Premiums are only half the story. Enter a plan's premium, deductible, coinsurance, and out-of-pocket maximum, plus your expected medical spending, to see the true total annual cost.
Sample input: Monthly premium ($): 400, Annual deductible ($): 2000, Coinsurance after deductible (%): 20, Out-of-pocket maximum ($): 6000, Expected medical spending this year ($): 5000
Estimated annual cost: 7400 (Moderate total cost)
For about $5,000 of expected medical spending, this plan costs roughly $7,400 per year (about $617/month) — $4,800 in premiums plus $2,600 in out-of-pocket costs, capped at the plan's out-of-pocket maximum.
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Premiums (paid whether or not you use care) plus your out-of-pocket share: the deductible, then coinsurance on spending above it, all capped at the out-of-pocket maximum. Premiums do not count toward the out-of-pocket maximum, per HealthCare.gov.
After you meet your deductible, coinsurance is the percentage of further covered costs you keep paying until you hit the out-of-pocket maximum. A 20 percent coinsurance means the plan pays 80 percent and you pay 20 percent of those costs (HealthCare.gov).
It is the most you will pay in a plan year for covered, in-network care. Once your deductible plus coinsurance plus copays reach it, the plan pays 100 percent of covered costs for the rest of the year (HealthCare.gov).
This estimate models premiums, the deductible, and coinsurance up to the out-of-pocket maximum. It does not separately add fixed copays or out-of-network charges, which have different cost-sharing. Check your plan's Summary of Benefits for the full picture.