Plan smarter by mapping every premium and charge. Add visits, prescriptions, labs, and hospital costs. Get a clear breakdown you can share instantly anywhere.
| Category | Example value | Why it matters |
|---|---|---|
| Total premium per month | $650.00 | Drives your baseline annual spending. |
| Employer contribution | 60% | Reduces your premium responsibility. |
| Deductible / OOP max | $1,500 / $6,000 | Controls when coinsurance starts and where costs cap. |
| Copays (PCP / Specialist) | $25 / $45 | Fixed charges for common office visits. |
| Expected yearly visits | PCP 3, Specialist 2 | Usage shifts cost from premium toward out-of-pocket. |
| Labs and imaging totals | $450 and $800 | Often billed through deductible and coinsurance. |
Monthly premium is multiplied by 12, then split by employer support. If total premium is $650 and the employer pays 60%, your share is $260 per month, or $3,120 yearly. If the employer instead contributes a fixed $300, your share becomes $350 monthly, or $4,200 yearly. Tracking this baseline matters because premiums are paid even when care use is low, and they are not reduced by the out-of-pocket maximum.
The model applies deductible first, then coinsurance on the remaining allowed amount. With a $1,500 deductible and 20% coinsurance, a $800 imaging total uses $800 of deductible, leaving $700 deductible remaining. A later $1,000 lab total consumes the last $700 deductible, then coinsurance applies to the remaining $300, costing $60.
Visits and prescriptions can be treated as fixed copays, or as allowed costs that flow through deductible and coinsurance. For example, 3 primary care visits at a $25 copay totals $75. If copays are not paid before the deductible, the same 3 visits at a $140 allowed cost total $420, which may fully apply to deductible early in the year.
The calculator caps eligible cost-sharing at the out-of-pocket maximum, such as $6,000, while premiums remain separate. If accumulated deductible, coinsurance, and counted copays reach the cap, additional counted services are modeled at $0 for the remainder of the year. This helps compare plans where a higher premium buys a lower risk ceiling.
Run multiple scenarios by adjusting visit counts, labs, imaging, or inpatient totals. A modest change, like adding one ER visit at a $250 copay, can move monthly averages quickly. Net effective cost is estimated as premiums plus out-of-pocket, minus employer HSA funding and tax savings. At a 22% marginal rate, a $2,000 contribution estimates $440 savings for planning.
It is the negotiated price your plan uses for cost sharing. Deductible and coinsurance are applied to allowed amounts, not the provider’s billed charge, which may be higher.
No. The out-of-pocket maximum typically caps eligible cost sharing, such as deductible, coinsurance, and some copays. Premiums are separate and continue regardless of reaching the cap.
If you select copays paid before the deductible, visits and prescriptions use fixed copays. If not, the tool uses your allowed-cost assumptions and applies deductible and coinsurance instead.
Net effective cost subtracts employer HSA funding and estimated tax savings on your contribution. It is a planning estimate and depends on eligibility, tax treatment, and how you actually use the account.
Use annual allowed totals if you have an explanation of benefits or pricing tool. If you only know billed charges, reduce them to a conservative allowed estimate so deductible and coinsurance aren’t overstated.
Yes. Run a scenario for Plan A, export CSV or PDF, then change inputs for Plan B. Keep utilization the same to isolate how premiums, deductible, coinsurance, and caps affect your costs.
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.