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Health Insurance Deductible Calculator

U.S. only tools

A deductible is not a bill, and a premium is not the price. What a health plan costs over a year is the premium you pay whether or not you use care, plus the deductible you pay first, plus your share of everything above it, up to the plan cap on your own spending.

Health Insurance Deductible Calculator - Danfio

https://danfio.com/tools/health-insurance-deductible-calculator/ - printed from this page

Currency: USD ($) - display only, nothing was converted

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The high-deductible plan sits here by default.

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The annual deductible on the plan summary; self-only and family figures differ.

Your share of the bill after the deductible is met.

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The annual cap on the plan summary, covering deductible, coinsurance and copays.

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The lower-deductible plan sits here by default.

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Plan B's annual deductible, again from the plan summary.

Your share after the deductible is met; 10% to 20% is common on a lower-deductible plan.

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Plan B's annual cap; if it sits below the deductible the page prices the deductible instead.

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Bills for covered services under Plan A, at the prices Plan A has negotiated - the quieter year belongs here.

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The same year of bills under Plan B, at Plan B prices - the year that uses more care belongs here.

Self-only or family; it also sets the HSA contribution limit.

Results update as you type. Nothing leaves your device.

Currency symbol

Symbol only - nothing is converted and no exchange rate is used. Figures quoted in the explanation text stay as the sources publish them.

Total cost with Plan A

$7,600.00

$3,000 of premium plus $4,600 of care on $6,000 of medical bills, against $7,050 with Plan B.

Cheaper at this spending level
Plan B $550.00 less over the year
Plan A premium
$3,000
Plan A cost for care
$4,600
Share of bills Plan A pays
23.3%

Where the money goes under Plan A

  • Premium$3,000.00
  • Deductible$4,000.00
  • Coinsurance$600.00

Half of a plan price is invisible on the premium line. The deductible and the coinsurance only appear in a year when you use care.

The same year under both plans

Plan APlan B
Monthly premium$250.00$500.00
Annual premium$3,000.00$6,000.00
Deductible paid$4,000.00$500.00
Coinsurance$600.00$550.00
Cost for care$4,600.00$1,050.00
Total cost$7,600.00$7,050.00
Out-of-pocket cap$8,500.00$5,000.00

Cost for care stops growing at the out-of-pocket cap, which is why the two totals converge in a very expensive year.

Total cost at different levels of care

Covered carePlan APlan BCheaper by
$0$3,000$6,000Plan A by $3,000
$1,000$4,000$6,550Plan A by $2,550
$3,000$6,000$6,750Plan A by $750
$6,000$7,600$7,050Plan B by $550
$12,000$9,400$7,650Plan B by $1,750
$30,000$11,500$9,450Plan B by $2,050
$60,000$11,500$11,000Plan B by $500

Once both plans have reached their out-of-pocket maximum only the premium differs, so the cheaper plan at low spending is the cheaper plan at every level above the caps.

The two plans cost the same at about $3,833 of covered care in a year. Below that the low-premium plan wins, above it the low-deductible plan does.

2026 health savings account limits (Rev. Proc. 2025-19)

LimitSelf-only coverageFamily coverage
HSA contribution limit$4,400$8,750
Catch-up contribution from age 55$1,000$1,000
Minimum deductible to qualify$1,700$3,400
Maximum out-of-pocket to qualify$8,500$17,000

🔄 Updated for self-only coverage — With the figures entered, Plan A meets the HSA-qualifying definition for self-only coverage, and Plan B does not. Meeting it is what lets you open an HSA and contribute $4,400 pre-tax in 2026, which is the part of a high-deductible plan that pays you back.

What the deductible does not cap

  • The deductible is only the first $4,000 of covered care under Plan A; after it, coinsurance of 30% runs until the out-of-pocket maximum of $8,500.
  • The premium is paid in every year — $3,000 for Plan A against $6,000 for Plan B — whether or not anyone sees a doctor.
  • A year with $6,000 of covered care under Plan A and $6,000 under Plan B adds $4,600 on Plan A and $1,050 on Plan B, which is where the $550.00 gap between the two totals comes from.
  • An out-of-pocket maximum is a ceiling on the year rather than a discount: it caps the deductible and the coinsurance together, at $8,500.00 on Plan A as this page prices it.
  • None of this is an HSA decision: qualification is a separate test, and at these deductibles and caps Plan A does qualify.

This calculator prices two plans against the year of medical bills you expect under each, showing the premium, the deductible, the coinsurance and the total, and finding the spending level at which the two plans swap places. That break-even figure is the answer to the usual question, which is not which plan is better but how much care it would take to make the expensive plan worth its premium.

About this health insurance deductible calculator

Open enrollment is a choice made without a bill. The deductible calculator prices two health plans against the year of care you expect under each, the way the plan documents work — premium, deductible, coinsurance and out-of-pocket maximum, in the order the plan applies them — so a comparison like this one can be finished before open enrollment rather than after a bad year.

