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Healthcare Cost Estimator

Enter your healthcare details to estimate annual costs.

Your share of the premium (after employer contribution)
% you pay after deductible (e.g., 20 for 80/20 plan)
Expected Annual Usage
Planned surgeries, procedures, etc.

Cost Estimate

Enter your healthcare details to see estimated annual costs.

2024 Health Plan Limits
  • HSA Limit (Single): $4,150
  • HSA Limit (Family): $8,300
  • FSA Limit: $3,200
  • OOP Max (Individual): $9,450
  • OOP Max (Family): $18,900
Common Plan Types
HMO (Health Maintenance Organization)

Lower premiums, requires referrals, in-network only

PPO (Preferred Provider Organization)

Higher premiums, no referrals needed, out-of-network coverage

HDHP (High Deductible Health Plan)

Lower premiums, high deductible, HSA eligible

EPO (Exclusive Provider Organization)

Lower premiums, no referrals, no out-of-network

Related Tools
Learn More

Healthcare Planning:

Disclaimer
This is an estimate only. Actual costs depend on your specific plan, provider network, and healthcare usage. Always review your plan's Summary of Benefits and Coverage (SBC) for accurate details.

What is a Healthcare Cost Estimator?

A healthcare cost estimator is a financial planning tool that helps you predict your total annual healthcare expenses based on your insurance plan details and expected medical usage. Understanding your true healthcare costs goes far beyond just looking at your monthly premium—it requires considering deductibles, copays, coinsurance, and out-of-pocket maximums.

With healthcare costs rising year over year, having a clear picture of your expected expenses is crucial for budgeting and financial planning. This calculator helps you estimate costs for various scenarios, from routine preventive care to major medical expenses like surgery or hospitalization.

Whether you're choosing between employer-sponsored plans during open enrollment, shopping on the ACA marketplace, or evaluating your current coverage, this tool provides valuable insights into your potential healthcare spending.

Understanding Healthcare Cost Components

Healthcare costs have multiple layers. Understanding each component helps you make informed decisions about your coverage and budget effectively.

Premium

Your monthly payment for health insurance coverage, regardless of whether you use medical services. For employer plans, your employer typically pays a portion. Lower premiums often mean higher deductibles and vice versa.

Deductible

The amount you pay out-of-pocket before insurance starts paying. For example, with a $1,500 deductible, you pay the first $1,500 of covered services. Preventive care is often covered before meeting the deductible.

Coinsurance

After meeting your deductible, you share costs with your insurer. An 80/20 plan means insurance pays 80% and you pay 20% of covered services until you reach your out-of-pocket maximum.

Out-of-Pocket Maximum

The most you'll pay in a year for covered services. Once reached, insurance pays 100% of covered care. This protects you from catastrophic expenses. For 2024, the ACA limit is $9,450 for individuals.

Copays vs. Coinsurance: What's the Difference?

Both copays and coinsurance are forms of cost-sharing, but they work differently.

Feature Copay Coinsurance
Amount Fixed dollar amount (e.g., $25) Percentage of costs (e.g., 20%)
When Applied Per visit or service After deductible is met
Predictability High - you know the exact cost Variable - depends on service cost
Common Uses Doctor visits, prescriptions Hospital stays, surgeries
Example $25 for each doctor visit 20% of a $10,000 surgery = $2,000

HSA vs. FSA: Tax-Advantaged Healthcare Accounts

Both HSAs and FSAs offer tax benefits for healthcare expenses, but they have important differences.

HSA (Health Savings Account)
Advantages:
  • Funds roll over year to year
  • Portable - you own it forever
  • Triple tax advantage (contributions, growth, withdrawals)
  • Can invest like a retirement account
  • 2024 limits: $4,150 individual, $8,300 family
Requirements:
  • Must have HDHP (High Deductible Health Plan)
  • Cannot have other health coverage
FSA (Flexible Spending Account)
Advantages:
  • No HDHP requirement
  • Full amount available day one
  • Tax-free contributions
  • Works with any health plan
  • 2024 limit: $3,200
Limitations:
  • Use it or lose it (some rollover allowed)
  • Employer-owned - not portable
  • Cannot invest funds

10 Ways to Reduce Your Healthcare Costs

  1. Use preventive care - Most plans cover annual checkups at 100%.
  2. Stay in-network - Out-of-network costs are significantly higher.
  3. Use generic drugs - Save 80-85% vs. brand names.
  4. Shop around - Prices vary widely for the same procedure.
  5. Use telehealth - Often cheaper than in-person visits.
  1. Max out HSA contributions - Triple tax benefit.
  2. Review bills carefully - 80% of medical bills contain errors.
  3. Negotiate bills - Especially for large expenses.
  4. Use urgent care vs ER - ER copays are often 10x more.
  5. Consider HDHP + HSA - Often cheapest for healthy people.

Frequently Asked Questions

The out-of-pocket maximum is the most you'll pay for covered healthcare services in a plan year. After you reach this amount through deductibles, copays, and coinsurance, your insurance pays 100% of covered services for the rest of the year. For 2024, the ACA maximum is $9,450 for individual plans and $18,900 for family plans.

No. Under the ACA, preventive services like annual physicals, immunizations, and screenings are covered at 100% before you meet your deductible. Some plans also exclude copays for doctor visits from the deductible. Always check your Summary of Benefits for specifics.

HDHPs work well for people who are generally healthy, can afford to pay the deductible if needed, and want to save on premiums while building tax-free savings in an HSA. They may not be ideal if you have ongoing medical needs or can't cover a large unexpected expense.

Deductibles, copays, and coinsurance for covered services count toward your out-of-pocket maximum. Premiums, out-of-network costs (in most cases), and services your plan doesn't cover do not count. Check your plan details for specific exclusions.

Calculate your total expected costs for each plan: (12 × monthly premium) + expected deductible usage + expected copays/coinsurance. Also consider your risk tolerance, whether your doctors are in-network, drug coverage, and whether you want HSA eligibility. The cheapest premium isn't always the cheapest plan overall.

In 2024, the average annual employer-sponsored family premium is about $24,000, with employees paying around $6,500 of that. Add in deductibles, copays, and out-of-pocket expenses, and the total family healthcare spending often exceeds $10,000-$15,000 annually.
Important Disclaimer

This calculator provides estimates for educational purposes only. Actual healthcare costs depend on your specific insurance plan, provider network, and individual healthcare usage. Always review your plan's Summary of Benefits and Coverage (SBC) for accurate details. Consult with your HR department or insurance provider for plan-specific information.