Apply entered in-network deductible, coinsurance, copays, and out-of-pocket maximum terms to an entered allowed-charge scenario, plus premiums.
A quick decision brief for this specific tool
Entered monthly premium, annual covered in-network allowed charges, applicable deductible, coinsurance, copays/other cost sharing, and in-network out-of-pocket maximum
Annual premiums, modeled deductible/coinsurance, uncapped and capped cost sharing, amount limited by the entered maximum, total scenario, and monthly budget average
Applies entered SBC-style cost sharing to an entered allowed-charge scenario, caps only modeled in-network cost sharing, and keeps premiums outside the cap
Choose your path
Apply entered SBC-style in-network cost sharing to an entered allowed-charge scenario while keeping premiums and excluded costs outside the entered maximum.
Use matching covered in-network allowed-charge assumptions across plans.
Copy premium, deductible, coinsurance, copays, and OOP maximum from each current SBC and rerun the same allowed-charge scenario.
Compares arithmetic without treating premium alone or one scenario as total future cost.
Recognize when a single simplified accumulator is insufficient.
Check individual/family, medical/drug, service-specific, and network accumulators before deciding whether the entered terms describe the scenario.
Stops rather than mixing incompatible deductibles or OOP limits.
Keep amounts outside the in-network cap visible as omitted.
Use the bounded in-network model only, then separately review balance billing, non-covered services, authorization, referral, formulary, and network facts.
Does not rely on the entered OOP maximum as a universal spending ceiling.
Outputs and checklists are planning aids. Review the linked current authorities and the records, terms, instructions, and requirements that apply to your exact situation before a consequential decision.
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Enter a scenario already limited to covered services at plan allowed amounts. Utilization, network, medical necessity, authorization, formulary, and benefit classification are external.
Charges after modeled deductible = max(0, entered allowed charges − deductible applied)The model applies the deductible up to entered charges, then entered coinsurance to the remainder, then adds entered copays and other cost sharing.
Uncapped cost sharing = deductible applied + coinsurance + entered copays/other cost sharingThe entered in-network out-of-pocket maximum caps modeled cost sharing; premiums are added afterward. Costs the plan excludes from the cap remain outside the model.
Scenario total = 12 × monthly premium + min(uncapped cost sharing, entered OOP maximum)Updated: August 2026
Apply a $2,500 deductible and 20% coinsurance to $12,000 of entered allowed charges, plus $600 other cost sharing and a $7,000 OOP maximum.
→ Shows $5,000 modeled cost sharing, $5,700 annual premiums, and $10,700 premium-plus-cost-sharing scenario.
Use $1,000 allowed charges with a $2,500 applicable deductible.
→ Applies no more than $1,000 of deductible and no coinsurance to those charges.
Use cost-sharing inputs whose uncapped total exceeds the exact in-network maximum.
→ Caps modeled in-network cost sharing at $7,000 while keeping premium and excluded costs outside the cap.
Use one plan's current Summary of Benefits and Coverage to enter premium and simplified in-network cost-sharing terms, then apply them to an entered annual allowed-charge scenario. The model caps only the entered in-network cost sharing and adds premiums outside that cap. It does not predict care, determine eligibility or subsidies, classify services, or include non-covered, out-of-network, or above-allowed charges.