This health insurance calculator is intended to help you understand the relationship between premium cost and out-of-pocket spending for different health insurance products and levels of utilization.  Please note that it is a very simplified model, and should not be used to make specific health insurance purchasing decisions.

The model has two areas that you can adjust – benefits and utilization.  The benefits section has three different health plans as its defaults – an HMO plan, a typical fee-for-service plan, and a high-deductible health plan (HDHP).  Each plan is described by six parameters:

·         Deductible – the amount you will have to pay for services before your coverage starts.

·         Coinsurance – your share of costs after meeting your deductible and before you reach your out-of-pocket maximum

·         Out-of-pocket maximum – the most you will have to pay in a single year in cost sharing (e.g. deductible, coinsurance)

·         Office visit co-pay – the amount you have to pay each time you visit a physician.  This is a fixed dollar amount, as opposed to coinsurance, which is a percentage of the total bill.  Not all health insurance has co-pays.

·         Premium – the total amount  paid for a policy per month, including both employer share (if any) and your share.

·         Employer share – the percent of the total premium paid by your employer.  If you purchase insurance directly from an insurance company, put 0% here.

The utilization  section lets you enter the number of times you expect to visit a physician, go to the hospital for outpatient services (such as a lab test or an x-ray) and the number of times you expect to be admitted to the hospital for an overnight (or longer) stay.  For each category, you can also change the amount that the average visit or stay costs.  For hospital care, be sure to include any physician costs (such as surgeon fees).

Click here to go to the calculator.