How to use the deductible comparison calculator
- Enter each plan's monthly premium, deductible, your coinsurance after the deductible and its out-of-pocket maximum. You can compare 2 to 4 plans.
- Enter three levels of yearly covered medical costs: a light, a medium and a heavy year.
- Read the total for each plan in each scenario, which is premiums plus what you pay for care, and the plan with the lowest total.
- Check the plan details table for the worst case total.
Formula
You pay for care = all costs up to the deductible, then coinsurance % of the rest, never more than the out-of-pocket maximum
Total for the year = 12 x monthly premium + what you pay for care
Worst case total = 12 x monthly premium + out-of-pocket maximum
All costs are treated as covered, in-network charges that count toward the deductible.
A lower deductible against a higher one
The lower deductible plan costs $420 a month with a $500 deductible, 20% coinsurance and a $4,500 maximum. The other costs $300 a month with a $3,000 deductible, 20% coinsurance and a $7,000 maximum.
In a light year of $600 the totals are $5,560.00 and $4,200.00, so the higher deductible plan wins. In a medium year of $5,000 they are $6,440.00 and $7,000.00, and in a heavy year of $30,000 they are $9,540.00 and $10,600.00, so the lower deductible plan wins both. The worst case totals are $9,540.00 and $10,600.00.
How the pieces fit
The premium is what you pay whether or not you use care. The deductible is what you pay for covered care before the plan shares costs. Coinsurance is your share after that. The out-of-pocket maximum caps what you pay in a year for covered care, though not the premium.
A plan with a lower premium costs less in a year with little care, and the one with a lower deductible tends to cost less in a year with a lot. The scenarios show the crossover for your own numbers.
What the scenarios mean
The three cost levels are numbers you choose and not forecasts. Think about what you and your family used in recent years, planned procedures and your tolerance for a bad year. The worst case total shows the most you could pay for covered care on each plan.
Copays, prescription tiers, out-of-network costs, a health savings account and employer contributions are not modeled and can change the answer, so check your plan documents. For other protection decisions, see the life insurance needs calculator, and to plan for a deductible, the emergency fund calculator. The budget planner covers monthly premiums.
Assumptions and limits
- The plan numbers and the three cost levels are examples. Use your plan documents.
- All costs are covered, in-network charges that count toward the deductible.
- Copays, prescription tiers, out-of-network costs, tax savings and employer contributions are not modeled.
- The out-of-pocket maximum must be at least the deductible.
Frequently asked questions
Is a high deductible plan worth it?
It can be when you expect little care, because the premium is lower. In a heavy year it can cost more. Compare the totals for light, medium and heavy years to see where the crossover is for you.
What is coinsurance?
It is the percent of a covered bill that you pay after you meet the deductible. If it is 20%, you pay 20% and the plan pays 80% until you reach the out-of-pocket maximum.
What does the out-of-pocket maximum cover?
It caps what you pay in a year for covered, in-network care. It does not include the premium, which you pay in addition.
How do I pick the medical cost levels?
Look at your recent claims and any planned care, and choose a light, a medium and a heavy figure. They are your own scenarios, not predictions.