Model your deductible, coinsurance, and maximum limits easily. Adjust expenses, visits, and copays for accuracy. Download clear reports and compare scenarios before enrollment season.
Use allowed costs (insurer-negotiated amounts), not billed charges.
Disclaimer: This tool provides an educational estimate. Real plans can vary by network tier, pharmacy rules, carve-outs, and whether items count toward deductibles or maximums.
These sample rows show how deductibles shift costs as medical use rises.
| Profile | Deductible | Coinsurance | OOP Max | Premium / mo | Allowed Costs | Typical Outcome |
|---|---|---|---|---|---|---|
| Low use | $1,500 | 20% | $6,000 | $250 | $1,200 | Mostly premium + copays |
| Moderate use | $1,500 | 20% | $6,000 | $250 | $8,000 | Deductible met, coinsurance matters |
| High use | $1,500 | 20% | $6,000 | $250 | $35,000 | OOP max likely reached |
1) Annual premium = monthly premium × 12
2) Deductible-eligible costs = allowed costs × eligible share
3) Paid toward deductible = min(remaining deductible, eligible costs)
4) Post-deductible eligible costs = eligible costs − paid toward deductible
5) Coinsurance paid by patient = post-deductible eligible costs × patient rate
6) Medical out-of-pocket (before cap) = deductible payments + coinsurance + copays
7) Medical out-of-pocket (capped) = min(out-of-pocket max, medical out-of-pocket before cap)
Notes: This model treats copays as separate from allowed costs and assumes deductible, coinsurance, and copays all count toward the out-of-pocket maximum.
High deductibles shift first-dollar spending to you. With a $1,500 deductible, the calculator assigns deductible-eligible costs from allowed spending using your eligible-share setting. In the default example, $8,000 allowed costs and 85% eligibility create $6,800 eligible spend, so you pay the first $1,500 before coinsurance applies.
After the deductible, coinsurance sets the slope of your cost curve. At 20% coinsurance, the remaining $5,300 eligible spend produces $1,060 in coinsurance payments. Adding $200 of copays (8 visits × $25) yields $2,760 medical out-of-pocket before any cap, which is the main driver of “deductible impact.”
The out-of-pocket maximum limits downside risk when costs spike. Using the same plan settings and $35,000 allowed costs, eligible spend becomes $29,750 and medical out-of-pocket would exceed $6,000, so the calculator caps your medical spending at $6,000. This converts uncertain high-usage exposure into a predictable maximum.
Premiums are the fixed part of annual cost. The calculator reports annual premium as monthly premium × 12, so $250 per month equals $3,000 yearly. With moderate usage, total annual cost becomes $3,000 + $2,760 = $5,760. Comparing plans means weighing higher premiums against lower cost sharing.
Forecast error is common, so the tool shows scenarios at 50%, 100%, and 150% of expected costs. If allowed costs fall to $1,200, eligible spend is $1,020 and you typically do not meet the deductible; medical out-of-pocket is about $1,245 including copays. Use these ranges to pick a plan that stays affordable even when care needs change.
If your plan counts copays toward the deductible, the deductible falls faster, changing timing of coinsurance. The patient-share metric and impact index summarize how much of allowed costs you fund.
Allowed costs are the insurer-negotiated amounts used for deductible and coinsurance calculations. Billed charges can be higher and are rarely paid in full. Using allowed amounts makes estimates closer to how claims are processed.
Not always. Many plans cover certain preventive services without applying the deductible. Some services use fixed copays, and some plans have separate rules for drugs or out-of-network care. Check your plan summary for exceptions.
It estimates what portion of your expected costs must satisfy the deductible. For example, 85% means most spending is subject to the deductible, while 60% implies more costs bypass it through copays or first-dollar coverage.
When deductible, coinsurance, and copays exceed the maximum, your medical out-of-pocket is capped at that limit. After the cap, the calculator assumes the plan pays remaining covered eligible costs for the year.
Yes. Enter Plan A values, calculate, and download the CSV or PDF. Then enter Plan B and repeat. Compare total annual cost, medical out-of-pocket, and whether the cap is reached under the sensitivity scenarios.
Pharmacy benefits vary widely. If drug costs are subject to the deductible, include them in allowed costs. If they are fixed copays, add them through visit copays or adjust expected allowed costs accordingly.
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.