Calculator Inputs
Plotly Graphs
Example Data Table
| Claim amount | Plan A total | Plan B total | Cheaper plan | Plan B − Plan A |
|---|---|---|---|---|
| $0.00 | $2,400.00 | $1,500.00 | High deductible plan | -$900.00 |
| $2,000.00 | $3,200.00 | $3,500.00 | Low deductible plan | +$300.00 |
| $4,000.00 | $3,600.00 | $4,800.00 | Low deductible plan | +$1,200.00 |
| $6,000.00 | $4,000.00 | $5,400.00 | Low deductible plan | +$1,400.00 |
| $8,000.00 | $4,400.00 | $6,000.00 | Low deductible plan | +$1,600.00 |
| $10,000.00 | $4,800.00 | $6,600.00 | Low deductible plan | +$1,800.00 |
| $12,000.00 | $5,200.00 | $7,200.00 | Low deductible plan | +$2,000.00 |
| $14,000.00 | $5,400.00 | $7,800.00 | Low deductible plan | +$2,400.00 |
| $16,000.00 | $5,400.00 | $8,400.00 | Low deductible plan | +$3,000.00 |
| $18,000.00 | $5,400.00 | $9,000.00 | Low deductible plan | +$3,600.00 |
| $20,000.00 | $5,400.00 | $9,000.00 | Low deductible plan | +$3,600.00 |
Formula Used
- Out-of-pocket = deductible + coinsurance × (claim − deductible), capped by out-of-pocket maximum.
- Total annual cost = annual premium + out-of-pocket.
- Break-even claim is where Plan A total equals Plan B total.
How to Use This Calculator
- Enter each plan’s annual premium, deductible, coinsurance rate, and out-of-pocket maximum.
- Set a maximum claim amount to preview costs across a realistic range.
- Click Calculate to show break-even and update charts and table.
- Use CSV or PDF downloads to save a scenario for sharing.
Premium and Deductible Trade-Off
High deductibles often reduce premiums, improving predictable cash flow. The trade-off is higher exposure when a loss occurs. This calculator converts plan terms into comparable annual totals, so pricing differences and risk tolerance can be evaluated consistently. Compare premium savings to the deductible increase to see how much loss you can absorb before savings disappear.
Break-Even Claim Amount
The break-even point is the claim level where both plans cost roughly the same for the year. Below that level, the lower premium plan may win. Above it, the lower deductible plan can become cheaper because cost sharing shifts from the policyholder to the insurer. Break-even is not a guarantee; it is a planning benchmark that depends on utilization and covered amounts.
Out-of-Pocket Cost Mechanics
Out-of-pocket is modeled in three steps: the deductible is paid first, then coinsurance applies to remaining covered costs, and finally an out-of-pocket maximum caps spending in high-loss scenarios. This structure reflects many benefit designs with tiered cost sharing. The model assumes one annual claim amount, so multiple events can be approximated by testing combined annual totals.
Scenario Range and Sensitivity
Use the max-claim range to stress test outcomes across minor, moderate, and severe events. Increasing the steps produces a smoother curve and a clearer crossover. Coinsurance changes the slope after the deductible, while out-of-pocket maximums flatten costs at higher losses. If lines never intersect within the tested range, the same plan may remain cheaper across your likely claim distribution.
Decision Support and Reporting
The table summarizes totals and the difference (Plan B minus Plan A) at each claim level. The comparison chart shows overall cost curves, while the difference chart makes the winner obvious. Export to CSV or PDF to document renewal decisions and share assumptions. Combine results with an expected-claims estimate to support budgeting and risk governance discussions. Review results annually as premiums and terms change.
FAQs
What does break-even mean in this calculator?
It is the claim amount where both plans have the same estimated annual total cost. Below it, one plan tends to cost less; above it, the other may become cheaper, given your inputs.
Why can break-even show “Not found”?
If Plan A is always cheaper or always more expensive within the tested range, the curves do not cross. Adjust the max claim range or verify that deductibles, coinsurance, and out-of-pocket caps are entered correctly.
How should I set the out-of-pocket maximum field?
Enter the plan’s annual out-of-pocket cap for covered expenses. If there is no cap or it does not apply to your scenario, enter 0. The model will then ignore the cap.
Does this include copays, exclusions, or separate deductibles?
No. It uses a simplified deductible-plus-coinsurance structure with an optional out-of-pocket cap. If your plan has copays, exclusions, or separate deductibles, treat results as directional and adjust inputs to approximate those effects.
How accurate are the totals for multiple claims in one year?
The model assumes a single annual claim amount. For multiple events, estimate the combined annual covered amount and test that value. You can also run several scenarios and compare a weighted average.
Which plan should I choose if I expect low claims?
If expected claims are low, the lower premium option often reduces total cost. However, confirm that you can afford the higher deductible in a worst-case year and that the coinsurance and cap do not create unacceptable exposure.