Medical Bill Cost Calculator
Your cost vs plan cost from deductible, coinsurance, max.
What it does
Health bills split three ways before you owe a dollar. The deductible comes first out of your pocket, coinsurance takes a percent of the rest, and the out-of-pocket max caps your year. A $5,000 bill on a $2,000 deductible with 20 % coinsurance costs you $2,600 while the plan takes $2,400.
The tool above runs that split with both caps. Enter the bill, remaining deductible, coinsurance percent, and remaining OOP max, and it prints your share, the plan share, and the deductible line. Small bills under the deductible stay fully yours; huge bills stop at the max.
Healthcare.gov defines each term with worked numbers. Its deductible page uses the $2,000-first example, its coinsurance page works $12,000 with $3,000 deductible at 20 % to $4,800 out of pocket, and its max page sets the ceiling rules. KFF confirms the forms and notes most covered workers carry deductibles near $1,886.
Remaining balances matter more than annual ones. Enter what is left on deductible and max, not the January figures, since paid claims already moved both. In-network covered care follows this math; out-of-network and uncovered services play by other rules.
How to use
- Enter the total covered bill.
- Enter the remaining deductible.
- Enter the coinsurance percent.
- Enter the out-of-pocket max.
- Read your share first, then the plan share.
- Check the deductible line for where you stand.
Formula
- bill
- Total covered bill in dollars.
- deductible
- You pay first before cost sharing.
- coinsurance
- Your percent after the deductible.
- OOP max
- Yearly ceiling on your share.
Matches the Healthcare.gov $12,000 worked example ($3,000 + 20 % x $9,000 = $4,800) exactly. KFF confirms the cost sharing forms.
Worked example
Example: $5,000 bill
Defaults: $5,000 bill with $2,000 deductible, 20 %, $6,000 max.
- Inputs: $5,000 bill, $2,000 deductible, 20 % coinsurance, $6,000 OOP max.
- Remainder: 5,000 minus 2,000 = 3,000.
- Coinsurance: 0.20 x 3,000 = 600.
- Raw share: 2,000 + 600 = 2,600, under caps.
- You pay $2,600, plan pays $2,400. Tool shows $2,600.00, $2,400.00, deductible met.
Reference table
| Bill | You pay | Plan pays |
|---|---|---|
| $1,500 ($2k ded) | $1,500 | $0 |
| $5,000 ($2k, 20%) | $2,600 | $2,400 |
| $12,000 ($3k, 20%) | $4,800 | $7,200 |
| $50,000 (capped) | $6,000 | $44,000 |
Limits
- Covered in-network care only. Other care differs.
- Copays and uncovered items sit outside.
- Remaining balances assumed; year-to-date needed.
- Plan quirks (per-service caps) ignored.
Common mistakes
- Using annual instead of remaining deductible.
- Forgetting coinsurance after the deductible.
- Missing the OOP max ceiling on big bills.
- Mixing out-of-network bills into the math.
- Ignoring copays beside the split.
Try it yourself
Quick checks. Answers sit tucked under each question.
$12,000 bill, $3,000 deductible, 20 %, $6,850 max?
Remainder 9,000. 0.20 x 9,000 = 1,800. Raw 3,000 + 1,800 = $4,800. Plan pays $7,200.
$50,000 bill, $2,000 deductible, 20 %, $6,000 max?
Raw 2,000 + 0.20 x 48,000 = $11,600, capped at $6,000. Plan pays $44,000.
Questions
How is my share figured?
Pay the full bill to the deductible, then coinsurance percent on the rest, capped by OOP max and the bill. Here $2,600.
What is a deductible?
The amount you pay before the plan starts paying. Here the first $2,000 is yours.
What is coinsurance?
Your percent after the deductible: 20 % of the $3,000 remainder is $600 here.
What is the out-of-pocket max?
The yearly ceiling on your cost sharing. Past it, covered care is fully paid by the plan.
What if the bill is under the deductible?
You pay the whole $1,500 bill and sit $500 from the deductible. The plan pays nothing yet.
What if the bill is huge?
The $50,000 case: raw $11,600 caps at the $6,000 max, so the plan pays $44,000.
Sources
- Healthcare.gov Glossary: Deductible
- Healthcare.gov Glossary: Coinsurance (worked $4,800 example)
- Healthcare.gov Glossary: Out-of-Pocket Maximum