A low premium with a $9,000 deductible and a high premium with a $1,500 deductible can end the year in completely different places. This works out the real annual total for a level of medical use you choose — and shows the worst case, which is the number that actually matters.
This tool applies officially published figures to the numbers you enter. It is not an insurance quote, it is not an eligibility determination, and it does not predict what a carrier will charge you. Only HealthCare.gov, Medicare.gov, Social Security or the carrier can determine your eligibility and your actual price.
Deductible & Out-of-Pocket Cost: how it works
Compare two plans on the worst case, not the premium
Run this once for each plan you are considering. The plan with the lower premium often wins in a quiet year and loses badly in a bad one. Insurance is bought for the bad year, so the worst-case figure deserves at least as much attention as the monthly cost.
What does not count toward the maximum
Premiums never count toward the out-of-pocket maximum. Neither does out-of-network care on most plans, or anything the plan does not cover at all. This calculator assumes in-network, covered care.
Common questionsCommon questions
How do I estimate my expected medical costs?
Look at last year. Add up what was billed — not what you paid — for visits, prescriptions, tests and any procedures. If this year looks like last year, that total is a reasonable starting figure. Then run the worst case too.
Does this work for Medicare Advantage?
Yes. Use the plan’s in-network maximum out-of-pocket and remember to add your Part B premium separately — you pay that on top of any Medicare Advantage plan.