Health Insurance Cost Calculator
Premium & expected costs
Your result will appear here
Fill in the fields and this updates as you type.
Know what this estimate is based on
- Jurisdiction
- United States — insurance is regulated state by state, so the rules behind a premium are your state's, not a federal schedule
- Rules and time period
- Premiums, limits and deductibles are the figures you enter. Health plan cost-sharing caps, Medicare amounts and state filings all reset annually.
- Scope and limitations
- Educational estimate only. Rates, required coverages and available discounts differ by where you live. Your premium is set by an insurer's own underwriting — driving record, claims history, credit-based insurance score where permitted, the property itself — and only a quote is binding. What a policy pays depends on its exclusions and limits, not on this estimate.
- Source links checked
- Sep 19, 2026
Built and regression-tested by Smart Tools Lab. It has not been individually reviewed by a licensed financial, tax, or legal professional.
How to use
- 01
Enter the monthly premium after any subsidy — the amount that actually leaves your account, not the sticker price on the plan.
- 02
Enter the medical costs you realistically expect this year. A healthy year with a physical and one urgent care visit is a few hundred dollars; a planned surgery or a chronic condition is a different number entirely.
- 03
Enter the plan's out-of-pocket maximum. It is the cap on everything you can be charged for in-network covered care in a year, and it is the most important number on a plan summary.
- 04
Open Advanced options to enter the deductible and your coinsurance share, both of which are on the plan's summary of benefits.
- 05
Read the total annual cost, then the scenario table: what a healthy year costs, what your estimate costs, and what the worst year costs.
Formula
Total annual cost = annual premium + out-of-pocket spending, where the premium is the monthly figure times twelve. Out-of-pocket follows the way U.S. plans actually work: you pay claims in full up to the deductible, then your coinsurance share of everything above it, and the total is capped at the out-of-pocket maximum. Written out, that is min(deductible + (claims − deductible) x coinsurance, out-of-pocket maximum) for claims above the deductible, or the claims themselves when they fall below it. The scenario table runs the same plan through a healthy year with no claims, the year you expect, and the worst case where you hit the cap — which together are the real range a plan puts you in.
Example
A plan with a $560 monthly premium, a $2,000 deductible, 20% coinsurance and a $10,600 out-of-pocket maximum — the 2026 ACA ceiling for self-only coverage, which is where the field opens — for someone expecting $3,500 of care. Step 1 — Annual premium: $560 x 12 = $6,720. You pay this whether or not you see a doctor. Step 2 — The deductible first: the initial $2,000 of the $3,500 is yours in full. Step 3 — Coinsurance on the rest: ($3,500 − $2,000) x 20% = $300. Step 4 — Out-of-pocket: $2,000 + $300 = $2,300, well under the $10,600 cap. Step 5 — Total annual cost: $6,720 + $2,300 = $9,020, or about $752 a month. Now the range, which is what the scenario table is for. A healthy year with no claims still costs $6,720. A bad year — a surgery, an accident, a diagnosis — costs $6,720 + $10,600 = $17,320 and cannot cost more, for in-network covered care. That ceiling is the product you are actually buying, and your own plan's maximum is usually lower than the legal one. When comparing two plans, compare all three of those numbers, not the premium.
Definitions
- Premium
- What you pay monthly to keep the plan, whether or not you use any care.
- Deductible
- What you pay in full before the plan begins sharing costs. Resets each plan year.
- Coinsurance
- Your percentage share after the deductible — commonly 20% — until the out-of-pocket maximum is reached.
- Copay
- A flat fee for a specific service, such as $30 for a primary care visit. Often applies before the deductible is met.
- Out-of-pocket maximum
- The annual cap on what in-network covered care can cost you. Capped by the ACA at $10,600 self-only and $21,200 family for 2026, and the field on this page opens on that figure.
- Metal tier
- Bronze, silver, gold or platinum — the average share of costs a plan pays, from about 60% to about 90%.
- HDHP
- A high-deductible health plan meeting IRS thresholds, the only kind that lets you contribute to an HSA.
- HSA
- Health Savings Account. Deductible contributions, untaxed growth, untaxed medical withdrawals, and the balance rolls over for life.
- Premium tax credit
- The marketplace subsidy that lowers your monthly premium, based on household income and the local benchmark plan.
- Cost-sharing reduction
- An extra marketplace subsidy on silver plans that lowers the deductible and out-of-pocket maximum for lower incomes.
- Network
- The providers your plan has contracted with. Care outside it is far more expensive and often outside the out-of-pocket cap.
- Summary of benefits and coverage
- The standardized document every U.S. plan must provide, carrying the deductible, coinsurance and out-of-pocket maximum this tool needs.
