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Try-it tool

Out-of-pocket estimator

Estimate what you may owe for one covered service. It is an estimate, and your EOB is what counts.

This estimator gives a rough idea of what you might owe for one covered service. It is an estimate. The explanation of benefits (EOB) your insurer sends after the claim is processed is what counts, and your plan's documents and your insurer have the final word on what you owe.

This is an estimate. It treats the amount you enter as the plan's allowed amount. The first part goes toward whatever deductible you have left, the coinsurance percentage applies to the rest, and the total is capped at the out-of-pocket maximum you have left. Copays, out-of-network charges and services your plan does not cover are not included. Each box starts with a made-up figure, so type the numbers from your own plan.

Applied to your deductible: $500.00

Coinsurance on the rest: $400.00

What you may owe: $900.00

What the plan may pay: $1,600.00

How this works

The estimator follows the usual order of cost sharing for a covered, in-network service:

  1. The part of the allowed amount up to your remaining deductible is yours to pay.
  2. Your coinsurance percentage applies to the allowed amount that is left.
  3. Your total is capped at the out-of-pocket maximum you have left.
  4. The plan may pay the difference between the allowed amount and what you owe.

What you may owe = the smaller of (the deductible portion + coinsurance on the rest) and your remaining out-of-pocket maximum

What it leaves out

  • Copays, which some plans charge instead of or on top of coinsurance.
  • Out-of-network care, balance billing and services the plan does not cover.
  • Separate deductibles or limits for certain services, such as prescriptions.
  • Any claim that is denied, or care that needed approval beforehand and did not get it.
  • Other claims still being processed that may use up your deductible or out-of-pocket maximum first.

The billed charge is usually higher than the allowed amount. If you enter a billed charge, the estimate will probably come out too high. To compare an actual bill with your coverage, use your EOB and read how to read an EOB. Nothing you enter is sent or saved, and the math runs in your browser.