Plan details
Enter each plan’s premium and cost-sharing rules, then model expected annual covered spending.
Example data table
Sample inputs and estimated totals for one spending scenario.
| Item | Plan A | Plan B |
|---|---|---|
| Monthly premium | $210 | $320 |
| Deductible | $1,000 | $500 |
| Coinsurance | 20% | 15% |
| Out-of-pocket max | $6,000 | $4,500 |
| Annual covered spending | $3,500 | $3,500 |
| Estimated total annual cost | $3,? (varies by copays) | $4,? (varies by copays) |
Replace the question marks by running the calculator with these values.
Formula used
This model estimates annual cost from premiums and cost-sharing. It’s a planning estimate, not a claim adjudication engine.
1) Split expected spending
Some spending may bypass the deductible (depending on benefits).
SubjectSpend = ExpectedSpend × SubjectPct
NonSubjectSpend = ExpectedSpend − SubjectSpend
2) Out-of-pocket estimate
Deductible applies first, then coinsurance. Copays are added.
DedPaid = min(Deductible, SubjectSpend)
CoinsOnSubject = (SubjectSpend − DedPaid) × CoinsRate
CoinsOnNonSubject = NonSubjectSpend × CoinsRate
Copays = VisitCopay×Visits + RxCopay×Fills
OOP = min(OOPMax, DedPaid + CoinsOnSubject + CoinsOnNonSubject + Copays)
3) Total annual cost
AnnualPremium = MonthlyPremium × 12
TotalAnnualCost = AnnualPremium + OOP
Breakeven spending is found by numeric search where Plan A and Plan B totals match.
How to use this calculator
- Enter each plan’s monthly premium, deductible, coinsurance, and out-of-pocket maximum.
- Add typical copays plus how many visits and prescriptions you expect yearly.
- Set the deductible-applicable share to reflect what must meet the deductible first.
- Type a single spending estimate to compare plans for one scenario.
- Optionally fill low, mid, and high scenarios with weights to compute an expected total.
- Submit to view results, then download CSV or PDF if needed.
If your plan treats copays differently or has separate deductibles, adjust inputs and interpret results accordingly.