The method is printed in full on the page, and the figures quoted for 2026 — the high-deductible definitions and the health savings account limits — come from IRS Rev. Proc. 2025-19, so a mistyped number is caught before it reaches a visitor. The site sells no data and takes no money for placements; there is no brokerage and nothing you enter is stored.

Not investment or insurance advice; quotes come from a licensed provider. Plan documents, network rules and balance billing all sit outside the arithmetic, and only what your own plan says is authoritative. Nothing here is an actuarial or insurance opinion, and you should check current figures with your plan before relying on them.

How this health insurance deductible calculator works

The four numbers that make up a plan

The premium is paid every month. The deductible is the care you pay for yourself before the plan starts sharing. Coinsurance is your share after that, usually 20% or 30% of the negotiated price. The out-of-pocket maximum is where your spending stops: past that cap, covered care is paid by the plan.

The order matters. A $4,000 deductible with 30% coinsurance is not the same as a $4,000 deductible with 10%, and neither is the same as a $4,000 deductible with a $5,000 cap versus an $8,500 one. Two plans with identical deductibles can differ by thousands of dollars in the year you actually get ill.

The break-even, which is the real comparison

A high-deductible plan wins in the years you barely use care, because the premium saving is banked. A low-deductible plan wins in the years you use a lot, because the plan starts paying sooner and the cap arrives earlier. Somewhere between those two years, the totals cross.

If the crossing point is at $4,000 of care, anyone who expects more than that should take the low-deductible plan; anyone who expects less should take the premium saving. If the two lines never cross, the choice is settled regardless of what the year holds, and the table of spending levels on this page shows that at a glance.

The health savings account and the 2026 limits

A plan can only be paired with a health savings account if it meets the high-deductible definition: for 2026 a deductible of at least $1,700 for self-only cover or $3,400 for family cover, and an out-of-pocket maximum no higher than $8,500 or $17,000. Rev. Proc. 2025-19 set those figures, along with contribution limits of $4,400 and $8,750 and a $1,000 catch-up from age 55.

That account is where a high-deductible plan earns its keep. Contributions are pre-tax, growth is untaxed, and withdrawals for qualified medical expenses are untaxed as well, which turns the deductible into spending with a tax subsidy attached. The calculation above ignores that saving on purpose, so the HSA makes the high-deductible column better than it looks rather than worse.

The two ends of the range, and why they settle the comparison

At the two ends of the spending range the comparison stops being close. With almost no care — the year nobody wants and most people get — the high-deductible plan is cheaper by exactly the premium difference, because neither deductible is reached and the only thing spent is the premium. With care that clears both caps, each plan costs its premium plus its own out-of-pocket maximum, so the low-deductible plan wins by the gap between the two maxima plus the difference in premiums; the deductible itself has dropped out of the arithmetic.

Those two ends bracket every other year, and they explain why the break-even exists and roughly where it will sit. A high-deductible plan spends the early years writing checks for nothing but premium, and the bad year paying close to the whole cap; a low-deductible plan spends more every month and less in the bad year. The table on this page runs through the middle so you can see which side of the break-even any realistic year falls on.

Worked examples

Each example below was run through the calculator on this page when the site was built, so the numbers match what you see when you enter the same inputs.

A high-deductible plan against a lower-deductible one

Plan A premium: $250.00 · Plan A deductible: $4,000.00 · Plan A coinsurance: 30% · Plan A out-of-pocket maximum: $8,500.00 · Plan B premium: $500.00 · Plan B deductible: $500.00 · Plan B coinsurance: 10% · Plan B out-of-pocket maximum: $5,000.00 · Plan A expected spend: $6,000.00 · Plan B expected spend: $6,000.00 · Coverage tier: Self-only

Total cost with Plan A

$7,600.00

$3,000 of premium plus $4,600 of care on $6,000 of medical bills, against $7,050 with Plan B.

Cheaper at this spending level: Plan B · Plan A premium: $3,000 · Plan A cost for care: $4,600 · Share of bills Plan A pays: 23.3%

At $6,000 of care the low-deductible plan is about $550 cheaper for the year, even though it costs $3,000 more in premium, because it starts paying much sooner.

A year with almost no care

Plan A premium: $250.00 · Plan A deductible: $4,000.00 · Plan A coinsurance: 30% · Plan A out-of-pocket maximum: $8,500.00 · Plan B premium: $500.00 · Plan B deductible: $500.00 · Plan B coinsurance: 10% · Plan B out-of-pocket maximum: $5,000.00 · Plan A expected spend: $400.00 · Plan B expected spend: $400.00 · Coverage tier: Self-only

Total cost with Plan A

$3,400.00

$3,000 of premium plus $400 of care on $400 of medical bills, against $6,400 with Plan B.

Cheaper at this spending level: Plan A · Plan A premium: $3,000 · Plan A cost for care: $400 · Share of bills Plan A pays: 0%

With only $400 of bills the whole premium difference is banked: the high-deductible plan is $3,000 cheaper, and the deductible never comes into play.

