Deductible
$1,200
Coinsurance
$0
Copays
$120
Patient cost
$1,320
Insurer share
$0
Patient share %
110.0%
Insurance & Protection Tools
Health Insurance Out-of-Pocket Calculator
Model how deductible, copay, coinsurance and an out-of-pocket maximum could affect the patient's share across several medical-spend scenarios.
Health-cost scenarios
Model deductible, copay, coinsurance and out-of-pocket maximum
Use multiple medical-spend scenarios to see how the simplified patient share changes as annual costs rise.
Simplified sequence: medical spend → deductible → coinsurance on remaining spend → copays → cap patient cost at the entered out-of-pocket maximum.
Medical-spend scenarios
Deductible
$1,500
Coinsurance
$700
Copays
$240
Patient cost
$2,440
Insurer share
$2,560
Patient share %
48.8%
Deductible
$1,500
Coinsurance
$3,700
Copays
$420
Patient cost
$5,620
Insurer share
$14,380
Patient share %
28.1%
Scenario comparison
| Scenario | Medical spend | Patient cost | Insurer share | Patient share |
|---|---|---|---|---|
| Routine year | $1,200 | $1,320 | $0 | 110.0% |
| Moderate year | $5,000 | $2,440 | $2,560 | 48.8% |
| High-cost year | $20,000 | $5,620 | $14,380 | 28.1% |
Keep the scenarios
Export or save the workspace
Keep CSV, printable report or reusable local project data.
Sample health-cost scenarios loaded.
Simplified estimate — not a plan-specific claim calculation
Real health plans can apply copays, deductibles, coinsurance, networks, pharmacy benefits and out-of-pocket maximums in different ways. Use the actual plan documents for decisions.
Scenario-based health costs
See how patient cost changes as medical spending rises
A routine year may never exceed the deductible, while a high-cost year may reach the out-of-pocket maximum. Comparing several spend levels makes that change easier to understand.
Transparent simplified sequence
Deductible → coinsurance → copays → OOP cap
The calculator shows each component separately. That makes the assumptions visible while avoiding any claim that the simplified sequence exactly matches a specific insurer's plan rules.
Frequently asked questions
What does this calculator estimate?
It estimates a simplified patient share and insurer share using the deductible, coinsurance percentage, per-visit copay and out-of-pocket maximum you enter.
How is the out-of-pocket maximum applied?
The simplified model calculates deductible, coinsurance and copays, then caps the patient cost at the entered out-of-pocket maximum.
Does this reproduce my actual health plan?
No. Real plans can apply deductibles, copays, coinsurance, pharmacy benefits, network rules and out-of-pocket limits differently. Always use current plan documents for decisions.
Can I compare several medical-spend levels?
Yes. The workspace supports up to eight scenarios so you can compare routine, moderate and high-cost years or create your own cases.
Does the calculator include premiums?
No. This tool focuses on medical cost sharing after care is used. Premium comparison belongs in the separate insurance premium and policy comparison tools.
Can I save the scenarios?
Yes. You can copy the summary, export CSV, print/save a PDF-style report, or save a local FormatForge project file and restore it later.
Insurance workflow
Compare health cost sharing, then review the full policy
Use this calculator for deductible/copay/coinsurance scenarios and the Policy Comparison Workspace for broader policy terms, coverage and exclusions.