execute Roth conversions and long-term capital gains harvesting to hit target MAGI without exceeding the ACA cliff.
January Update OOP tracker for the new plan year, confirm new plan details and any deductible changes. Adjust OOP inputs if needed.
Year-round Keep investment income (dividends, LTCG, Roth conversions) below the ACA cliff. Monitor MAGI monthly and adjust withdrawal strategy if needed.