United States · health-plan costs
How much will this health plan really cost me?
The premium is only the predictable part. Model expected covered care, deductible, coinsurance, copays and the out-of-pocket maximum, then compare a second plan under the same usage assumption.
Annual USD estimate In-network covered care assumption 7 calculators inside
Your situation
What cost scenario are you planning for?
Start with normal expected care, compare two plans or stress-test the annual maximum. The result is designed to make the trade-off visible before enrollment.
That's not my case
Fine-tune the estimate
Your health-plan numbers
Enter monthly premiums and covered in-network care for one year. The second-plan fields are used in the comparison case; set them to 0 if you are reviewing only Plan A.
Informational estimate. This assumes covered in-network care and simplified cost sharing. Premium tax credits, employer contributions, prescriptions, provider networks, non-covered services and plan-specific rules can change the actual cost. Review the Summary of Benefits and Coverage.
How the total adds up
Annual cost layers
The plan’s annual cost is premium plus covered care you pay, capped by the entered in-network maximum. The maximum does not normally include premium.
Compare the predictable premium with the deductible, coinsurance, copays and maximum exposure.
What if it changes?
Quick answer
What applies to you
What's included
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Frequently asked questions
What is the total cost of health insurance?
For planning, add twelve months of premium to the covered care you pay through deductible, coinsurance and copays. The plan’s in-network out-of-pocket maximum limits many, but not all, covered expenses.
Does the out-of-pocket maximum include premiums?
Usually no. Premiums are generally separate from the out-of-pocket maximum, which is why a bad-year budget often adds annual premiums to the maximum.
What is a deductible?
A deductible is the amount you generally pay for covered services before the plan begins paying according to its cost-sharing rules, subject to plan exceptions.
What is coinsurance?
Coinsurance is the percentage of the allowed amount you pay after applicable deductible rules. The plan pays the remaining percentage until the out-of-pocket rules apply.
Why can a low premium plan cost more?
A low premium may come with a higher deductible, coinsurance or out-of-pocket maximum. Compare the total under both low-use and high-use scenarios.
Does this include out-of-network care?
No. The estimate is for covered in-network care. Out-of-network benefits, balance billing and non-covered care can create additional exposure.
What is the Summary of Benefits and Coverage?
It is a standardized document that helps compare a plan’s premiums, deductibles, cost sharing and examples of coverage. Use it with the network and formulary information.
Should I include employer contributions?
Yes. Subtract employer or marketplace contributions from the premium you actually pay before comparing your household cost.
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