Enter Details
Example Data Table
| Item | Plan A | Plan B |
|---|---|---|
| Monthly premium | $320 | $210 |
| Deductible | $1,500 | $3,000 |
| Coinsurance after deductible | 20% | 30% |
| Out-of-pocket max | $6,000 | $7,500 |
| Other allowed charges (annual) | $2,500 | |
| Visit & prescription copays (annual) | $360 | $290 |
| Estimated net total | $6,200 | $5,980 |
Formula Used
- Annual Premium = Monthly Premium × 12
- Copays = (primary visits × primary copay) + (specialist visits × specialist copay) + (urgent visits × urgent copay) + (ER visits × ER copay) + (Rx fills × Rx copay)
- Deductible Paid = min(Deductible, Other Allowed Charges)
- Coinsurance Paid = max(0, Other Allowed Charges − Deductible Paid) × Coinsurance%
- Out-of-Pocket (raw) = Copays + Deductible Paid + Coinsurance Paid
- Out-of-Pocket (capped) = min(Out-of-Pocket raw, Out-of-Pocket Max)
- Credits = Employer HSA Contribution + (Your HSA Contribution × Tax Rate)
- Estimated Net Total = Annual Premium + Out-of-Pocket (capped) − Credits
How to Use This Calculator
- Enter how many visits and prescription fills you expect this year.
- Add “Other allowed charges” for tests, procedures, or therapy costs.
- Fill in each plan’s premium, deductible, coinsurance, copays, and out-of-pocket max.
- If applicable, add employer and personal HSA contributions and your estimated tax rate.
- Click Compare Costs to see totals and a detailed breakdown above.
- Use the download buttons to save a CSV or PDF report.
Annual cost starts with predictable premiums
Premiums are the baseline expense because you pay them whether you use care or not. This calculator annualizes monthly premiums and compares them against expected usage. A $420 monthly premium becomes $5,040 per year, while $280 becomes $3,360. That $1,680 spread is guaranteed, so it should be evaluated before worrying about coinsurance percentages.
Out-of-pocket exposure depends on usage and caps
Medical use converts into copays, deductible payments, and coinsurance. If other allowed charges are $3,000 and the deductible is $2,000, only $1,000 moves into coinsurance. At 20% coinsurance, that adds $200. The out-of-pocket maximum caps the total, helping heavy-use scenarios. For example, once your capped amount reaches $6,500, additional covered spending should not increase your net total, aside from premiums.
Copays shift costs toward frequent visits
Copays behave like fixed fees per event, so they scale with visit counts and prescriptions. Ten primary visits at $30 is $300, and eight specialist visits at $60 is $480. Add two urgent care visits at $75 and one ER visit at $300, and copays alone reach $1,230. Plans with higher premiums sometimes offer lower copays, which can be valuable for families managing recurring care.
HSA contributions and tax savings reduce net cost
If your employer contributes $1,000 to an HSA and you add $1,500, the calculator treats both as credits, plus estimated tax savings. With a 22% tax rate, $1,500 yields about $330 in savings. Combined, the net offset becomes $2,830, which directly reduces the estimated annual total. These offsets often favor high-deductible plans when you can fund the account and keep cash for the deductible. It highlights cost sensitivity to spending.
Breakeven testing clarifies when to switch plans
The breakeven estimate varies the “other allowed charges” amount while holding visits steady. When the net totals match, that spending level becomes your decision threshold. If Plan A wins below $6,500 of allowed charges and Plan B wins above it, you can choose based on realistic risk tolerance.
FAQs
What does “other allowed charges” mean?
It represents negotiated amounts for services beyond copays, such as labs, imaging, procedures, or therapy. The calculator applies the plan’s deductible and coinsurance to this number, then caps costs at the out-of-pocket maximum.
Why can a higher-premium plan be cheaper?
If you expect frequent visits or large allowed charges, lower copays, lower coinsurance, or a lower out-of-pocket maximum can reduce your capped spending enough to beat the premium difference.
Does the calculator include out-of-network bills?
No. It assumes costs follow in-network plan rules. Out-of-network care can have separate deductibles, higher coinsurance, balance billing, or no coverage, so results may differ.
How are HSA savings estimated?
Employer and your contributions reduce net cost as credits. The tax savings is approximated as your contribution multiplied by your entered tax rate. Actual savings can vary by income, state rules, and eligibility.
How should I pick a tax rate to enter?
Use your best estimate of your marginal federal rate, and include state tax only if you want a combined rate. If unsure, try 12%, 22%, and 32% to see sensitivity.
Can I compare more than two plans?
This tool compares two plans at a time for clarity. To compare three or more, run multiple comparisons using the same usage assumptions and keep a note of each net total.