Out-of-Pocket Maximum Calculator
Calculate your expected out-of-pocket costs based on planned medical procedures, deductible, coinsurance, and OOP maximum.
Medical Disclaimer
This calculator is for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making decisions about your health. Never disregard professional medical advice or delay seeking it because of results from this tool.
Inputs
Results
Expected Out-of-Pocket
$4,540.00
≈ 5 smartphones
Total Annual Health Cost
$9,940.00
≈ 7 months of rent
How to Use This Calculator
- Enter your plan's annual deductible.
- Enter your plan's coinsurance percentage after the deductible.
- Enter the plan's out-of-pocket maximum.
- Input your expected annual medical claims to see your projected cost.
- Review at what spending level your out-of-pocket cap kicks in to fully protect you.
How the result changes with Annual Deductible
| Annual Deductible | Expected Out-of-Pocket | Total Annual Health Cost |
|---|---|---|
| $1,000.00 | $2,940.00 | $8,340.00 |
| $3,500.00 | $4,940.00 | $10,340.00 |
| $6,500.00 | $7,340.00 | $12,740.00 |
| $9,000.00 | $8,700.00 | $14,100.00 |
What each input means
- Annual Deductible
- Your plan's annual deductible before insurance starts paying.
- Your Coinsurance
- Your share after deductible. 20% means the plan pays 80%, you pay 20%.
- Out-of-Pocket Maximum
- Annual OOP max. After this, insurance pays 100%.
- Planned Procedure Costs
- Total cost of planned surgeries, procedures, or hospitalizations.
- Annual Prescription Costs
- Total annual cost of prescriptions before insurance.
- Regular Visit Costs
- Annual cost of regular doctor visits, specialists, and tests.
- Monthly Premium
- Your monthly health insurance premium.
How this is calculated
Worked example, using the default values
- Identify Input Parameters4 parametersAnnual Deductible = 3000, Your Coinsurance = 20, Out-of-Pocket Maximum = 8700, Planned Procedure Costs = 8000 = 7 input(s) provided
- Calculate Expected Out-of-PocketExpected Out-of-Pocket4540 = $4,540
- Calculate Total Annual Health CostTotal Annual Health Cost9940 = $9,940
- Calculate Insurance PaysInsurance Pays = Math6160 = $6,160
- Calculate Annual Premium CostAnnual Premium Cost5400 = $5,400
Engine last updated . Checked against 2 independently-derived tests — how we verify calculators.
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