Out-of-pocket cost estimator
Enter your plan's numbers from your insurance card or portal, plus the allowed amount for a service, and see how the deductible, coinsurance, and out-of-pocket maximum split the bill.
How the math works
The calculation follows the same order your insurer applies:
- Deductible first. Whatever remains of your deductible comes out of the allowed amount at 100% your cost.
- Coinsurance on the rest. Anything above the remaining deductible is split - you pay your coinsurance percentage of it.
- The out-of-pocket maximum caps everything. Your total for the year cannot exceed what is left of your out-of-pocket maximum, whatever steps 1 and 2 say.
If any of those words are fuzzy, our guide to deductibles, copays, and coinsurance walks through a full plan year with real numbers.
Where to find your numbers
| Number | Where it lives |
|---|---|
| Deductible and OOP max | Your Summary of Benefits and Coverage, page 1, or your member portal |
| Progress toward both | Member portal dashboard, or the year-to-date box on any recent EOB |
| Allowed amount | Your insurer's cost estimator tool, or the hospital's published prices |
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