Good to know
The premium is the floor, not the price
A health plan quotes one number and charges three. The premium is what you pay to hold the plan, whether or not you see a doctor — $560 a month is $6,720 a year before any care at all. Then the deductible, which you pay in full before the plan begins sharing. Then coinsurance, your percentage of everything above the deductible, until the out-of-pocket maximum stops the meter. Comparing plans on the premium alone is how people end up with the more expensive one: a plan $100 a month cheaper that carries $5,000 more deductible saves $1,200 and costs $5,000 the first year anything goes wrong. The only fair comparison adds the premium to what you would actually pay for the care you expect, which is what this page does.
The out-of-pocket maximum is the product
Of all the numbers on a plan summary, this is the one that matters most and gets the least attention. It is the ceiling on what in-network covered care can cost you in a year — deductible, copays and coinsurance all count toward it, and once you reach it the plan pays everything. For 2026 the ACA caps it at $10,600 for self-only coverage and $21,200 for a family, and many plans sit below that. What you are buying with a health plan is not the discount on a doctor's visit; it is the guarantee that a catastrophic year has a known price. A $560 premium with a $10,600 cap means the worst year costs $17,320 and cannot cost more. That number, not the premium, is what should decide between two plans.
Running the arithmetic on a real year
Take a plan with a $2,000 deductible, 20% coinsurance and a $10,600 cap, and a year with $3,500 of care. The first $2,000 is yours in full. Of the remaining $1,500, you pay 20%, or $300. Out-of-pocket comes to $2,300, well under the cap, and total cost is $6,720 of premium plus $2,300, or $9,020. Now run the same plan through a healthy year: $6,720, all premium. And a bad one: $6,720 plus the full $10,600, or $17,320. Those three numbers are the plan. When you compare two plans, compare all three — a plan that wins in a healthy year and loses badly in a bad one is a bet on your health, and worth taking only if you could absorb losing it.
When the high-deductible plan is the right answer
A high-deductible plan trades a lower premium for more exposure, and it comes with the only triple-tax-advantaged account in the U.S. code. HSA contributions are deductible, growth is untaxed, and withdrawals for medical costs are untaxed — which effectively discounts your out-of-pocket spending by your marginal tax rate, and lets the balance roll forward for life if you do not spend it. That makes the high-deductible plan a strong choice for someone healthy with savings to cover the deductible and the discipline to fund the account. It is a poor choice for someone taking regular medications, managing a chronic condition, or likely to postpone care because of the cost — and postponed care is the real failure mode, not the arithmetic.
What this model does not see
Four things sit outside these numbers. Out-of-network care, which often carries a separate and far higher out-of-pocket maximum, or none at all, and where the provider may balance-bill you — the federal No Surprises Act covers some emergency and unexpected situations, not a choice to go out of network. Prescriptions, which frequently sit on a separate drug deductible or tier structure. Dental and vision, which are usually separate policies entirely. And subsidies: marketplace premium tax credits are set by household income, and cost-sharing reductions on a silver plan can lower the deductible and the cap as well as the premium. Enter after-subsidy figures here, and check HealthCare.gov or your state exchange for what you qualify for before comparing anything.
Frequently asked questions
Why is the cheapest premium not the cheapest plan?
Because a low premium is normally bought with a high deductible. A plan $100 a month cheaper that carries $5,000 more deductible costs you more the moment you need care. The only fair comparison is premium plus what you would actually pay for the care you expect — which is what this page computes.
What is an out-of-pocket maximum?
The most you can pay in a year for in-network covered care, including the deductible, copays and coinsurance. Once you reach it the plan pays 100%. For 2026 the ACA caps it at $10,600 for self-only coverage and $21,200 for a family, and many plans sit below that.
What is the difference between a deductible and coinsurance?
You pay the deductible in full before the plan starts sharing. After that you pay coinsurance — a percentage, commonly 20% — until you hit the out-of-pocket maximum. Copays are flat fees for specific visits that often apply before the deductible is met.
What do the metal tiers mean?
They describe how much of total costs a plan pays on average: bronze about 60%, silver 70%, gold 80%, platinum 90%. Bronze has the lowest premium and the highest out-of-pocket exposure. They say nothing about the quality of care or the size of the network.
Should I take the high-deductible plan?
Often yes if you are healthy, have savings to cover the deductible, and can use an HSA — the tax deduction is real money. Often no if you take regular medications, have a chronic condition, or would postpone care because of the cost.
What is an HSA worth?
It is the only triple-tax-advantaged account in the U.S. code: deductible going in, untaxed growth, untaxed withdrawals for medical costs. It requires a qualifying high-deductible plan. Effectively it discounts your out-of-pocket spending by your marginal tax rate.