Calculator inputs
Enter annual usage estimates and plan design values for up to three benefit options.
Example data table
| Plan | Payroll / Period | Deductible | OOP Max | Coinsurance | Employer Funding |
|---|---|---|---|---|---|
| Bronze HSA | $80 | $3,500 | $7,000 | 20% | $1,200 |
| Silver PPO | $140 | $1,500 | $5,000 | 20% | $300 |
| Gold PPO | $220 | $500 | $2,500 | 10% | $0 |
These sample values match the default form fields, so you can test the calculator immediately.
Formula used
Annual premium = Payroll deduction per pay period × Number of pay periods.
Copay total = Sum of visit copays and prescription copays across estimated annual use.
Medical cost sharing = Deductible used + Coinsurance on remaining allowed charges.
Out-of-pocket spend = Minimum of the plan out-of-pocket maximum and total cost sharing.
Net annual employee cost = Annual premium + Out-of-pocket spend − Employer HSA or HRA contribution.
Maximum exposure = Annual premium + Out-of-pocket maximum − Employer contribution.
How to use this calculator
- Choose your payroll frequency first.
- Enter low, expected, and high usage multipliers.
- Estimate annual visits, prescriptions, and allowed medical charges.
- Fill in premium deductions, deductible, out-of-pocket maximum, coinsurance, and copays for each plan.
- Add any employer HSA or HRA funding for each option.
- Click Compare health plans to show results above the form.
- Review expected cost, worst-case exposure, and the chart before deciding.
- Use the CSV and PDF buttons to save or share your comparison.
Important note
This calculator provides an educational estimate. Real claims, network pricing, family tier rules, embedded deductibles, and pharmacy tiers can differ by carrier and employer plan design.
FAQs
1. What does this calculator compare?
It compares annual employee cost across three health plan options using premiums, deductibles, copays, coinsurance, allowed charges, and employer funding.
2. Why can a higher-premium plan still cost less overall?
Higher-premium plans often have lower deductibles, lower copays, and lower out-of-pocket limits, which can reduce total annual cost when care use rises.
3. Does this replace the official plan summary?
No. Use it as a decision aid, then confirm details with your official summary of benefits and employer enrollment materials.
4. What are allowed charges?
Allowed charges are the negotiated covered amounts used to calculate deductible and coinsurance, not the provider’s full billed amount.
5. Are copays counted toward the out-of-pocket maximum here?
Yes. This model assumes copays, deductible amounts, and coinsurance all contribute toward the out-of-pocket limit for simplified comparison.
6. How should families use this tool?
Combine expected family visits, prescriptions, and hospital spending into the annual usage fields, then compare family-tier payroll deductions and limits.
7. Can employer HSA or HRA funding change the best option?
Absolutely. Employer funding can significantly reduce net annual cost, especially for high-deductible plans with lower premiums.
8. What if I expect very high medical use?
Focus on expected and high scenarios, then compare worst-case exposure. Lower out-of-pocket maximums can matter more than lower premiums.