Health Plan: Deductible vs Premium

Total annual cost = premiums × 12 + expected medical × cost-share until OOPM.

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How to use this calculator

  • Enter premium + plan limits + expected medical use.
  • Compare totals across plan options.

About this calculator

Health plans trade off premium vs. cost-share. Low-deductible plans charge higher premiums but lower per-visit. High-deductible (HDHP) charges low premium, you cover first $3,000+ of care, but caps your worst-case at OOP max. The break-even depends on actual usage — light users prefer HDHP; heavy users (chronic conditions, planned surgery) prefer low-deductible.

Frequently asked

OOP max includes premiums?+
No — OOP max is your medical cost cap. Premiums are separate. Total annual cost = premium + OOP medical (capped at OOP max).
HDHP advantage?+
Lower premiums + HSA eligibility (triple tax advantage). For healthy people: huge savings.
What's coinsurance?+
% you pay after deductible until OOP max. 20% means insurer pays 80%, you pay 20%.
In-network vs. OON?+
OON usually doesn't count toward deductible/OOP max, or counts at lower rate. Stay in-network when possible.
Pre-deductible coverage?+
Many plans cover preventive care (annual physical, screenings) at 100% before deductible. Check plan SBC.

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