Out-of-pocket cost estimator
This free estimator shows roughly what you might owe for a medical procedure once insurance is applied. Enter the procedure price plus your deductible remaining, coinsurance percentage and out-of-pocket maximum remaining. It pays the price toward your deductible first, then your coinsurance share of the remainder, capped at your out-of-pocket maximum. It runs entirely in your browser with no sign-up and nothing sent to a server. It is a simplified educational estimate, not a quote.
How the estimate is calculated
The formula mirrors a common insurance design: amount toward deductible = min(price, deductible remaining); coinsurance = (price − deductible portion) × coinsurance %; you pay = min(deductible portion + coinsurance, out-of-pocket maximum remaining). The result updates as you type, and your inputs never leave your device.
Important limitations
Real plans are more complex than this model. They may use fixed copays, separate accumulators for facility and professional charges, different in- and out-of-network rules, and benefit exclusions. Use this tool to build intuition, then rely on your insurer’s Summary of Benefits and Coverage and the hospital’s good-faith estimate for an actual figure.
Frequently asked questions
How does the out-of-pocket estimator work?
It applies a typical insurance design: you pay the procedure price up to your remaining deductible, then a coinsurance percentage of the rest, and the total is capped at your remaining out-of-pocket maximum. Everything runs in your browser — nothing is sent to a server.
Is this the exact amount I will owe?
No. It is a simplified estimate for education only. Real plans add copays, separate facility and professional accumulators, network rules, and benefit exclusions. Always confirm with your insurer’s plan documents and the hospital’s good-faith estimate.
Where do I find these numbers?
Your deductible remaining, coinsurance percentage and out-of-pocket maximum are on your insurance card portal or Summary of Benefits and Coverage. For the procedure price, start from a hospital’s machine-readable file or its required good-faith estimate.
Disclaimer
This estimator is general information, not medical, insurance or financial advice. See our disclaimer. To compare procedure prices, browse our price comparisons.
Last updated: 2026-06-13