Health Plan Total Cost Comparison Calculator
Health Plan Total Cost Comparison Result
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Full calculation and sourcesReview the equation, normalized inputs, assumptions, and version.
Versioned calculationFormula v1.0.0
Method
The entered values are normalized, validated, and passed to the versioned calculation.
Important boundary
This result is an estimate. Confirm important decisions against the relevant source or professional guidance.
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The result reflects the current inputs and selected workflow.
Calculated with the versioned 1.0.0 model.
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Method and test recordFormula v1.0.0
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- Publisher
- CalculatorGeek
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- Definition fixtures
- 1 configured scenarios
- Published examples
- 1 shown below
Recorded method
No tool-specific review method has been recorded.
These records describe the published model and reference tests. A test-case count is not a certification of every possible input or an independent specialist review. Editorial policy
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Method sources
Reference inputs and expected results
Up to 12 examples from the configured definition fixtures are shown. Expected values use the stated output units; invalid inputs are intended to be rejected.
| Case | Inputs | Expected result |
|---|---|---|
| Reference case | Market and currency: us; Expected in-network allowed medical spending: 5000 currency; Plan A annual employee premium: 3000 currency; Plan A deductible: 2000 currency; Plan A member coinsurance: 20 pct; Plan A expected copays: 0 currency; Plan A out-of-pocket maximum: 6000 currency; Plan A employer HSA/HRA funding: 1000 currency; Plan A employee HSA contribution: 2000 currency; Plan A assumed HSA tax-value rate: 25 pct; Plan B annual employee premium: 5000 currency; Plan B deductible: 1000 currency; Plan B member coinsurance: 10 pct; Plan B expected copays: 0 currency; Plan B out-of-pocket maximum: 4000 currency; Plan B employer HSA/HRA funding: 0 currency; Plan B employee HSA contribution: 0 currency; Plan B assumed HSA tax-value rate: 0 pct | Plan A modeled member cost sharing: 2600; Plan A modeled annual net cost: 4100; Plan B modeled member cost sharing: 1400; Plan B modeled annual net cost: 6400; Difference in modeled annual cost: 2300 (allowed numeric tolerance: 1.0E-6) |
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What this calculator answers
The lower premium is not automatically the lower-cost plan. This comparison adds employee premium and modeled cost sharing, then subtracts employer funding and the user-entered HSA tax value.
Compare two written US health-plan designs under the same allowed-spending scenario.
Method and calculation order
For each plan, the model applies the deductible, then coinsurance to remaining allowed spending, adds entered copays, caps member cost sharing at the entered out-of-pocket maximum, and combines that amount with premiums and funding.
Worked reference example
For 5,000 of allowed spending, Plan A with a 2,000 deductible and 20% coinsurance produces 2,600 of modeled cost sharing. After premium, employer funding and entered HSA tax value, its net annual cost is 4,100.
How to use the result
Run low-use, expected-use and high-use scenarios. Separately verify networks, formularies, prior authorization, embedded family deductibles, services outside the deductible and expenses that do not count toward the out-of-pocket maximum.
What the calculator cannot know
This simplified model cannot reproduce every service-specific copay, separate drug deductible, tier, family accumulator, network rule, balance bill, excluded care or employer tax treatment. The Summary of Benefits and Coverage and plan documents control.
Frequently asked questions
Does the cheaper modeled plan have better coverage?
Not necessarily. Cost, access, network, formulary and authorization rules are separate decisions.
Is HSA eligibility checked?
No. Enter an HSA contribution only after confirming eligibility and current limits.
Primary sources and review status
- CMS — Health insurance terms you should know
- CMS — Summary of Benefits and Coverage
- CMS — 2026 plan comparison tip sheet
Sources and model boundaries checked 2026-10-08. This new opportunity-map expansion has automated formula, fixture and source QA but has not been represented as human editorial review. Keep the route noindex until CalculatorGeek records a completed YMYL editorial review.