{
  "id": "v20-us-health-insurance",
  "version": "20.16.0",
  "name": "Health Insurance Out-of-Pocket Calculator — United States",
  "shortName": "Health Insurance Out-of-Pocket",
  "description": "Model a deductible-and-coinsurance contract using confirmed policy values rather than infer subsidy eligibility or national underwriting prices. USD planning view; stated limitations apply.",
  "category": "Finance",
  "categorySlug": "finance",
  "keywords": [
    "health-insurance",
    "us",
    "insurance-consumer",
    "insurance-terms"
  ],
  "status": "live",
  "workStatus": "pending",
  "reviewStatus": "pending",
  "migrationStatus": "new",
  "engine": "native",
  "creator": null,
  "reviewer": null,
  "quality": {
    "availability": "live",
    "technicalReviewRecord": "/reviews/v20-us-health-insurance.json",
    "qualifiedReview": "pending",
    "qualifiedReviewer": null,
    "qualifiedReviewDate": null,
    "formulaVersion": "20.16.0",
    "referenceCoverage": "references-listed",
    "releaseTestScope": "Catalog and regression checks are not a professional formula audit; consult release evidence.",
    "historicalMetadataDate": "",
    "historicalMetadataNotice": "The imported date is not evidence of a completed human review."
  },
  "notice": "Illustrative defaults are not local quotes or verified legal rules. Dated reference components and user-entered assumptions are explicitly distinguished. Professional review is pending.",
  "urls": {
    "page": "/us/health-insurance/",
    "definition": "/us/health-insurance/definition.json",
    "schema": "/us/health-insurance/schema.json",
    "llms": "/us/health-insurance/llms.txt",
    "legacyDefinition": "/us/health-insurance/definition.json"
  },
  "queryExample": "https://askcalculators.com/us/health-insurance/?annualPremium=6000&confirmedSubsidy=0&eligibleSpending=8000&deductible=2000&coinsurance=20&outOfPocketMax=6000&excludedSpending=0",
  "queryParameters": {
    "annualPremium": {
      "label": "Annual premium before confirmed subsidy",
      "type": "money",
      "required": true,
      "default": 6000
    },
    "confirmedSubsidy": {
      "label": "Confirmed annual premium subsidy",
      "type": "money",
      "required": true,
      "default": 0
    },
    "eligibleSpending": {
      "label": "Eligible covered in-network charges",
      "type": "money",
      "required": true,
      "default": 8000
    },
    "deductible": {
      "label": "Annual deductible",
      "type": "money",
      "required": true,
      "default": 2000
    },
    "coinsurance": {
      "label": "Patient coinsurance after deductible",
      "type": "percent",
      "required": true,
      "default": 20
    },
    "outOfPocketMax": {
      "label": "Applicable covered out-of-pocket maximum",
      "type": "money",
      "required": true,
      "default": 6000
    },
    "excludedSpending": {
      "label": "Excluded or non-covered spending",
      "type": "money",
      "required": true,
      "default": 0
    }
  },
  "inputs": [
    {
      "id": "annualPremium",
      "label": "Annual premium before confirmed subsidy",
      "type": "money",
      "defaultValue": 6000,
      "required": true,
      "min": 0,
      "max": 1000000000000,
      "step": 0.01,
      "prefix": "USD",
      "help": "Illustrative starting value; replace with your own evidence."
    },
    {
      "id": "confirmedSubsidy",
      "label": "Confirmed annual premium subsidy",
      "type": "money",
      "defaultValue": 0,
      "required": true,
      "min": 0,
      "max": 1000000000000,
      "step": 0.01,
      "prefix": "USD",
      "help": "Illustrative starting value; replace with your own evidence."
    },
    {
      "id": "eligibleSpending",
      "label": "Eligible covered in-network charges",
      "type": "money",
      "defaultValue": 8000,
      "required": true,
      "min": 0,
      "max": 1000000000000,
      "step": 0.01,
      "prefix": "USD",
      "help": "Illustrative starting value; replace with your own evidence."
    },
    {
      "id": "deductible",
      "label": "Annual deductible",
      "type": "money",
      "defaultValue": 2000,
      "required": true,
      "min": 0,
      "max": 1000000000000,
      "step": 0.01,
      "prefix": "USD",
      "help": "Illustrative starting value; replace with your own evidence."
    },
    {
      "id": "coinsurance",
      "label": "Patient coinsurance after deductible",
      "type": "percent",
      "defaultValue": 20,
      "required": true,
      "min": 0,
      "max": 100,
      "step": 0.1,
      "help": "Illustrative starting value; replace with your own evidence."
    },
    {
      "id": "outOfPocketMax",
      "label": "Applicable covered out-of-pocket maximum",
      "type": "money",
      "defaultValue": 6000,
      "required": true,
      "min": 0,
      "max": 1000000000000,
      "step": 0.01,
      "prefix": "USD",
      "help": "Illustrative starting value; replace with your own evidence."
    },
    {
      "id": "excludedSpending",
      "label": "Excluded or non-covered spending",
      "type": "money",
      "defaultValue": 0,
      "required": true,
      "min": 0,
      "max": 1000000000000,
      "step": 0.01,
      "prefix": "USD",
      "help": "Illustrative starting value; replace with your own evidence."
    }
  ],
  "outputs": [
    {
      "id": "netPremium",
      "label": "Premium after confirmed subsidy",
      "format": "currency",
      "digits": 2,
      "currency": "USD"
    },
    {
      "id": "coveredOutOfPocket",
      "label": "Modeled covered out-of-pocket",
      "format": "currency",
      "digits": 2,
      "currency": "USD"
    },
    {
      "id": "annualTotal",
      "label": "Premium and modeled medical spending",
      "format": "currency",
      "digits": 2,
      "primary": true,
      "currency": "USD"
    }
  ],
  "formula": {
    "expression": "covered out-of-pocket = minimum(maximum, minimum(charges, deductible) + maximum(0, charges − deductible) × coinsurance).",
    "note": "Inputs are converted to canonical units before evaluating this stated formula."
  },
  "examples": [
    {
      "label": "Illustrative defaults; required verification checks remain unconfirmed",
      "inputs": {
        "unitSystem": "imperial",
        "annualPremium": 6000,
        "confirmedSubsidy": 0,
        "eligibleSpending": 8000,
        "deductible": 2000,
        "coinsurance": 20,
        "outOfPocketMax": 6000,
        "excludedSpending": 0
      }
    }
  ],
  "sources": [
    {
      "label": "NAIC consumer insurance resources",
      "url": "https://content.naic.org/consumer"
    },
    {
      "label": "NAIC insurance glossary",
      "url": "https://content.naic.org/glossary-insurance-terms"
    }
  ],
  "publicSlug": "health-insurance",
  "namespace": "us",
  "countries": [
    "us",
    "ie"
  ]
}