This calculator estimates what you will actually pay for a year of medical care given your plan’s deductible, coinsurance, and out-of-pocket maximum. Enter your expected total bills to see your share.
How Your Costs Are Calculated
Health plans share costs in stages. First you pay 100% until you meet your deductible. After that, you and the insurer split costs by your coinsurance rate (for example, you pay 20%). Once your total spending reaches the out-of-pocket maximum, the plan pays 100% of covered costs for the rest of the year.
Worked Example
With $12,000 in bills, a $2,500 deductible, 20% coinsurance, and an $8,000 out-of-pocket max: you pay 2,500 + (12,000 − 2,500) × 20% = 2,500 + 1,900 = $4,400 — below the max, so that is your cost.
Terms to Know
- Deductible: what you pay before the plan starts sharing costs.
- Coinsurance: your percentage share after the deductible is met.
- Out-of-pocket maximum: the most you pay in a year; the plan covers 100% after that.
This is a simplified estimate. Real plans also use copays, and monthly premiums are separate from these cost-sharing amounts.