Health Plan Coverage Savings Tool Calculator

Find the plan that fits your family budget. Model doctor visits, prescriptions, and surprise bills. Get a clear savings estimate before enrollment deadlines arrive.

Calculator

Enter two plans and a utilization scenario to estimate annual savings.

Utilization assumptions
These drive modeled out-of-pocket cost.
Please enter a number.
Please enter a number.
Please enter a number.
Total copays for regular prescriptions.
Please enter a number.
Charges that hit deductible/coinsurance.
Please enter a number.
Used to estimate pre-tax savings.
Please enter a number.
Plan A details
Used to estimate tax savings.
Plan B details
Used to estimate tax savings.

Example data table

This example shows one scenario and the resulting net annual costs.

Scenario Primary / Specialist / ER visits Rx copays Other charges Tax rate Plan A (Lower Premium) net Plan B (Richer Coverage) net
Example 4 / 2 / 0 $240.00 $2,500.00 22% $3,510.00 $4,265.00
Use “Load Example Inputs” to populate the form with this scenario.

Formula used

This tool uses a simplified, transparent model.
Out-of-pocket model
  • Annual Premium = Monthly Premium × 12
  • Visit Cost = (PC Visits×PC Copay) + (Spec Visits×Spec Copay) + (ER Visits×ER Copay)
  • Deductible Paid = min(Deductible, Other Allowed Charges)
  • Coinsurance Paid = max(0, Other Charges − Deductible Paid) × Coinsurance%
  • Medical Before Cap = Visit Cost + Rx Copays + Deductible Paid + Coinsurance Paid
  • Capped OOP = min(OOP Max, Medical Before Cap)
Net cost model
  • Eligible Pre-tax Base = min(Your Contribution, Capped OOP)
  • Estimated Tax Savings = Eligible Base × Tax Rate
  • Net Annual Cost = Annual Premium + Capped OOP − Employer Funding − Tax Savings
  • Break-even other charges are found by searching where Plan A and Plan B net costs match (0–$200,000).
Real plans vary: networks, tiers, embedded deductibles, and prescription rules can change outcomes.

How to use this calculator

  1. Enter your expected visits, prescriptions, and other allowed charges.
  2. Fill Plan A and Plan B details from plan summaries.
  3. Set your marginal tax rate to estimate pre-tax savings.
  4. Click Calculate Savings to view results above.
  5. Use Download CSV or Download PDF for sharing.
  6. Adjust “Other allowed charges” to test worst-case scenarios.

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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.