How Does Health Insurance Cover You?
Health insurance can divide eligible medical costs between you and your insurer. Your share is shaped by the deductible, coinsurance, and out-of-pocket maximum.
Use the simulator to follow those three stages and compare your estimated share with the amount an example health plan may pay.
This educational example assumes covered, in-network care and treats the selected amount as the plan-allowed cost. It excludes premiums, copays, prior authorization, non-covered services, and any spending already accumulated during the plan year.
Coverage Simulator
See How Health Insurance Shares an Eligible Medical Cost
$0
$100,000
Assumes this is the plan-allowed amount for covered, in-network care.
Deductible:
$2,500
Coinsurance:
20%
Out-of-Pocket Maximum:
$7,500
You Pay:
$7,500
Insurance Pays:
$42,500
Deductible Billed:
$2,500
Coinsurance Paid:
$5,000
Coinsurance Waived by Out-of-Pocket Maximum:
$4,500
Calculate Your Coverage
Ready to review estimated Marketplace pricing and savings based on your household?