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Patient tool · Insurance & visit costs

Annual out-of-pocket cost planner

Plan a year of healthcare costs, up to your out-of-pocket maximum, and what to set aside monthly.

Editorial review in progress · How we review

Uses 2026 figures
Expected care
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$
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Your plan
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Your results will appear here.
Adjust the numbers, then press Calculate.

Assumptions
  • Copays and prescription costs count toward the out-of-pocket maximum (as ACA-compliant plans require) but not the deductible.
  • Other care goes to the deductible first, then coinsurance. Premiums never count toward the out-of-pocket maximum.
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Healthcare costs are easier to handle when you plan for them as a monthly amount instead of a surprise. This planner adds up a typical year of care, applies your plan's rules, and tells you what to set aside each month.

How it works

Enter the care you expect:

  • Office visits and the copay for each.
  • Your monthly cost for prescriptions.
  • Other care, like lab tests, imaging or a planned procedure, at its full cost.

Then enter your plan's deductible, coinsurance, out-of-pocket maximum and your monthly premium.

Copays and prescription costs are added as they are. Other care goes toward your deductible first, then you pay your coinsurance share. Everything you pay for care is capped at your out-of-pocket maximum. Premiums are added on top, because they don't count toward that maximum.

The result is your total yearly cost and the monthly amount that covers it.

Example

Taylor expects six visits at a $35 copay ($210), $40 a month in prescriptions ($480), and a $2,500 procedure. With a $2,000 deductible and 20% coinsurance, the procedure costs $2,100 out of pocket.

  • Out-of-pocket total: $2,790 (well under the $6,000 maximum).
  • Premiums: $150 × 12 = $1,800.
  • Total: $4,590, or about $383 a month.

When to rerun it

Run the planner again during open enrollment, after a new diagnosis or prescription, or when you learn about a planned surgery. If your total comes close to the out-of-pocket maximum, it can be worth budgeting for the full maximum instead, so a second unexpected bill doesn't catch you off guard.

Make the plan work

Set up an automatic transfer for the monthly amount, or elect it in an FSA or HSA so you also save on taxes.

FAQ

Frequently asked questions

Do premiums count toward my out-of-pocket maximum?

No. Premiums are the price of having coverage. The out-of-pocket maximum caps what you pay for covered care: deductibles, coinsurance and copays.

Does out-of-network care count?

Often not, or it has its own, higher maximum. This planner assumes in-network care.

How can I lower these costs?

Paying with an HSA or FSA saves taxes on every dollar. Generic or mail-order prescriptions, in-network providers and asking about cash prices can help too.

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