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Premiums are the number on the brochure. Total cost is premiums plus deductible plus coinsurance, and it’s the only number that matters. Put two plans in and see where they cross.
What you'll need
Monthly premium, deductible, coinsurance percentage and out-of-pocket maximum, for two plans. All four are on the Summary of Benefits and Coverage, which every plan has to publish.
What you get
The total annual cost of each plan at every level of care, and the exact amount of medical spending where the cheaper plan changes.
Your total medical bills before insurance, not what you pay.
Lower is better. Where the lines cross, the better plan changes.
Which account nets you more, and how much of an FSA you would forfeit.
What continuing your old plan really costs at 102% of the full premium.
This tool only knows the numbers you typed. It doesn’t know about the plan on page 14 you skipped, your 401(k) match, or what a specialist visit actually costs under each option.
Benefits Decoder reads the whole guide. Upload it, answer four questions, and about two minutes later you get the verdict: every plan priced, real-life moments costed out, 401(k) match decoded.
One payment covers your guide, your spouse’s, and re-runs when HR sends a better document.
The ACA enhanced premium tax credits expired at the end of 2025. Premiums jumped, and a lot of people reacted by moving to whichever plan had the smallest monthly number. Deductibles then did this:
Trading premium for deductible isn’t automatically wrong. It’s right for a lot of healthy people. It’s wrong when you don’t know where the break-even sits. That’s the number this gives you.
Figures: KFF, 2026 marketplace analysis
For each plan, at a given level of medical spending: you pay costs yourself until you hit the deductible; after that you pay the coinsurance share of everything else; you stop paying at the out-of-pocket maximum, which already includes the deductible. Premiums are added on top and are never capped by the out-of-pocket max.
If a plan is HSA-eligible, any employer contribution is subtracted, and your own contribution is credited at your marginal tax rate, so money you’d have paid in tax stays yours.
Simplifications worth knowing: this assumes in-network care, ignores per-visit copay structures, and treats a year of spending as one lump.
Every US plan has a Summary of Benefits and Coverage, a standardized four-page document, the same format for every insurer, legally required. Premium, deductible, coinsurance and out-of-pocket max are all on page 1. Ask HR for the SBC, or find it on the plan listing at Healthcare.gov or your state exchange.
Not insurance advice. This is arithmetic on the numbers you enter. It doesn’t know your network, your prescriptions, your providers, or your tax situation, and it can’t tell you which plan to buy. Check the Summary of Benefits and Coverage and talk to your HR team or a licensed broker before deciding.
Nothing you type here is sent anywhere. The calculator runs entirely in your browser.