Compare two health plans over a full year and find the break-even point
The allowed amount of care you expect to run through the deductible: labs, imaging, procedures, hospital care. Don't count visits and prescriptions already covered by the flat copay fields above.
Educational comparison, not insurance advice. Check each plan's summary of benefits, networks, and drug tiers before choosing.
| Term | What it means | Typical 2025 range |
|---|---|---|
| Deductible | You pay 100% of allowed costs until your spending reaches this amount | ~$1,800 avg employer single plan; ~$5,000 avg marketplace silver |
| Copay | Flat fee per visit or prescription, often owed even before the deductible | $20 to $60 per office visit |
| Coinsurance | Your percentage share of costs after the deductible is met | 10% to 40%, most often 20% |
| Out-of-pocket maximum | Annual cap on your cost sharing; the plan pays 100% beyond it | 2025 marketplace cap: $9,200 single / $18,400 family |
| HDHP minimum deductible | IRS floor a plan must meet to qualify for an HSA | $1,650 single / $3,300 family (2025) |
| HSA contribution limit | Pre-tax dollars you can bank each year while on an HDHP | $4,300 single / $8,550 family (2025) |
| Expected expenses | Plan A (HDHP) total | Plan B (copay plan) total | Cheaper plan |
|---|---|---|---|
| $1,000 | $5,200 | $7,640 | Plan A by $2,440 |
| $4,000 | $7,640 | $8,240 | Plan A by $600 |
| $10,000 | $8,840 | $9,440 | Plan A by $600 |
| $30,000 | $12,200 | $11,240 | Plan B by $960 |
Totals use the default plans above and include 12 months of premiums. Notice the pattern: the HDHP leads in cheap and moderate years, then loses once a truly expensive year pushes both plans to their out-of-pocket caps. For these two plans the flip happens near $22,000 of care.
Health plans charge you in two places: the premium you pay every month no matter what, and the cost sharing you pay when you actually get care. The deductible is the part you cover in full first. Copays are flat fees per visit that usually skip the deductible entirely. Coinsurance is the percentage you keep paying after the deductible, and the out-of-pocket maximum is the ceiling on all of it. Low premiums almost always travel with high deductibles, which is exactly why plan shopping feels like a trap.
Each plan's yearly cost is 12 times the monthly premium plus what you pay out of pocket. Out of pocket equals copays, plus the portion of expenses that goes to the deductible, plus coinsurance on whatever's left, all capped at the plan's out-of-pocket maximum. The calculator also scans expense levels from $0 to $100,000 in $100 steps to find where the cheaper plan flips.
Pull each plan's premium, deductible, coinsurance, and out-of-pocket max straight from its summary of benefits. Put the flat fees you expect to pay anyway (office visits, prescription copays) in the copay field. Then estimate your annual medical expenses and try a low, medium, and high figure. The break-even line tells you how bad a year would have to get before the richer plan earns its premium.
Take the defaults: an HDHP at $350 a month with a $3,300 deductible, 20% coinsurance, and an $8,000 cap, versus a copay plan at $520 a month with a $1,000 deductible, 20% coinsurance, a $5,000 cap, and $400 in copays. At $4,000 of care, the HDHP member pays the full $3,300 deductible plus 20% of the remaining $700, so $3,440 out of pocket and $7,640 total. The copay plan member pays $400 in copays, the $1,000 deductible, and 20% of $3,000, so $2,000 out of pocket but $8,240 total. The HDHP wins by $600 even though it felt worse at the doctor's office.
There's a hidden factor too: that HDHP qualifies for an HSA. In 2025 you can shelter $4,300 (single) or $8,550 (family) pre-tax, and many employers seed the account. Count the tax savings and the HDHP's lead usually grows by four figures.
A deductible is the amount you pay for covered care before your plan starts paying its share; with a $3,300 deductible, the first $3,300 of allowed charges is yours. A copay is a flat fee per service, usually $20 to $60 for an office visit, and on most plans you owe it whether or not you've met the deductible.
Usually not. On most plans the $30 you hand over at the front desk doesn't reduce your deductible, which only shrinks when you pay the full allowed cost for deductible-subject care like imaging or surgery. Copays do count toward the out-of-pocket maximum on ACA-compliant plans, so they fill a different bucket rather than being wasted.
It depends on how much care you use. With this page's default plans, the low-premium HDHP wins by $2,440 in a $1,000-expense year and by $600 at $4,000. The copay plan only pulls ahead past about $22,000 of care, where its lower $5,000 out-of-pocket max takes over. Healthy years favor low premiums; expensive years favor low deductibles and low caps.
Coinsurance is the percentage of each bill you keep paying after the deductible is met. At 20% coinsurance, a $10,000 hospital bill after a met deductible costs you $2,000 while the plan pays $8,000. It keeps running until you reach the out-of-pocket maximum, and after that the plan pays 100% for the rest of the year.
Yes. On ACA-compliant plans, copays, deductible payments, and coinsurance for in-network essential health benefits all count toward the out-of-pocket maximum, capped at $9,200 for single coverage in 2025 ($18,400 family). Premiums never count, and out-of-network care usually has a separate, higher cap or no cap at all.