Enter Plan Details
Formula Used
This calculator estimates each plan’s total annual cost using a simplified cost-sharing model. It combines premiums with expected out-of-pocket spending, then subtracts any credits.
- Annual Premium = Monthly Premium × 12
- Copays Total = (PCP Visits × PCP Copay) + (Specialist Visits × Specialist Copay) + (Rx Fills × Rx Copay)
- Deductible Paid = min(Allowed Charges, Deductible)
- Coinsurance Paid = max(0, Allowed Charges − Deductible) × Coinsurance Rate
- Estimated Out-of-Pocket = min(OOP Max, Copays Total + Deductible Paid + Coinsurance Paid)
- Total Annual Cost = Annual Premium + Estimated Out-of-Pocket − Employer/HSA Credit
- Deductible Savings = |Total Cost Plan A − Total Cost Plan B|
Important
Real plans can differ by network rules, exclusions, and service categories. Use this estimate for planning and comparisons.
How to Use This Calculator
- Enter your estimated annual allowed charges for covered services.
- Add typical usage: primary care visits, specialist visits, and prescriptions.
- Fill Plan A and Plan B premiums, deductibles, coinsurance, and out-of-pocket maximums.
- Include any employer contributions or account credits to reduce net cost.
- Click Calculate Savings to view totals and the estimated cheaper option.
- Download a CSV or PDF summary to share or save.
Example Data Table
Example only. Replace values with your plan documents and expected usage.
| Input / Output | Plan A | Plan B |
|---|---|---|
| Monthly premium | $220 | $350 |
| Deductible | $2,000 | $750 |
| Coinsurance | 20% | 10% |
| Out-of-pocket max | $6,500 | $4,500 |
| Allowed charges (annual) | $4,000 | |
| Estimated total annual cost | $6,? (varies) | $6,? (varies) |
| Estimated savings | Difference between the two totals | |
Tip: Try a low, moderate, and high spending scenario to see how the winner changes.
Why deductible choices change total cost
Deductibles shift cost timing. A higher deductible can lower premiums, but it also increases early-year exposure. This calculator estimates total annual cost by combining annual premium, expected out-of-pocket spending, and any credits. Use it to compare plans under one set of assumptions, then stress test with scenario spending. It helps you quantify that tradeoff very clearly.
Using allowed charges as a planning anchor
Allowed charges represent the amount a plan recognizes for covered services. If your annual allowed charges are $4,000, a $2,000 deductible means the first $2,000 is typically paid before coinsurance starts. Changing allowed charges by even $500 can move you from “below deductible” to “after deductible,” shifting which plan is cheaper. When unsure, use last year’s claims summary or provider estimates.
Premiums versus out-of-pocket tradeoffs
Many comparisons hinge on the premium gap. For example, a $130 monthly difference equals $1,560 per year. A lower-premium plan can remain cheaper even if out-of-pocket rises, especially when employer or account credits offset spending. The results area separates premium and estimated out-of-pocket so you can see what drives the difference. If coinsurance dominates, totals become more sensitive to spending.
Coinsurance and the out-of-pocket maximum
After the deductible, coinsurance applies to remaining allowed charges. A 20% coinsurance rate on $2,000 of post-deductible charges adds $400. However, the out-of-pocket maximum caps covered cost sharing, so high spending scenarios can favor plans with lower caps even when premiums are higher. Compare caps as downside protection, not just a distant limit. In some years, one hospital stay can reach it quickly.
How to use scenarios for better decisions
Run at least three scenarios: low, typical, and high spending. The Plotly sensitivity chart uses 50%, 100%, and 200% of your estimate to show how totals change. If the winner flips as spending increases, consider your cash flow, emergency savings, and risk tolerance. Choose the plan that stays competitive across realistic outcomes. Recheck during open enrollment if premiums or benefits change.
FAQs
1) What does “allowed charges” mean?
It is the plan’s recognized amount for covered services, not the provider’s sticker price. Your cost sharing is usually calculated from allowed charges, after discounts and network pricing.
2) Does the calculator replace my plan documents?
No. It is a planning tool that simplifies categories into deductible, coinsurance, copays, and an out-of-pocket maximum. Always verify details such as exclusions, networks, and service rules.
3) Are copays counted toward the out-of-pocket maximum?
Many plans count copays toward the out-of-pocket maximum, but rules vary. This calculator assumes copays contribute to the cap for comparison purposes. Adjust inputs if your plan differs.
4) How do employer or account credits affect results?
Credits reduce your net annual cost. Examples include employer HSA contributions, plan incentives, or reimbursements. Enter them to see how they change total cost and plan ranking.
5) Why can a higher deductible plan still win?
If premiums are much lower, the savings can exceed the extra deductible and coinsurance you expect to pay. This is common in low-to-moderate spending years.
6) What should I do if results are close?
When totals are similar, compare risk factors: deductible size, out-of-pocket maximum, and your cash reserve. Run a high-spend scenario to see which plan limits downside better.