Calculator inputs
Formula used
Allowed spending = billed spending × (1 − discount rate).
Eligible after preventive = max(0, allowed − preventive).
Annual premium = premium per period × periods per year.
Copays total = sum(copay × count) across categories.
Eligible pays deductible first, then coinsurance applies.
Out-of-pocket max caps eligible payments, plus copays.
Net cost = total cost − employer support − tax savings.
How to use this calculator
- Enter billed spending for deductible eligible services.
- Set your typical discount and preventive amounts.
- Add copays and annual visit or fill counts.
- Enter three plans, using matching premium frequency.
- Press Calculate, then compare totals and curves.
Example data table
| Scenario | Billed eligible spending | Discount | Preventive | Copays pattern | Plan A premium | Plan B premium | Plan C premium |
|---|---|---|---|---|---|---|---|
| Light usage | $1,200 | 25% | $200 | Primary + Rx | $210 | $140 | $175 |
| Moderate usage | $3,000 | 25% | $300 | Primary + Specialist + Rx | $210 | $140 | $175 |
| High usage | $10,000 | 25% | $400 | Includes urgent and ER events | $210 | $140 | $175 |
Understanding deductible tradeoffs
Deductible plans shift early-year costs to the member, then share costs through coinsurance. A higher deductible usually pairs with a lower premium, but the cheaper premium can be offset once spending rises. This calculator estimates those tradeoffs by combining premium, deductible, coinsurance, and an out-of-pocket limit into one annual figure.
To reduce bias, enter spending that is subject to deductible, not premium-paid services. For families, model one member or use a household total, then confirm whether the out-of-pocket maximum is individual or family. Re-run scenarios for low, typical, and worst-case years to stress-test decisions and document assumptions you used for each run.
Modeling billed versus allowed charges
Most pricing comparisons work better with allowed amounts than raw bills. The discount input approximates network pricing by converting billed eligible spending into allowed spending. Preventive services are commonly covered with no cost sharing, so the preventive amount is subtracted before applying deductible and coinsurance. This makes low-spend scenarios more realistic.
Separating copays from coinsurance
Copays can dominate routine care costs even when major services are rare. The calculator totals primary, specialist, urgent care, emergency, and prescription copays using annual counts. You can also control whether copays count toward the deductible and whether they count toward the out-of-pocket maximum, reflecting common plan rule differences.
Comparing three plans with curves
Plan A, B, and C can be compared at a single spending estimate and across a spending range. The Plotly curve shows how total or net cost changes as billed eligible spending increases. A vertical marker highlights your current spending input, and the first break-even point indicates where the best plan may change.
Using net cost with tax advantages
If you contribute to a tax-advantaged account and receive employer funding, the cheapest total cost may not be the cheapest net cost. The calculator estimates tax savings as contribution times marginal tax rate, then subtracts tax savings and employer contributions from total cost. Use net mode for high-deductible plans paired with accounts.
FAQs
What should I enter as billed eligible spending?
Use expected annual charges that are subject to deductible and coinsurance. Exclude premiums and services that are fully covered. If you only know allowed amounts, set discount to zero and enter allowed spending directly.
Why include a provider discount?
Network pricing often reduces billed charges. The discount converts billed spending into an allowed estimate, which improves comparisons. If you already have allowed amounts from statements or plan tools, set the discount to zero.
Do copays usually count toward the deductible?
Many plans treat copays separately and do not apply them to the deductible, but designs vary. Toggle the setting to match your plan documents. When unsure, run both settings to see the sensitivity.
What does the out-of-pocket maximum cap here?
The model caps eligible cost sharing and, optionally, copays. Premiums are never capped. Some plans have separate prescription caps; treat the result as a planning estimate unless your plan uses one combined limit.
How is net cost calculated with tax savings?
Net cost equals total annual cost minus employer contributions and estimated tax savings. Tax savings are your contribution multiplied by your marginal tax rate. This is a simplified estimate and may differ from your filing outcome.
How should I interpret the break-even point?
Break-even is the first spending level where the top-ranked plan and the next-best plan switch. If it is far above your realistic range, premium differences may dominate. If it is near your input, review scenarios carefully.