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Health Insurance Cost Calculator
Open enrollment for 2027 coverage opens November 1, and the cheapest premium is usually not the cheapest plan. A low premium with a $4,000 deductible can cost more than a pricier plan once you actually need care, or it can save you thousands if you stay healthy. Enter both plans below and the ledger prices the full year: premiums plus everything you pay out of pocket, with the exact bill amount where the winner flips.
Sources: KFF 2025 Employer Health Benefits Survey (family premium $26,993, worker share $6,850; single premium $9,325, worker share $1,440); IRS Revenue Procedure 2025-19 (2026 HSA and HDHP limits); CMS out-of-pocket ceilings for 2026 and 2027; HealthCare.gov open enrollment dates. Model: total yearly cost equals 12 times your monthly premium share, plus out-of-pocket costs computed as billed charges up to the deductible, then your coinsurance share above it, capped at the out-of-pocket maximum. Copays, out-of-network charges, prescription tiers, and HSA tax savings are excluded. This is an estimate for comparison, not insurance advice. Check your plan documents and network before enrolling.
Step 1 — Plan A: the low-premium plan
Defaults describe a high-deductible plan: $250 a month, $4,000 deductible, 20% coinsurance, $8,000 out-of-pocket max. Enter your share of the premium, not the full premium your employer pays. If your plan charges copays instead of coinsurance for office visits, the result will read slightly high; see the questions below.
Step 2 — Plan B: the higher-premium plan
Defaults describe a richer plan: $400 a month, $1,000 deductible, 20% coinsurance, $4,000 out-of-pocket max. The premium gap is $150 a month, or $1,800 a year, which Plan B must earn back in lower out-of-pocket costs before it wins.
Step 3 — Your expected medical bills
Use last year's explanation of benefits as your guide: add up the billed charges, not what you paid. A healthy year with one urgent-care visit and a prescription runs near $800. A year with a surgery or an emergency room visit runs past $12,000. The scenario table below prices all three, so you do not have to guess exactly right.
The itemized ledger at your bills
| Line item | Plan A | Plan B |
|---|
Every scenario, side by side
The same two plans at three bill levels, plus the worst case where both plans hit their out-of-pocket maximums. The worst case is the number that decides whether you can sleep at night on the cheap plan.
| Scenario | Billed charges | Plan A total | Plan B total | Cheaper |
|---|
Step 4 — Before you enroll, check these
One: is your doctor in network on both plans, and are your prescriptions on formulary? Two: does the low-premium plan qualify for a Health Savings Account, and does your employer seed it? Three: if you buy on the marketplace, have you updated your income, since the enhanced credits expired at the end of 2025? Four: is December 15 on your calendar, the deadline for January 1 coverage? The arithmetic above answers the cost question. These four checks answer the rest.
Health plan cost questions
- How do you compare two health plans fairly?
- Compare total yearly cost, not the monthly premium. Total cost equals 12 times your monthly premium share, plus what you pay out of pocket: your billed charges up to the deductible, then your coinsurance share above it, capped at the out-of-pocket maximum. At the calculator defaults, Plan B charges $1,800 a year more in premiums than Plan A, yet at $3,500 in billed charges Plan B still wins by $200, because its lower deductible saves $2,000 in out-of-pocket costs. Premium-only comparisons get this backwards.
- What is the break-even bill amount?
- The amount of billed medical charges at which the two plans cost exactly the same. At the defaults, the break-even is $3,250. Below $3,250 in bills, the low-premium Plan A wins; above it, the higher-premium Plan B wins. At $800 in bills Plan A wins by $1,800; at $12,000 in bills Plan B wins by $600. Your own break-even moves with every input, which is why the calculator recomputes it live.
- What counts toward the out-of-pocket maximum?
- For covered, in-network care: your deductible, your coinsurance, and your copays. Premiums do not count. The federal ceiling on that maximum for 2026 is $10,600 for one person and $21,200 for a family, rising to $12,000 and $24,000 in 2027. A plan may set its maximum lower than the ceiling, and most do: the calculator defaults use $8,000 and $4,000.
- What does this calculator leave out?
- Copays, out-of-network charges, prescription drug tiers, and any employer HSA contribution. It also ignores networks and drug formularies, which can matter more than the arithmetic: a cheap plan that excludes your doctor is not cheap. Treat the result as the cost comparison, then check the network, the drug list, and the plan documents before you enroll. This is an estimate, not insurance advice.
- When is open enrollment, and what changed for 2027?
- Marketplace open enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027 on HealthCare.gov, and December 15, 2026 is the deadline for coverage starting January 1, 2027. The enhanced premium tax credits from the pandemic years expired December 31, 2025, so households that qualified for extra help before may pay more now. KFF found a median proposed 2027 premium increase of 15% across marketplace insurers. Do not let last year's plan renew without checking it.