Calculator inputs
Example data table
| Scenario | Monthly premium | Deductible | Coinsurance | OOP max | Visit copay |
|---|---|---|---|---|---|
| Low premium / higher deductible | $280.00 | $3,000.00 | 30% | $6,500.00 | $40.00 |
| Balanced plan | $425.00 | $1,500.00 | 20% | $4,500.00 | $30.00 |
| Higher premium / lower deductible | $560.00 | $750.00 | 10% | $3,000.00 | $20.00 |
Formula used
- Annual net premiums = max(0, Monthly Premium − Employer Support) × 12
- Annual copays = (Visit Copay × Visits) + (Prescription Copays × 12)
- Deductible paid = min(Deductible, Allowed Services Cost)
- Coinsurance paid = (Allowed Services Cost − Deductible Paid) × Coinsurance Rate
- Raw cost sharing = Copays + Deductible Paid + Coinsurance Paid
- Capped cost sharing = min(Raw Cost Sharing, Out-of-Pocket Maximum)
- Annual total = Annual Net Premiums + Capped Cost Sharing + Extras
- Tax savings estimate = HSA Contribution × Tax Rate (simplified)
How to use this calculator
- Enter your monthly premium and any employer support.
- Fill in deductible, coinsurance rate, and out-of-pocket maximum.
- Add your expected visits, visit copay, and monthly prescription copays.
- Estimate annual allowed services cost for tests, procedures, and hospital care.
- Optional: add non-covered and out-of-network extra costs.
- Use projection settings to see how costs may change over 1–5 years.
- Click Calculate breakdown to view results above the form.
- Use Download CSV or Download PDF for sharing.
Premium structure and support
A plan with a $425 monthly premium costs $5,100 per year before any help. If the employer contributes $125 monthly, the employee share becomes $300, or $3,600 annually. That $1,500 gap is meaningful because it lowers fixed spending every month and reduces how much cash flow you must reserve for healthcare. Use this difference to compare plans with higher deductibles but lower premiums safely.
Deductible and coinsurance mechanics
Allowed services are the amounts the plan recognizes for deductible and coinsurance. With $5,200 of allowed services, a $1,500 deductible is paid first. The remaining $3,700 is then split using 20% coinsurance, producing $740 of coinsurance expense. Separating these steps helps you see whether higher use primarily increases deductible exposure or ongoing percentage cost sharing.
Out-of-pocket maximum as risk control
This calculator assumes the out-of-pocket maximum caps copays, deductible, and coinsurance for covered care. With a $4,500 cap, any raw cost sharing above that level is reduced to the ceiling, creating a practical worst-case boundary. This is useful for stress testing large events, while still keeping non-covered and out-of-network amounts outside the cap when you enter them.
Copays and predictable recurring items
Copays behave like “known” costs. Eight visits at $30 each total $240, and prescription copays of $18 per month add $216 per year, bringing annual copays to $456. Adding $150 of non-covered costs produces a clearer cash estimate for routine care, supplements, or services that are commonly excluded depending on plan rules.
Tax-advantaged funding and budgeting projection
If you contribute $1,200 to an HSA and apply a 22% tax rate, the simplified tax savings estimate is $264, reducing the after-tax cost view. The projection table then applies 5% premium growth and 6% medical inflation to show how totals can climb over the next 1–5 years. In the default example, the first-year annual total is $6,446, or about $537 monthly, before any tax effects.
FAQs
What does the annual total include?
It adds net premiums, capped cost sharing (copays, deductible, coinsurance), plus extras like non-covered and out-of-network costs you enter.
Does the out-of-pocket maximum always cap copays?
Not always. Some plans exclude certain services, balance billing, or non-covered items. This tool assumes the cap applies to copays, deductible, and coinsurance for covered care.
How should I estimate allowed services cost?
Use prior-year claims, provider estimates, or planned procedures. Enter the plan-allowed amount when possible, not the billed amount, to better match deductible and coinsurance calculations.
What’s the difference between employer support and HSA funding?
Employer premium support lowers your premium payment directly. HSA funding is shown as a benefit or tax estimate that can offset your effective cost, but it is not a premium reduction.
Can I compare two plans with this calculator?
Yes. Run one plan, download the CSV, then change inputs for the second plan and download again. Compare net premiums, capped cost sharing, and totals side by side.
Why do deductible and coinsurance change when the cap applies?
If raw cost sharing exceeds the out-of-pocket maximum, the calculator reduces costs to the cap. It decreases coinsurance first, then deductible, then copays to match the capped total.