Health Insurance Plan Comparison Lab

A deductible is the amount you pay for covered medical care each year before your insurance starts sharing costs. For example, with a $1,500 deductible, you pay the first $1,500 of covered bills yourself; after that, coinsurance kicks in. KFF's 2025 Employer Health Benefits Survey put the average annual deductible for single coverage at $1,644. Preventive services required under the Affordable Care Act are typically covered before the deductible.

Coinsurance is a percentage of the bill you pay after meeting your deductible — for example 20% coinsurance on a $1,000 covered charge means you pay $200. A copay is a fixed dollar amount per service, such as $30 per primary-care visit. KFF's 2025 survey found average hospital coinsurance of 20% and an average hospital-admission copay of $311. Many plans use copays for office visits and coinsurance for hospital care.

The out-of-pocket maximum (OOP max) caps what you pay in a year for covered services — deductibles, coinsurance, and usually copays. Once you hit it, the plan pays 100% of covered costs for the rest of the year. Monthly premiums do NOT count toward the OOP max, and out-of-network care often doesn't either. KFF's 2025 survey found 18% of covered workers face an OOP max of $6,000 or more.

Compare the full annual cost, not just the premium: 12 months of premiums plus your expected out-of-pocket spending (deductible + coinsurance + copays), capped by each plan's out-of-pocket maximum. The Plan Comparator tab does this math for two plans at any spending level, and the Monte Carlo tab shows the range of possible outcomes. Enter the exact numbers from your plans' Summary of Benefits and Coverage documents — sample numbers are only examples.

It depends entirely on your medical spending and the plan details — there is no universal answer, and this tool does not declare a winner for your situation. High-deductible health plans (HDHPs) usually have lower premiums and higher deductibles; PPOs usually have higher premiums and lower deductibles. Run both plans through the comparator at several spending levels (low, medium, high), check the break-even tab, and — for HDHPs — subtract HSA tax savings in the HSA tab before judging.

For 2026, the IRS allows $4,400 for self-only HDHP coverage and $8,750 for family HDHP coverage (IRS Revenue Procedure 2025-19). If you are 55 or older and not on Medicare, you can add a $1,000 catch-up contribution. Employer contributions count toward the same limit — they are not extra on top of it. A plan only qualifies as HSA-eligible if its 2026 deductible is at least $1,700 self-only / $3,400 family and its out-of-pocket max does not exceed $8,500 / $17,000.

A Health Savings Account is triple-tax advantaged: contributions are pre-tax (or tax-deductible), growth is tax-free, and withdrawals for qualified medical expenses are tax-free. Contributions made through payroll also skip Social Security and Medicare taxes (7.65%). The HSA tab estimates your savings as your contribution multiplied by your marginal tax rate (plus 7.65% if via payroll), then subtracts that — along with any employer seed money — from the HDHP's total cost.

The break-even point is the annual medical-spending level at which two plans cost exactly the same. Below it, one plan's estimated total is lower; above it, the other wins. The Break-Even tab solves for that spending level using your two plans' premiums, deductibles, coinsurance, and out-of-pocket maximums. Some plan pairs never cross — one simply costs less at every spending level — which the tool reports honestly.

There is no single 'good' number — a deductible is only good relative to its premium and your spending. For context: KFF's 2025 survey found the average single-coverage deductible was $1,644, and 2026 HSA-qualifying HDHPs must have deductibles of at least $1,700. A $3,000 deductible paired with a much lower premium and an HSA can beat a $500-deductible plan for a healthy person; for someone expecting surgery, the low deductible usually wins. Compare total annual cost, not the deductible alone.

Family plans commonly double the individual deductible and out-of-pocket maximum (for example, $3,000 / $6,000), which is the simplified model this tool uses. Real plans vary: 'embedded' designs cap each person's spending at the individual amount, while 'aggregate' designs require the whole family to meet the combined deductible first. Check your plan document to see which design applies, because it changes the math for families with one high-spending member.

Under the Affordable Care Act, most plans must cover a set of preventive services — annual checkups, vaccinations, many screenings — with no cost sharing, even before you meet your deductible. That is why the calculator treats office-visit copays as optional inputs rather than assuming every visit costs you money. Confirm which services your specific plan classifies as preventive, since plan documents define the list.

Often the low-premium plan does have the lowest estimated total for light users, and the Monte Carlo tab's 'low utilizer' profile will show that range — but the estimate assumes your health year stays uneventful. The out-of-pocket maximum exists precisely because one bad year (an ER visit, an appendectomy) can erase years of premium savings. Compare the worst-case column too, and discuss your risk comfort with a licensed benefits advisor.

Open enrollment is the once-a-year window (usually November–December for employer and marketplace plans) when you can choose or change coverage for the next year. The Checklist tab walks through the practical steps: gather both plans' Summary of Benefits and Coverage, list expected prescriptions and doctors (check networks!), estimate your visits, compare total annual cost — not just premiums — and confirm HSA eligibility and employer seed money before you submit.

Instead of guessing one spending number, the simulator draws thousands of possible annual medical bills from a lognormal distribution calibrated to three utilizer profiles (low: median $1,200; medium: median $3,500; high: median $9,000), then prices each draw through both plans' cost formulas. It reports the expected (mean) cost and the 10th, 50th, and 90th percentile outcomes per plan, plus how often each plan's estimated total came out lower. The random seed is shown so results are reproducible.

They are simplified illustrations, not quotes. The model assumes one deductible, one coinsurance rate, and flat copays; it does not handle tiered drug formularies, out-of-network balance billing, embedded family deductibles, separate prescription deductibles, or services your plan excludes. Always verify against your plan's Summary of Benefits and Coverage. The methodology section lists every assumption explicitly.

No. This tool provides educational estimates only. It does not recommend any plan, does not predict your health costs, and is not a substitute for a licensed insurance broker, benefits advisor, or medical professional. All calculations run locally in your browser — no data is sent anywhere — but the numbers you enter and the scenarios you choose are your responsibility to verify against official plan documents.