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Use this out-of-pocket cost calculator to determine your total medical costs that aren’t reimbursed by your health insurance provider. To calculate your out-of-pocket costs, enter the procedure rate, deductible, co-insurance, co-pay, and out-of-pocket remaining. Your deductible, copay, and coinsurance amount will depend on your individual insurance plan.
The procedure rate is the overall cost of a procedure that your insurance company has negotiated with the health care provider.
Let’s say you need knee surgery at University Hospital. Your insurance company and the hospital have agreed upon the rate of $10,000 as the overall total amount that will be paid by the insurance company to the hospital.
Your deductible is the amount of money you'll have to spend out-of-pocket before insurance kicks in.
This amount is dependent on the specific health insurance plan. In general, the lower your monthly premium, the higher your deductible. Your plan may not have a deductible at all. Deductibles reset every year. According to a study fromehealthinsurance.com, in 2020, the average annual deductible for single, individual coverage was $4,364 and $8,439 for family coverage.
Your coinsurance is a percentage of the procedure cost that you are liable to pay out of pocket.
For example, your health insurance plan might have a 20% coinsurance requirement for each procedure, which kicks in only after you have met your deductible.
Your copayment (copay) is a fixed amount that you are liable to pay for the procedure out of pocket.
For example, your health insurance plan might have a $20 copay requirement for each procedure, which kicks in only after you have met your deductible.
In the example of our $10,000 knee surgery at University Hospital. Enter the procedure rate of $10,000 in the procedure rate field in the calculator.
Next, assume our plan has a $2,000 yearly deductible. Enter the deductible of $2,000 in the deductible remaining field in the calculator.
Next, our plan has a coinsurance requirement of 20%. Enter the 20% coinsurance field in the calculator.
Next, our plan has an out-of-pocket maximum of $6,000. Enter the $6,000 in the out-of-pocket field in the calculator.
Our total out of pocket cost for this medical procedure is $3,608
Do not avoid getting health care based on the information on this site. Not affiliated with any insurance provider, hospital, or medical professional. Prices are just estimates based on available data, and may vary based on plan, state, and provider. For informational purposes only.