Healthcare Benefits & HSA Pack

Why this Data Set exists

Most planning engines treat healthcare as an opaque expense line. The household pays $X per month for premiums, $Y per year for out-of-pocket, and the plan moves on. This is fine until the household hits a transition: COBRA coverage from a job loss, ACA marketplace shopping during a sabbatical, Medicare enrollment at 65, IRMAA-tier-driving income decisions in the gap years. At each transition, the healthcare line item suddenly becomes a strategic variable — and most planning engines can't model it because the underlying data doesn't capture the structural distinctions.

For builders, the data problem is one of structural depth. A household's healthcare data isn't a single field; it's a structured profile of plan type (HDHP, PPO, HMO, Medicare, ACA marketplace), HSA / FSA balances and contribution history, benefit-eligibility transitions, disability claim histories where applicable, and the income-driven premium adjustments that interact with the household's tax planning. Most fixture data has none of this.

This Data Set provides 250 households where the full healthcare-benefits picture is structured: HDHP-with-HSA accumulators (where the HSA is being treated as a retirement account); COBRA / ACA marketplace gap-fillers; SSDI and LTD claimants; Medicare-bridge pre-retirees deciding when to retire vs. when to enroll; and IRMAA-exposed retirees whose income decisions affect Medicare premiums on a 2-year lag.

Use Cases

Who uses this Data Set

What's inside

The 250 households span twelve archetypes covering the full healthcare-benefits lifecycle. About 25% are early-career employees in HDHP plans (the HSA accumulator population); 20% are self-employed or gig workers navigating ACA marketplace plans; 25% are pre-retirees in the Medicare bridge window (60-65); 20% are recently-retired (65-70) with active Medicare planning decisions; 10% are in benefits-gap or disability-claim situations.

Each household has structured healthcare data: current plan type, premium and out-of-pocket cost structure, HSA balance and contribution history (where applicable), FSA participation, ACA marketplace subsidy eligibility (with APTC and PTC calculations), Medicare enrollment status and election, IRMAA tier history, and disability claim status (SSDI / private LTD). Where the household has had a recent benefits transition (job loss, retirement, disability onset), the structured event log captures the transition timing and the bridge-coverage details.

The Data Set ships as JSON and CSV. The WealthSynth Methodology PDF documents the plan-type taxonomy, the HSA-as-retirement-account modeling methodology, the Medicare and IRMAA calculation chain, the ACA APTC subsidy formula, and the SSDI / LTD offset structures. Calibration sources include CMS, KFF, the SSA, and the major HSA-administrator industry publications.

Preview a sample household

A redacted summary of one household from this Data Set — names, employers, exact balances, and metro area are stripped. Ages are bucketed, income and net worth are reported as bands. The full record (and all 250 like it) ships in the ZIP.

Technical Highlights

Sample Schema Fields

{
  "insurance.health.plan_type": <value>,
  "accounts.hsa.balance": <value>,
  "accounts.hsa.contribution_history": <value>,
  "insurance.disability.benefit_amount": <value>,
  "taxes.irmaa_tier": <value>
}

Sample queries

households.filter(h =>
  h.insurance.health.plan_type === 'HDHP' &&
  h.accounts.hsa.contribution_history.current_year_pct === 1.0 &&
  h.members[0].age < 55
)

households.filter(h => {
  const age = h.members.find(m => m.role === 'primary').age;
  return age >= 60 && age < 65 &&
    h.events.life_events.some(e =>
      e.type === 'planned_retirement' &&
      monthsBetween(today(), e.date) <= 36);
})

households.filter(h => {
  const margin = h.taxes.next_irmaa_threshold -
                 h.taxes.modified_agi;
  return margin > 0 && margin < 5000;
})

households.filter(h =>
  h.insurance.health.plan_type === 'ACA_marketplace' &&
  h.taxes.modified_agi >
    h.insurance.health.aca_aptc_assumed_income * 1.10
)

Methodology

Each household's healthcare profile is generated against archetype-specific patterns. HSA accumulators draw from realistic HDHP-population distributions (about 30% of W-2 workers under 55 have HDHP coverage). ACA marketplace households are concentrated in self-employed and gig-worker archetypes, with subsidy eligibility computed against current-year FPL thresholds. Medicare-eligible retirees split between Original Medicare with Medigap (~40%, weighted toward higher-income retirees) and Medicare Advantage (~45%, weighted toward middle-income retirees). IRMAA tier history uses the 2-year-lookback methodology with current Medicare Part B and Part D surcharge brackets. SSDI claim populations are sized from SSA program statistics; private LTD claim populations from disability-insurance industry data. The corpus passes the WealthSynth consistency validator (premium and benefit calculations are internally consistent; IRMAA tier history is correctly lagged; HSA contribution math reconciles with IRS limits) and the LLM-as-judge gate. Annual refresh tracks ACA FPL updates, Medicare bracket changes, HSA contribution limits, and any benefit-program statutory changes.

Included Archetypes (12)

Frequently asked questions