Line up two options and compare every cost. Adjust coverage, discounts, and out-of-pocket limits quickly. Download your results to share with family later easily.
| Input | Option A example | Option B example |
|---|---|---|
| Consultation fee × visits | $40 × 1 | $55 × 1 |
| Procedure cost | $650 | $590 |
| Labs | $110 | $135 |
| Imaging | $220 | $180 |
| Medications | $85 | $95 |
| Follow-ups × cost | 2 × $25 | 1 × $30 |
| Discount | 10% | 5% |
| Eligible for coverage | 90% | 85% |
| Travel + lost wages | $20 + $60 | $35 + $90 |
| Goal | Compare total patient cost and savings | |
The calculator uses the following steps for each option.
Gross = Consultations + Procedure + Labs + Imaging + Medications + Follow-ups + Hospital stay + Other fees
Discount amount = Gross × (Discount% ÷ 100)
Discounted bill = Gross − Discount amount
Eligible = Discounted bill × (Eligible% ÷ 100)
Not eligible = Discounted bill − Eligible
Remaining deductible = max(Deductible − Deductible met, 0)
Deductible paid now = min(Eligible, Remaining deductible)
After deductible = Eligible − Deductible paid now
Coinsurance paid = After deductible × (Coinsurance% ÷ 100)
Copays = Copay per visit × (Consult visits + Follow-up visits)
Covered patient cost = Deductible paid now + Coinsurance paid + Copays
If out-of-pocket max is provided: Covered patient cost ≤ max(Out-of-pocket max − Out-of-pocket met, 0)
Total patient cost = Covered patient cost + Not eligible + Travel + Lost wages
In a typical comparison, start with the gross bill: consults, procedure, labs, imaging, medications, follow‑ups, stay, and fees. Example: 2 visits at 45, procedure 650, labs 120, imaging 200, meds 90, follow‑ups 2×25, fees 30. Gross becomes 1,235 before discounts. If a one‑day stay at 300 is added, gross rises to 1,535.
When insurance applies, the eligible portion first meets the remaining deductible. If deductible is 500 and 150 is already met, 350 remains. With eligible 900, you pay 350, then coinsurance on the remaining 550. At 20% coinsurance, that adds 110. If copay is 10 per visit and you have 4 visits, copays add 40. If out‑of‑pocket max is 2,500 and 300 is already met, covered costs cap at 2,200.
Discounts reduce the starting bill, then eligibility decides what can be covered. With a 10% discount on 1,235, the bill drops by 123.50 to 1,111.50. If 90% is eligible, 1,000.35 enters the insurance math, while 111.15 stays fully patient‑paid. Changing eligibility from 90% to 80% increases non‑eligible cost by 111.15. For flat discounts, convert to a percent by dividing by gross.
Two options can look similar on medical charges but differ in practical impact. Add travel, parking, lodging, and lost wages. Example: Option A adds 25 travel and 60 time cost; Option B adds 35 travel and 90 time cost. That 40 difference can flip a close result, especially for low‑cost services. If follow‑ups require three extra trips, multiply travel and time accordingly.
Savings should be read alongside uncertainty. Use the breakdown chart to spot the biggest drivers, then stress‑test one variable at a time. If coinsurance rises from 20% to 30%, the 550 post‑deductible share increases from 110 to 165. Re‑run both options to confirm the cheaper choice remains stable. Prefer the option with the lower, more predictable patient total. Document assumptions in the notes.
Eligible for coverage is the portion of the discounted bill your plan typically considers covered. Exclusions, noncovered items, and denied charges remain “Not Eligible” and are fully patient-paid in the final total.
The calculator applies the remaining deductible first: max(deductible − met, 0). That amount is paid by the patient up to the eligible total, then coinsurance and copays apply to the rest.
Copays are estimated as copay per visit × (consultation visits + follow‑up visits). If your plan uses different copays by service type, use an average value or move the difference into Other fees.
If you enter an out‑of‑pocket maximum, covered patient cost is capped at max(oop max − oop met, 0). Not Eligible, travel, and lost wages are still added, because many plans do not count them toward the cap.
Two options can have similar medical charges but very different real impact. Adding travel, parking, lodging, and time cost helps compare the full financial burden, especially when multiple visits or long-distance care is involved.
This tool provides planning estimates. Actual bills depend on procedure codes, network rules, negotiated rates, prior authorizations, and claim adjudication. Use your insurer’s EOB and provider estimates to refine inputs before deciding.
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.