Health Insurance Deductible Break-Even Calculator

US health plan cost comparison

Health Insurance Deductible Break-Even Calculator

Compare a lower-deductible plan with a higher-deductible plan using premiums, covered medical costs, copays, coinsurance, out-of-pocket limits and employer health benefits. Find the medical spending levels where the cheaper plan changes.

1. Estimate your annual covered care

Enter the annual in-network allowed charges for services that are subject to the deductible and coinsurance. This is the negotiated cost of care before your insurance pays, not the amount you expect to pay personally.

Annual allowed medical charges ($) Use the same assumed allowed charges for both plans only when their networks and negotiated prices are comparable.

Comparison chart maximum ($) Break-even points are searched within the selected spending range.

Adjust medical charges interactively

Your premium, fixed annual copays and employer-funded health benefits are entered separately for each plan. Do not count the same service in both annual allowed charges and fixed copays.

2. Enter each plan’s terms

Use figures from your Summary of Benefits and Coverage. Enter your net employee/household monthly premium after any employer premium subsidy or Marketplace premium tax credit already reflected in your bill.

Plan A · Lower deductible

Monthly premium ($)

Annual deductible ($)

Your coinsurance after deductible (%)

Annual in-network out-of-pocket maximum ($)

Other fixed annual copays ($) Copays for covered care excluded from medical charges above.

Employer health dollars used toward costs ($) Only usable funds; applied up to modeled out-of-pocket costs.

Plan B · Higher deductible

Monthly premium ($)

Annual deductible ($)

Your coinsurance after deductible (%)

Annual in-network out-of-pocket maximum ($)

Other fixed annual copays ($) Copays for covered care excluded from medical charges above.

Employer health dollars used toward costs ($) Only usable funds; applied up to modeled out-of-pocket costs.

Employer HSA/HRA funding: This calculator shows current-year cash cost after funds used for covered expenses. Unspent HSA balances are still your assets and can carry over; unspent funds are not valued in the result. For an economic-value comparison, consider the ownership, carryover and tax effects separately. An HSA is not created merely because a plan has a high deductible.

Your estimated annual plan costs

Plan A annual cash cost — Premium plus uncovered personal share

Plan B annual cash cost — Premium plus uncovered personal share

Estimated annual savings — At your medical spending amount

Maximum modeled annual cash cost — For the lower maximum-cost plan

Where the money goes

Annual premiums, A / B—

Deductible + coinsurance, A / B—

Additional covered copays, A / B—

In-network member cost after OOP cap, A / B—

Employer funds actually used, A / B—

Personal medical cash cost, A / B—

Allowed charges are not the same as what you owe. The out-of-pocket limit caps modeled covered in-network deductible, coinsurance and applicable copays, not premiums.

Premium and worst-case comparison

Plan A annual premium—

Plan B annual premium—

Plan A maximum modeled annual cost—

Plan B maximum modeled annual cost—

Cost difference at $0 deductible-based charges—

Worst-case amounts assume you reach the annual in-network out-of-pocket maximum and can use the entered employer-funded benefit. Excluded care, out-of-network costs, non-covered services and uncovered balance bills can exceed these estimates.

Annual total cost vs. medical spending

Where the lines meet, the plans have the same estimated annual cash cost under these assumptions. Both the selected spending value and any crossing points are calculated numerically.

Plan A Plan B Current spending

Compare medical spending scenarios

Estimated annual cash cost by allowed medical spending
Annual allowed charges	Plan A total	Plan B total	Lower-cost plan	Difference

How the deductible break-even calculation works

For each plan, the model estimates covered member charges = min(allowed charges, deductible) + coinsurance × max(0, allowed charges − deductible). It adds separately entered covered copays, then caps that sum at the out-of-pocket maximum. Next it subtracts the available employer health dollars used toward that spending. Finally, it adds 12 × monthly premium.

A break-even point is an annual allowed-charge amount at which the plans’ estimated total cash costs are equal. Deductibles, coinsurance, employer benefits and out-of-pocket caps create piecewise cost curves, so there can be zero, one or multiple crossings. The comparison assumes eligible covered services are priced the same by both plans.

The model treats listed fixed copays as spending on other covered services, not already included in the entered allowed charges. It assumes those copays count toward the same in-network out-of-pocket limit but do not reduce the deductible. Your plan may handle services or drugs differently.

Frequently asked questions

Is a lower deductible always better?

No. A lower deductible may come with a higher premium. Compare annual premiums and your expected covered costs, coinsurance, copays and out-of-pocket limits rather than deductible alone.

What medical spending should I enter?

Enter the expected total in-network allowed amount for services governed by the deductible and coinsurance. Do not enter your estimated personal bill, the provider’s sticker price, or services separately counted as copays.

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

No. For covered in-network care, the maximum generally includes eligible deductibles, copays and coinsurance. Premiums, non-covered services and out-of-network costs are generally outside that limit.

Can an HSA make a high-deductible plan cheaper?

Employer HSA contributions can help pay qualified medical expenses, and unused HSA funds generally carry forward. This comparison subtracts only dollars actually spent on modeled care, so the separate value of unused HSA money and any tax benefits are not reflected.

Can a plan have more than one break-even point?

Yes. The deductible and out-of-pocket ceiling change how fast your total costs increase as medical spending rises. Two plans may switch which one is cheaper more than once.

Will this work for family plans?

It is best for a single modeled pool of covered costs. Many family plans have separate individual and family deductibles and embedded out-of-pocket limits. For a precise family comparison, use plan-specific individual-by-individual cost sharing or your insurer’s estimator.

Sources: HealthCare.gov: total costs, out-of-pocket maximum, and HSA-eligible plans. Disclaimer: Educational modeling only, not medical, legal, tax or insurance advice. Your Summary of Benefits and Coverage and insurance contract control. Actual negotiated rates, formularies, network access, preventive services, special copay rules, embedded family limits and excluded services can change the result.