United States version
How it works
Model a deductible-and-coinsurance contract using confirmed policy values rather than infer subsidy eligibility or national underwriting prices.
This is the United States planning view, with monetary inputs and outputs in USD. A currency label does not establish that a tax rate, construction price, coverage rule or legal limit has been verified locally. The inputs and limitations below describe the actual scope.
Input query strings and outputs
Use an input name in this page’s URL as ?name=value, and join additional inputs with &. Portable shared links may instead use the compact ?ac= state parameter.
Input query strings
7-
?annualPremium=Annual premium before confirmed subsidyMoney · Required · Default: 6,000
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?confirmedSubsidy=Confirmed annual premium subsidyMoney · Required · Default: 0
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?eligibleSpending=Eligible covered in-network chargesMoney · Required · Default: 8,000
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?deductible=Annual deductibleMoney · Required · Default: 2,000
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?coinsurance=Patient coinsurance after deductiblePercentage · Required · Default: 20
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?outOfPocketMax=Applicable covered out-of-pocket maximumMoney · Required · Default: 6,000
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?excludedSpending=Excluded or non-covered spendingMoney · Required · Default: 0
Outputs
3-
netPremiumPremium after confirmed subsidyCurrency · Currency: USD
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coveredOutOfPocketModeled covered out-of-pocketCurrency · Currency: USD
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annualTotalPremium and modeled medical spendingCurrency · Primary output · Currency: USD
Formula
covered out-of-pocket = minimum(maximum, minimum(charges, deductible) + maximum(0, charges − deductible) × coinsurance).
Calculations retain numeric precision internally. Displayed values are rounded for readability. Quantities that must be purchased as whole units are rounded up only where the formula explicitly requires it.
Read the inputs before calculating
- Annual premium before confirmed subsidy: Enter the quantity described by the label.
- Confirmed annual premium subsidy: Enter the quantity described by the label.
- Eligible covered in-network charges: Enter the quantity described by the label.
- Annual deductible: Enter the quantity described by the label.
- Patient coinsurance after deductible: Enter the quantity described by the label.
- Applicable covered out-of-pocket maximum: Enter the quantity described by the label.
- Excluded or non-covered spending: Enter the quantity described by the label.
Reproducible worked example
The following is a fictional arithmetic example, not a local quote, a verified claimant or a market forecast. Its values are included so the formula can be checked. The form does not automatically confirm any verification checkbox.
| Input | Example value |
|---|---|
| Annual premium before confirmed subsidy | 6,000 |
| Confirmed annual premium subsidy | 0 |
| Eligible covered in-network charges | 8,000 |
| Annual deductible | 2,000 |
| Patient coinsurance after deductible | 20 |
| Applicable covered out-of-pocket maximum | 6,000 |
| Excluded or non-covered spending | 0 |
| Output | Calculated result |
|---|---|
| Premium after confirmed subsidy | USD 6,000 |
| Modeled covered out-of-pocket | USD 3,200 |
| Premium and modeled medical spending | USD 9,200 |
Interpreting a changed assumption
Start with one complete scenario and change only one input when diagnosing a difference. Recheck units, the period of every rate, whether an amount is recurring or one-off, and whether a cost is already included elsewhere. A larger calculated benefit is not evidence that an assumption is more likely to occur.
Limitations
- Use actual policy wording, quotes and jurisdiction-specific requirements. This is a planning worksheet, not a coverage recommendation, insurer quote or determination of a payable claim.
- Premiums and excluded spending are outside this modeled out-of-pocket limit. Copays, separate benefit caps, family embedded deductibles and non-US policy structures may not follow this formula; use it only where the actual contract matches.
Frequently asked questions
What does this Health Insurance Out-of-Pocket result represent?
Model a deductible-and-coinsurance contract using confirmed policy values rather than infer subsidy eligibility or national underwriting prices. It applies the displayed formula to your inputs; it does not infer omitted facts.
Are the starting amounts verified United States prices or legal rules?
No. Numeric defaults are illustrative unless an input or dated reference explicitly identifies a researched component. Currency is USD; local quotes, eligibility and unsupported rules must be entered and verified separately.
What must I check before relying on the result?
Use actual policy wording, quotes and jurisdiction-specific requirements. This is a planning worksheet, not a coverage recommendation, insurer quote or determination of a payable claim.
Can I compare or share different assumptions?
Change one assumption at a time and use the browser-local project or share controls. A shared URL contains the encoded input values; do not include information you do not wish to disclose.
Sources and reference scope
- NAIC consumer insurance resources — retrieved 2026-09-24. US coverage education. Not a quote, underwriting table or a substitute for another country’s regulator.
- NAIC insurance glossary — retrieved 2026-09-24. Terminology only; policy wording and local law govern actual coverage.
These references support only their stated scope. They are not evidence that every local rule or price needed by the master expansion has been loaded.