A year that reaches both caps

Plan A premium: $250.00 · Plan A deductible: $4,000.00 · Plan A coinsurance: 30% · Plan A out-of-pocket maximum: $8,500.00 · Plan B premium: $500.00 · Plan B deductible: $500.00 · Plan B coinsurance: 10% · Plan B out-of-pocket maximum: $5,000.00 · Plan A expected spend: $60,000.00 · Plan B expected spend: $60,000.00 · Coverage tier: Self-only

Total cost with Plan A

$11,500.00

$3,000 of premium plus $8,500 of care on $60,000 of medical bills, against $11,000 with Plan B.

Cheaper at this spending level: Plan B · Plan A premium: $3,000 · Plan A cost for care: $8,500 · Share of bills Plan A pays: 85.8%

Once both plans hit their out-of-pocket maximums the cost of care is fixed, so the totals differ only by the premium and the cap: the gap narrows to a few hundred dollars a year.

A year at the point the plans trade places

Plan A premium: $250.00 · Plan A deductible: $4,000.00 · Plan A coinsurance: 30% · Plan A out-of-pocket maximum: $8,500.00 · Plan B premium: $500.00 · Plan B deductible: $500.00 · Plan B coinsurance: 10% · Plan B out-of-pocket maximum: $5,000.00 · Plan A expected spend: $3,900.00 · Plan B expected spend: $3,900.00 · Coverage tier: Self-only

Total cost with Plan A

$6,900.00

$3,000 of premium plus $3,900 of care on $3,900 of medical bills, against $6,840 with Plan B.

Cheaper at this spending level: Plan B · Plan A premium: $3,000 · Plan A cost for care: $3,900 · Share of bills Plan A pays: 0%

At about $3,800 of care the two totals cross: below that mark the premium saving makes Plan A cheaper, and above it Plan B pays back and the line swings the other way. A few hundred dollars of care either side is enough to change the right answer.

Frequently asked questions

What is a deductible, and does it count toward the out-of-pocket maximum?

The deductible is what you pay for covered care before the plan starts sharing the cost. Amounts you pay towards the deductible normally also count towards the out-of-pocket maximum, so a $4,000 deductible inside an $8,500 cap leaves $4,500 of coinsurance and copays before your spending stops.

Why does the calculator add the premium to the care costs?

Because the premium is paid whether or not you use care, and it is usually the larger of the two numbers in a healthy year. Comparing plans on deductibles alone is how people end up paying more: a $500 deductible with a $6,000 annual premium can cost more than a $4,000 deductible with a $3,000 premium.

Which plan should I choose?

Find the level of care at which the two plans cost the same, then ask which side of it you expect to be on, and how much cash you could produce if a bad year arrived in January. The premium saving is certain; the care spending is not. Households that could not cover a large deductible from savings should weigh the low-deductible plan even when the arithmetic favors the other one.

Does the plan pay anything before the deductible is met?

Usually something. Preventive care is covered without cost sharing on ACA-compliant plans, and many plans charge fixed copays for primary care or generic prescriptions that apply before the deductible. Those details live in the summary of benefits, and where they exist they make the plan better than a pure deductible-plus-coinsurance model suggests.

Should I use health savings account money to pay the deductible?

Paying qualified medical expenses from the account is tax-free at any age, so it always works. The stronger play, if cash flow allows, is to pay current bills from ordinary money and leave the account invested: the receipts never expire, so you can reimburse yourself years later and let the balance compound untaxed in the meantime.

What is left out of this comparison?

Out-of-network care, balance billing, prescription tiers, dental and vision, and the tax treatment of the premium itself. If the plan is bought on the Marketplace, the premium tax credit changes the premium you actually pay, and the ACA subsidy calculator works that out; if the plan is offered at work, the premium is usually taken pre-tax, which lowers its real cost.

Assumptions and sources

  • High-deductible definitions and health savings account limits for 2026 come from IRS Rev. Proc. 2025-19: $4,400 self-only and $8,750 family contributions, $1,000 catch-up from age 55, a $1,700 or $3,400 minimum deductible and an $8,500 or $17,000 maximum out-of-pocket limit.
  • Method: premium, deductible, coinsurance and out-of-pocket maximum are applied in the order the plan applies them, with member spending capped at the plan maximum. The numbers entered are the ones taken from the plan documents you are comparing.
  • Deductibles and caps generally apply to in-network essential health benefits; out-of-network care, balance billing, drug tiers and any premium tax credit sit outside this model.

Last reviewed 2026-09-14. Not investment or insurance advice; quotes come from a licensed provider. Read the full disclaimer.

Where a figure on this page comes from an official agency — HUD, IRS, FICO or a state body — the site keeps a dated snapshot of the source page in its sources library, and a scheduled job re-checks that snapshot, so the number can be traced back to the document it came from.

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