Plan smarter coverage with clear numbers and scenarios. Balance premium comfort against out-of-pocket surprises better. Get a practical estimate and adjust as life changes.
| Scenario | Income | Net premium | Deductible | Coinsurance | Out-of-pocket max | Expected spend |
|---|---|---|---|---|---|---|
| Balanced | $65,000 | $370/mo | $2,500 | 20% | $7,500 | $3,500 |
| Lower premium | $65,000 | $280/mo | $4,000 | 30% | $9,000 | $2,200 |
| Higher protection | $65,000 | $520/mo | $1,500 | 10% | $5,000 | $4,800 |
These sample rows show common tradeoffs between premium and maximum exposure.
premiumAnnual = netMonthly × 12
spendAfterDed = max(0, expectedSpend − deductible)
oop = min(oopMax, deductible + spendAfterDed × coinsurance)
total = premiumAnnual + oop + rxMonthly×12reserve = oopMax × riskMult × (1 + bufferPct)band ≈ 5–10% of monthly income (+ dependent factor)score = 0.55×premiumFit + 0.45×reserveFitFor best results, run multiple scenarios (lower premium vs higher protection) and compare the total expected annual cost and suggested reserve fund.
Healthcare costs can be lumpy, so planning for volatility protects cash flow. In the example table, a balanced scenario uses $370 net premium per month, $2,500 deductible, 20% coinsurance, and a $7,500 out-of-pocket cap. That structure can produce a very different annual outcome than a lower premium plan with a $4,000 deductible and 30% coinsurance.
This estimator combines three annual buckets: net premiums, expected out-of-pocket spending, and predictable prescriptions. Net premiums are annualized from monthly premium minus employer support. Expected out-of-pocket follows a deductible-plus-coinsurance model, then is limited by the out-of-pocket maximum, which acts as a ceiling for covered services.
A practical affordability band helps you sanity-check premiums against income. The calculator uses a 5% to 10% monthly income range and adds a small dependent adjustment. If your net premium lands above the upper band, the score declines, signaling that the plan may strain the budget even if benefits look generous.
Even strong coverage can leave meaningful exposure, especially early in the year. The suggested reserve targets the out-of-pocket maximum, adjusted by a risk factor and a user-chosen buffer percentage. Selecting high risk increases the reserve multiplier, encouraging a larger cushion for chronic conditions or frequent care.
Run multiple scenarios with the same income but different plan designs. Compare total expected annual cost alongside the reserve suggestion and the score. A higher protection plan may raise premiums but reduce expected out-of-pocket. When the total cost is similar, preference often hinges on how much risk you want to absorb.
For instance, with $3,500 expected spend, $2,500 deductible, and 20% coinsurance, expected out-of-pocket becomes $2,700 before the cap. If the cap is $7,500, the ceiling is far above the estimate, so savings still matter. Adjust prescriptions and buffer to reflect your household. Recheck results after major life events annually.
No. It is a budgeting tool that estimates yearly costs using the values you enter. Always confirm deductibles, coinsurance, copays, exclusions, and network rules in your plan materials before making decisions.
It assumes you pay the deductible first, then pay coinsurance on remaining expected spend, capped by the out-of-pocket maximum. This simplifies real plans, but it gives a useful planning baseline.
Many employer plans split premium costs. The calculator estimates your personal budget impact by using net premium, which equals monthly premium minus employer support, never going below zero.
It is a rule-of-thumb range based on monthly income, with a small adjustment for dependents. If your net premium sits above the upper band, affordability risk increases and the score may drop.
Pick low for infrequent care, medium for typical use, and high for chronic conditions or ongoing treatment. The buffer adds extra cushion to the reserve so unexpected timing or services do not disrupt cash flow.
Yes. Enter Plan A values, submit, and download the CSV or PDF. Then change fields for Plan B and submit again. Compare total expected cost, reserve suggestion, and the chart to see tradeoffs clearly.
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.