Distinct from this site’s out-of-pocket maximum calculator, which tracks spending across the whole plan year — this finds what one specific claim costs today, given how much deductible is already used up.
How it works
Whatever remaining deductible is left absorbs the claim first, dollar for dollar. Only the portion of the claim above that gets coinsurance applied — the patient’s share after the deductible is met.
What this does not include
This doesn’t check against the plan’s out-of-pocket maximum — once total spending for the year reaches that cap, the plan pays 100% regardless of the coinsurance rate, which this site’s out-of-pocket-max calculator tracks separately.
How to use this calculator
- Enter the billed claim amount and remaining deductible before this claim.
- Enter the coinsurance rate that applies after the deductible.
Frequently asked questions
Why isn’t coinsurance applied to the whole claim?
Because coinsurance only applies after the deductible is satisfied — the portion of a claim that goes toward the deductible is paid in full by the patient, with coinsurance kicking in only afterward.
What if this claim is smaller than the remaining deductible?
The entire claim goes toward the deductible with no coinsurance applied yet — the patient pays the full billed amount for this claim.
Should I track this against my out-of-pocket max too?
Yes — this site’s out-of-pocket max calculator tracks the running total across the year; once that cap is reached, the plan covers 100% of costs regardless of what this calculator shows for an individual claim.
