Model pocket costs across multiple medical services. Adjust copay rules, deductible timing, and coinsurance rates. View results instantly, then download files for your records.
A sample set you can copy into the services list:
| Service | Allowed | Cost share | Copay | Deductible applies | Coinsurance override |
|---|---|---|---|---|---|
| Primary Care Visit | 180.00 | Copay | 30.00 | No | — |
| Specialist Visit | 320.00 | Copay | 60.00 | No | — |
| Imaging (MRI) | 1400.00 | Coinsurance | 0.00 | Yes | 20 |
| Lab Work | 500.00 | Coinsurance | 0.00 | Yes | — |
This tool provides estimates for planning and comparison. Always confirm coverage rules with your plan documents.
Copays are fixed amounts, often 10 to 75, paid per visit. Deductibles are annual thresholds, commonly 500 to 3,000, paid before most coverage begins. Coinsurance is a percentage, such as 10% to 30%, applied after the deductible. The same service can cost different amounts across the year.
Each line item starts with an allowed amount, the price your plan recognizes. If the service is deductible eligible, the tool applies the remaining deductible first, then calculates copay or coinsurance on what is left. If an out-of-pocket limit is provided, counted payments stop at that cap. Plan payment equals allowed amount minus your share. Overrides let you model a different coinsurance rate for specific services.
Assume a 1,500 deductible with 600 remaining, 20% coinsurance, and a 3,500 out-of-pocket cap. An office visit allowed at 180 with a 30 copay may cost 30 if copays do not apply to the deductible. A lab test allowed at 500 could apply 500 to the deductible, leaving 100 remaining. A scan allowed at 1,200 would apply the last 100 deductible, then 20% on 1,100, for 220 coinsurance.
The patient total combines deductible, copay, and coinsurance across services. Deductible remaining after shows what is still unpaid, based only on deductible eligible amounts. If you enter an out-of-pocket limit, the tool also reports cap remaining after counted payments. Use the table to spot which events drive spending and where plan payment grows.
Run best case and worst case scenarios by changing allowed amounts, copays, and deductible rules. If you use a health savings account, the patient total can guide monthly contributions. Compare two providers by changing allowed amounts while keeping plan terms constant. The graph shows when costs spike, supporting scheduling and asking for written estimates.
Plans differ. Use the setting for whether copays apply to the deductible. If enabled, copay amounts can reduce remaining deductible. If disabled, copays are added separately while deductible rules apply to eligible charges.
It is the negotiated price your plan recognizes for a service. Your share is calculated from the allowed amount, not the provider’s billed charge. If you only know billed charges, enter a conservative estimate.
When you enter an out-of-pocket maximum, counted payments stop once the remaining cap reaches zero. The tool can include deductible, copay, and coinsurance in the cap based on your selections.
If a deductible is still remaining, most or all of an eligible service may be paid by you. For copay-only services, a low allowed amount can also leave little for the plan to pay.
Yes. Each service row includes an optional coinsurance override. Enter a percent to model exceptions such as specialty drugs or imaging. Leave it blank to use the plan’s default coinsurance rate.
No. It provides planning estimates using the inputs you supply. Real claims depend on network status, coding, prior authorization, and benefit rules. Confirm details with your insurer or plan documents.
Important Note: All the Calculators listed in this site are for educational purpose only and we do not guarentee the accuracy of results. Please do consult with other sources as well.