ACA Marketplace Risk Pool & Premium Dynamics Simulator

Policy & Market Levers

Enhanced PTC Subsidies (ARPA/IRA)

Benchmark Silver Deductible $5,400

Healthy Cohort Base Share 64%

Healthy Price Elasticity -1.20

Underlying Medical Inflation 6.5%

Insurer Target Margin / Admin 15%

Subsidies cap enrollee premium contributions at 8.5% of income, insulating subsidized low-risk buyers from headline rate shocks.

Equilibrium Premium

$480 /mo

+0.0% vs base ($480)

Healthy Participation

82.5%

6.34M enrollees

Medical Loss Ratio (MLR)

84.0%

Target: 85.0%

Projected Dropoffs

12.00M Total Enrollees

Risk Pool Population Flow

Healthy Enrollees

Chronic / High Claims

Uninsured Exit

5-Year Premium Escalation Trajectory

Projected Premium ($/mo)

Net Enrollee Volume

Metal Tier Actuarial Comparison (Year 1)

Tier	Actuarial Value	Monthly Gross	Net Subsidized (Avg)	Avg Deductible	Exp. Low-Risk OOP	Exp. Chronic OOP	Enrollees