Health Insurance Cost Calculator (Premium + Deductible)
Add up the true annual cost of a health plan — premiums plus deductible, coinsurance and copays up to the out-of-pocket maximum — for a healthy, expected and worst-case year, and compare two plans side by side with HSA money and tax savings.
How it works
Annual premium = monthly × 12 · Out-of-pocket = min(deductible, bills) + max(0, bills − deductible) × coinsurance + copays, capped at the OOP max · Total = premium + out-of-pocket · Net = total − employer HSA/HRA money − HSA contribution × tax rate
The sticker premium is only half of a health plan's cost. On covered care you first pay everything up to the deductible, then a coinsurance share, and flat copays for visits and prescriptions, until you reach the out-of-pocket maximum. After that the plan pays 100% for the rest of the year. Comparing plans on premium alone is misleading: a cheaper premium usually comes with a higher deductible, so the cheaper plan depends on how much care you use. The calculator shows a healthy year, your expected year and the worst case, a table and chart across levels of care, and the bill level at which you hit the maximum. Turn on the second plan to compare, for example, a PPO with a high-deductible plan. It reports which is cheaper at your expected bills and the bill level where the two cost the same. Under More options you can enter premiums per paycheck, copays, employer HSA or HRA money and the tax you save by contributing to an HSA. The calculator also checks the plan against the 2026 legal limits.
Worked example
A $450/month plan is $5,400 in premiums. With a $3,000 deductible and 20% coinsurance, $5,000 of covered bills costs you $3,000 (the deductible) plus 20% of the remaining $2,000 ($400) = $3,400 out of pocket, so about $8,800 total for the year. If you hit the $8,000 out-of-pocket max, the worst case is $5,400 + $8,000 = $13,400. Compare it with a $330/month plan with a $5,000 deductible: at $5,000 of bills that plan costs $3,960 + $5,000 = $8,960, so the first plan is $160 cheaper. The two cost the same at $4,800 and again at $23,300 of bills: the cheaper-premium plan wins in a healthy year and in a very expensive one, because its out-of-pocket maximum is reached sooner and its premiums are lower.
Sources: HealthCare.gov — Out-of-pocket maximum/limit · HealthCare.gov — Your total costs for health care · IRS Publication 969 — Health Savings Accounts
Frequently asked questions
What is the difference between deductible and out-of-pocket max?
The deductible is the amount you pay before coinsurance kicks in; the out-of-pocket maximum is the most you can pay in a year for covered care, including the deductible, coinsurance and copays. Once you reach the max, the plan covers 100% of covered services. For 2026 the ACA caps it at $10,600 for one person and $21,200 for a family ($12,000 and $24,000 for 2027 plans).
Should I always pick the lowest premium?
Not necessarily. A low premium usually comes with a high deductible, which is cheaper if you rarely use care but expensive if you have a costly year. Turn on the second plan to compare both at your expected bills and see the bill level where they cost the same.
Do premiums count toward the deductible or out-of-pocket max?
No. Premiums are separate; they never count toward the deductible or the out-of-pocket maximum. Only your spending on covered services counts.
How do copays fit in?
Many plans charge a flat copay for office visits or prescriptions instead of applying the deductible. Copays count toward the out-of-pocket maximum. Enter the number of visits and fills under More options; they are added on top of the deductible and coinsurance and capped together at the maximum.
How does an HSA change the comparison?
A high-deductible plan that qualifies for a health savings account lets you put money aside tax-free; for 2026 the limit is $4,400 for self-only and $8,750 for family coverage, including employer money. Turn on “Count HSA tax savings” to subtract the tax you save and any employer contribution from that plan’s cost.
What counts as “covered medical bills”?
The plan’s allowed amounts for in-network care that falls under the deductible: hospital stays, imaging, lab tests, surgery and specialist care. Use your past claims or an estimate. Preventive care is usually free and should be left out.
Related calculators
Educational estimate only, not insurance, tax or financial advice. Real premiums, contribution limits and costs depend on your carrier, plan, state and personal circumstances — get a quote and check current IRS limits.