Annual care cost calculator

Model a year of covered care

Enter the annual premium you personally pay and the plan’s deductible, coinsurance percentage and total in-network out-of-pocket maximum. Medical costs mean the plan’s allowed charges, not a provider’s original billed amount. All defaults are illustrative, not current plan prices.

The model first allocates charges to the deductible, then applies coinsurance to the remaining charges. It caps the combined deductible and coinsurance at the out-of-pocket maximum. A zero maximum means zero modeled cost sharing; it does not mean unlimited liability. The deductible must not exceed the maximum.

Worked example

For illustrative allowed charges of $12,000, a $2,000 deductible and 20% coinsurance, you pay $2,000 + ($10,000 × 20%) = $4,000 for care. Add $4,800 in annual premiums for $8,800 total. The $6,000 maximum does not bind in that scenario.

What this leaves out

This model has no copayments, separate drug deductible, family accumulators, pre-deductible benefits or services outside coverage. Premiums, noncovered services and many out-of-network charges do not count toward the in-network maximum. Do not use it to estimate emergency legal protections or subsidy eligibility. Check the actual benefit document and ask your insurer about individual services.