Understanding your total healthcare costs goes beyond just the monthly premium. This calculator helps you estimate your true annual healthcare expenses.
How This Calculator Works
> [!IMPORTANT] > Key Insight: A plan with a low premium often has higher deductibles and out-of-pocket costs. Always calculate total potential costs, not just monthly premiums.
This calculator factors in:
- Monthly Premiums - Your regular insurance payment
- Deductible - What you pay before insurance kicks in
- Coinsurance - Your percentage share after deductible
- Out-of-Pocket Maximum - Most you'll pay in a year
- Copays - Fixed costs per doctor visit
Understanding Your Costs
| Term | What It Means | Example |
| Premium | Monthly payment for coverage | $450/month |
| Deductible | You pay first, then insurance starts | $2,000/year |
| Coinsurance | Your share after deductible | 20% |
| OOP Max | Cap on your annual costs | $6,000/year |
| Copay | Fixed cost per visit | $30/visit |
Cost Comparison Example
Scenario: $5,000 in medical expenses
| Plan | Premium | Deductible | Coinsurance | Your Cost |
| Bronze | $300/mo | $3,000 | 40% | $6,400/yr |
| Silver | $450/mo | $1,500 | 20% | $7,100/yr |
| Gold | $600/mo | $500 | 10% | $7,850/yr |
At low medical costs, cheaper plans win. With major expenses, Gold's lower OOP max protects you.
Frequently Asked Questions
HSA vs FSA - What's the difference?
HSA (Health Savings Account) works with high-deductible plans, rolls over yearly, and is yours forever. FSA is use-it-or-lose-it annually but works with any plan.
What is an out-of-pocket maximum?
The most you'll pay for covered services in a year. After hitting this limit, insurance pays 100%. In 2024, the ACA limit is $9,450 individual / $18,900 family.
Which metal tier should I choose?
Bronze: Low premium, high costs - good if you're healthy and rarely use healthcare. Silver: Balanced - best value for most people. Gold/Platinum: High premium, low costs - good if you have ongoing medical needs.
What does preventive care cover?
Most plans cover annual physicals, vaccinations, screenings at 100% with no deductible. This is mandated by the ACA.
Key Points to Remember
- Total cost = Premiums + Out-of-Pocket for the year
- Maximum OOP protects you from catastrophic costs
- Use in-network providers to avoid huge bills
- HSAs are powerful tax-advantaged savings tools
- Review plans annually during open enrollment