Health Plan Comparison Estimator

This estimator projects annual cost using premium plus expected member payments, capped by the out-of-pocket maximum. It applies deductibles first, then coinsurance, and adds copays where selected.

• Annual premium = monthly premium × 12
• Deductible payment = min(allowed cost, remaining deductible)
• Coinsurance payment = remaining allowed cost × (coinsurance % you pay)
• Copay-only items = copay amount (unless you mark the item as deductible-based)
• Out-of-pocket cap = member payments stop at out-of-pocket max
• Gross total = annual premium + out-of-pocket total
• Net total = gross total − employer funding − (planned HSA × tax rate)

1. Enter each plan’s premium, deductibles, coinsurance, and out-of-pocket maximum.
2. Fill in copays for office, urgent, emergency care, and prescriptions.
3. Decide whether office visits or drugs are deductible-based for your plan.
4. Set your expected yearly usage, then press Compare plans.
5. Review the table, breakdown, and curve to see tradeoffs.
6. Use CSV or PDF export to save and share results.

Premium Versus Risk Exposure

Annual premium is predictable cash outflow, while care usage is uncertain. A plan at $220 per month costs $2,640 yearly before any services. A lower premium can still be expensive if you frequently use care. This estimator combines premium with modeled member payments to show a comparable annual total for each option, using your own visit and prescription counts. It also flags the lowest net cost option clearly.

Deductible And Coinsurance Flow

For services marked deductible based, the model pays the allowed amount until the deductible is satisfied. After that, you pay coinsurance, such as 20% of remaining allowed charges. Example: with a $1,500 deductible and a $3,000 major service, you pay $1,500 plus 20% of the remaining $1,500, before any out of pocket cap applies.

Prescription Tier Cost Drivers

Drug spending often separates similar plans. If drugs are not subject to a drug deductible, the calculator uses fixed copays for generic and brand fills. If they are deductible based, each fill uses an allowed cost assumption, then applies deductible and coinsurance. Specialty drugs are modeled as annual allowed spending with a separate specialty coinsurance percentage, helping stress test high cost therapies.

Out Of Pocket Ceiling

The out of pocket maximum limits your covered spending risk. Member payments accumulate across categories and stop once the cap is reached. In heavy usage years, two plans with different deductibles can converge near the cap, making premium and employer funding more decisive. The results table highlights estimated out of pocket total and the cap value so you can judge downside protection.

Scenario Curve For Decisions

Because major services are hard to predict, the what if curve varies annual allowed spending from $0 to your selected maximum. Each curve plots net total, which subtracts employer funding and estimated tax savings from planned HSA contributions. If one plan stays lower across most of the range, it is the robust choice. Crossovers indicate where risk preferences matter.

How many plans can I compare here?

Enter values for Plan A, Plan B, and Plan C. If you only need two, keep one plan’s premium high or leave its name blank and ignore its row.

What does “allowed cost” mean in the usage section?

It is the negotiated amount used for deductible and coinsurance math. If you do not know it, keep the defaults and focus on realistic visit counts and major services.

When should I mark office visits as deductible-based?

Use it when your plan says office visits are subject to the medical deductible before any copay applies. If your plan lists a fixed copay from day one, leave it unchecked.

How is net total calculated?

Net total equals annual premium plus estimated out-of-pocket, then subtracts employer funding and estimated tax savings on your planned HSA contribution using your marginal tax rate.

Why can two plans look similar in high-usage years?

Once spending reaches the out-of-pocket maximum, additional covered costs are capped. At that point, differences in premium, employer funding, and coinsurance rules drive results.

What is the purpose of the scenario curve?

It shows how your choice changes as major services spending increases. If one plan stays cheaper across most values, it is less sensitive to unexpected medical events.