Medical Plan Savings Calculator

This tool estimates annual cost for each plan as:

• Employee Premium = Monthly Premium × (1 − Employer % ) × 12 − Annual Credit.
• Copays = PCP Visits × PCP Copay + Specialist Visits × Specialist Copay + Rx Fills × Rx Copay.
• Eligible Expenses = max(0, Other Covered Expenses − Preventive Covered).
• Deductible Paid = min(Eligible Expenses, Deductible).
• Coinsurance Paid = (Eligible Expenses − Deductible Paid) × Your Coinsurance %.
• Out-of-Pocket = min(Out-of-Pocket Max, Deductible Paid + Coinsurance Paid + Copays).
• Tax Savings = Pretax Contribution × Tax Rate.

1. Enter your expected annual visits, prescriptions, and other covered expenses.
2. Fill in Plan A and Plan B details: premiums, deductible, coinsurance, copays, and out-of-pocket maximum.
3. Add your pretax contribution and an estimated marginal tax rate.
4. Click Calculate Savings to see net annual costs and the estimated savings.
5. Use Download CSV or Download PDF to save your comparison.

Annual cost structure

The calculator estimates net annual cost as employee premium plus expected out-of-pocket costs, then subtracts tax savings and employer account funding. Using the built‑in example utilization (4 primary care visits, 2 specialist visits, 12 prescription fills, and $2,500 of other covered expenses with $400 preventive), the model produces a comparable, apples‑to‑apples annual view for both options.

Premium share and employer support

Premiums are converted to yearly amounts and adjusted for employer contributions. In the example, Plan A uses a $650 monthly premium with 60% employer support, while Plan B uses $520 with 55% support. The employee premium portion becomes the largest fixed cost driver for many households, so small percentage changes can materially shift annual totals.

Deductible, coinsurance, and maximum exposure

For non‑preventive covered expenses, the tool applies the deductible first, then coinsurance to the remaining eligible amount, and finally caps spending at the out‑of‑pocket maximum. Example terms: Plan A deductible $1,500, coinsurance 20%, max $6,500; Plan B deductible $2,500, coinsurance 15%, max $7,000. Copays for visits and prescriptions are added and assumed to count toward the cap.

Tax-advantaged contributions and credits

Pretax contributions reduce net cost through estimated tax savings. With a 20% marginal rate, a $1,500 pretax contribution yields about $300 in tax savings, while $2,000 yields about $400. Employer account funding is treated as a direct offset (example: $500 vs $800). If you also receive annual premium credits or wellness incentives, enter them to reduce employee premium totals.

Interpreting savings and break-even levels

The results section highlights which plan is cheaper and by how much per year, then estimates a break‑even level of other covered expenses where the choice flips. If Plan B shows lower net cost, it typically means premium savings and tax advantages outweigh its higher deductible. Use the break‑even figure to test realistic scenarios for a low‑use year, a typical year, and a high‑use year before enrollment. Recheck inputs whenever provider networks, drug tiers, or expected procedures change during the year.

What does “other covered expenses” mean?

Enter the plan’s allowed amount for services beyond routine copays, such as labs, imaging, and procedures. The calculator applies deductible and coinsurance to this amount, then caps spending at the out-of-pocket maximum.

How should I estimate copays if my plan has tiers?

Use a weighted average. For example, if 70% of fills are generic and 30% brand, multiply each copay by its share and add them. Do the same for visit copays if you expect mixed provider types.

Do preventive services reduce the deductible here?

Preventive covered amount is treated as excluded from deductible and coinsurance modeling. If your plan applies cost sharing to some preventive items, reduce the preventive input and move the remainder into other covered expenses.

Why do pretax contributions lower net cost?

Pretax contributions reduce taxable income. The calculator estimates savings as contribution multiplied by your marginal tax rate. If you itemize or face payroll taxes, your real savings may differ, but the estimate is useful for comparisons.

How is the break-even figure calculated?

The calculator scans increasing expense levels and finds where Plan A and Plan B net costs match, then interpolates between steps. It reflects your current copays, deductible, coinsurance, premium shares, tax rate, and employer contributions.

Can I use this for family coverage?

Yes. Enter family premiums and use combined annual visits, prescriptions, and expenses for everyone covered. Out-of-pocket maximums can be higher for family policies, so confirm whether your plan has individual and family caps.