Health Insurance Calculator
Estimate your health insurance premiums and total healthcare costs
Personal Information
Your current age (premiums increase with age)
Number of people covered by the plan
Total household income (affects subsidy eligibility)
Preferred Provider Organization - Flexible network
Covers ~70% of costs, moderate premium
Percentage of premium paid by employer (typically 50-80% for employer-sponsored plans)
Plan Details
Amount you pay before insurance covers costs
Maximum you'll pay in a year
Your share of costs after deductible (typically 10-30%)
Fixed amount per doctor visit
Estimated Medical Usage
Total medical bills before insurance (including prescriptions, procedures, etc.)
Number of doctor visits per year
Available for marketplace plans if household income is between 100% and 400% of Federal Poverty Level
Cost Summary
Premium Breakdown
Out-of-Pocket Costs
Cost Analysis
Example Calculation
Family Health Insurance Example
Profile: Family of 4, parents age 35 and 33
Annual Income: $75,000
Plan: PPO Silver (employer-sponsored, 70% employer contribution)
Deductible: $3,000 family
Coinsurance: 20% after deductible
Out-of-Pocket Max: $8,000 family
Estimated Annual Costs
Gross Premium: $1,200/month × 12 = $14,400
Employer Pays (70%): $14,400 × 0.70 = $10,080
Employee Pays (30%): $14,400 × 0.30 = $4,320
Estimated Medical Expenses: $5,000
Deductible: $3,000
Coinsurance: ($5,000 - $3,000) × 20% = $400
Copays: 10 visits × $30 = $300
Total Out-of-Pocket: $3,700
Total Annual Cost: $4,320 + $3,700 = $8,020
Monthly Average: $668
Cost Breakdown
Average Monthly Premium by Age
* Individual Silver plan estimates. Actual costs vary by location and insurer.
Insurance Tips
Compare plans during open enrollment period
Consider HSA-eligible plans for tax savings
Check if you qualify for subsidies on Healthcare.gov
Review network coverage for your doctors
Factor in prescription drug coverage
Balance premium vs. out-of-pocket costs
Understanding Health Insurance Costs
Key Terms
- •Premium: Monthly payment for insurance coverage, regardless of whether you use medical services
- •Deductible: Amount you pay for covered services before insurance starts paying
- •Copay: Fixed amount you pay for a covered service (e.g., $30 for doctor visit)
- •Coinsurance: Your share of costs after deductible (e.g., you pay 20%, insurance pays 80%)
- •Out-of-Pocket Maximum: Most you'll pay in a year; after this, insurance pays 100%
Plan Types
HMO (Health Maintenance Organization)
Lower costs, requires primary care physician, network-only coverage
PPO (Preferred Provider Organization)
More flexibility, higher costs, out-of-network coverage available
HDHP (High Deductible Health Plan)
Lower premiums, higher deductible, HSA-eligible for tax savings
EPO (Exclusive Provider Organization)
Network-only, no referrals needed, moderate costs
Metal Tiers (ACA Marketplace)
Bronze
Covers ~60% of costs
Lowest premium, highest out-of-pocket
Silver
Covers ~70% of costs
Moderate premium and out-of-pocket
Gold
Covers ~80% of costs
Higher premium, lower out-of-pocket
Platinum
Covers ~90% of costs
Highest premium, lowest out-of-pocket
Choosing the Right Plan
Choose a lower premium / higher deductible plan if:
- • You're generally healthy with few medical expenses
- • You can afford to pay more when you need care
- • You want to save on monthly costs
- • You're eligible for an HSA
Choose a higher premium / lower deductible plan if:
- • You have ongoing medical needs
- • You take regular medications
- • You prefer predictable costs
- • You visit doctors frequently
ACA Premium Tax Credits
If you buy insurance through the Health Insurance Marketplace (Healthcare.gov), you may qualify for premium tax credits (subsidies) based on your income and family size. These credits reduce your monthly premium.
Eligibility Requirements:
- • Household income between 100% and 400% of Federal Poverty Level
- • Not eligible for affordable employer-sponsored coverage
- • Not eligible for government programs (Medicare, Medicaid)
- • Must enroll through the Health Insurance Marketplace