Health Insurance Out-of-Pocket Cost Calculator : Free Online Calculator

Your Plan & Usage Details

Annual Deductible ($)

Amount you pay before insurance kicks in

Out-of-Pocket Maximum ($)

Most you'll pay in a year

Coinsurance Rate (%)

Your share after meeting deductible (e.g. 20 for 80/20)

Monthly Premium ($)

What you pay each month for coverage

Estimated Annual Medical Bills ($)

Total expected medical costs before insurance

Copay per Visit ($)

Fixed fee per doctor/specialist visit

Estimated Number of Visits per Year

Doctor, specialist, urgent care visits combined

Your Estimated Annual Costs

Annual Premiums

:

Deductible You Pay

:

Coinsurance Costs

:

Copay Costs

:

Total Estimated Annual Out-of-Pocket Cost

:

(Premiums + Medical Cost-Sharing, capped at your OOP max)

Premiums Medical Cost-Sharing

: :

How It Works

1

Annual Premium Cost

Your monthly premium × 12. This is fixed regardless of medical usage.

2

Deductible Applied

You pay 100% of medical bills up to your deductible. If total bills exceed the deductible, you move to coinsurance.

3

Coinsurance on Remaining Bills

After the deductible, you pay your coinsurance % of remaining covered expenses: (Bills − Deductible) × Coinsurance%

4

Out-of-Pocket Maximum Cap

Deductible + coinsurance is capped at your plan's out-of-pocket maximum. You never pay more than this for in-network covered care.

5

Copays Added

Copays are fixed per-visit fees: Copay × Number of Visits. These may or may not count toward your deductible depending on your plan.

Formula Summary:
Medical Cost-Sharing = min(Bills, Deductible) + min(max(Bills − Deductible, 0) × Coinsurance%, OOP Max − Deductible)
Medical Cost-Sharing is then capped at OOP Max.
Total = Annual Premiums + Medical Cost-Sharing + Copays (capped at OOP Max + Premiums)

Tips to Lower Your Out-of-Pocket Costs

✓ Use in-network providers : out-of-network costs often don't count toward your deductible or OOP max.
✓ Open an HSA (Health Savings Account) if you have a high-deductible plan (HDHP) to pay costs tax-free.
✓ Request itemized bills and check for errors : medical billing mistakes are common.
✓ Use preventive care : most plans cover it at 100% with no cost-sharing required.
✓ Compare total annual costs (not just premiums) when choosing between plans : a lower premium isn't always cheaper overall.