Be prepared for the ACA marketplace, or "Obamacare," open enrollment period for health insurance

Health Insurance Comparison Calculator

This calculator will help you compare the costs of different health insurance plan options. You can compare different options from your employer or different plans sold through the State Health Insurance Marketplace. You can also compare employer-sponsored options to Marketplace options.

Health Insurance Terms to Understand

  • Monthly premium: what you pay each month to have health insurance coverage – you pay these costs even if you never get medical care.
  • Annual deductible: the amount you must pay out-of-pocket each year before your health insurance policy kicks in.
  • Co-payment: a fixed dollar amount you pay each time you get certain types of medical care (e.g., office visit).
  • Co-insurance (aka cost-share): a percentage difference between what the insurance company pays for your medical expenses and what you pay.
  • Out-of-pocket maximum: a fixed dollar amount that represents the most you will have to pay for your covered medical expenses out of your own pocket. Once you reach your out-of-pocket maximum, your insurance pays 100% of your covered medical expenses for the rest of the year. Most insurance companies only count expenses towards the out-of-pocket maximum that are from in-network providers. Marketplace plans have out-of-pocket maximums that include co-payments, deductibles, co-insurance, and out-of-pocket prescription drug costs. Some employer plans may carve out deductibles from the plan’s out-of-pocket maximum. They may also have a separate out-of-pocket maximum and/or deductible for prescription drug costs.

How To Use The Calculator

Input the information about the plans you are considering below to get a sense of what your out-of-pocket costs will be for each plan, assuming you will reach your out-of-pocket maximum. Please keep in mind that this calculator provides an estimate that assumes that you are seeing in-network providers (e.g., doctors, hospitals, labs, pharmacies) for covered services. If you see an out-of-network provider or receive a service that your health insurance plan does not cover, you will likely have additional costs.

Document

About the Plans

Option #1

Type of Plan
Plan Type
Insurance Company Name:
Plan Name:
Is my primary care physician in the plans's network?
Are my hospitals and specialists (e.g., oncologist, surgeon) in the plan's network?
Are the prescription drugs I take covered by the plan?

Option #2

Type of Plan
Plan Type
Insurance Company Name:
Plan Name:
Is my primary care physician in the plans's network?
Are my hospitals and specialists (e.g., oncologist, surgeon)in the plan's network?
Are the prescription drugs I take covered by the plan?

Plan Costs

Option #1

Monthly Premium:
$
Deductible:
$
Out-of-pocket Maximum for an Individual:
$
Does your plan include deductibles in the out-of-pocket maximum?
Does your plan have a separate deductible and/or out-of-pocket maximum for prescription drugs?

Option #2

Monthly Premium:
$
Deductible:
$
Out-of-pocket Maximum for an Individual:
$
Does your plan include deductibles in the out-of-pocket maximum?
Does your plan have a separate deductible and/or out-of-pocket maximum for prescription drugs?

Results

Below is your total out-of-pocket cost for your in-network, covered, health care for the year, assuming health care expenses will reach the out-of-pocket maximum.

Option #1

Option #2

More information about choosing and using health insurance:

Last reviewed for updates: 05/2025

Disclaimer: This tool is intended to provide general information on the topics presented. It is provided with the understanding that Triage Cancer is not engaged in rendering any legal, medical, or professional services by its publication or distribution. Although this content was reviewed by a professional, it should not be used as a substitute for professional services. © Triage Cancer 2025

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