Answers
What will I really pay?
Put in the numbers from your plan and the cost of the care. See your share and the plan's share before the bill arrives.
You pay about
Your plan pays about .
- Toward your deductible:
- Coinsurance:
You reach your out-of-pocket maximum with this care, so your share stops there.
An estimate for covered, in-network care. Your plan's own decision and your bill have the final word.
How the sum works
- Deductible first. You pay the full cost until your deductible is used up.
- Then coinsurance. After that, you pay your percentage and the plan pays the rest.
- The maximum stops it. Once you reach your out-of-pocket maximum, the plan pays 100% of covered care for the rest of the plan year.
An example
The care costs $5,000. Your deductible is $2,000 and you haven't paid any of it yet. Your coinsurance is 20% and your out-of-pocket maximum is $6,000.
- Deductible: you pay the first $2,000.
- Coinsurance: 20% of the other $3,000 is $600.
- You pay $2,600. The plan pays $2,400.
What the calculator can't see
- Copays. A fixed amount for a visit or a prescription is added on its own.
- Care before the deductible. Many plans cover preventive care, like a yearly checkup, at no cost to you.
- Out-of-network care. It can cost more, and may not count toward your deductible or maximum.
- Separate amounts. Some plans have their own deductible for drugs, or one for each person and one for the family.
Premium, deductible, out-of-pocket maximum: which one matters?