US Health Insurance Cost Sharing Calculator

Frequently Asked Questions

Does the premium count toward the out-of-pocket maximum?

Generally no. Premiums are separate from cost sharing. Deductibles, coinsurance and copays for covered in-network care usually count, subject to plan rules.

What is coinsurance?

It is your percentage share of the allowed amount after the deductible. For example, 20% coinsurance means the plan pays 80% of the allowed amount.

Are out-of-network costs included?

No. Out-of-network care can have a separate deductible, higher coinsurance and balance billing. This calculator focuses on covered in-network care.