Health Insurance Cost Estimator Example | Insurance Help

Research and Process Navigation →

About this example: A client suddenly had to choose a new health insurance plan after their carrier left the state. The plans, premiums, and copay structures were available, but making sense of them felt impossible. I researched the options, built this estimator, and walked through the results together so the decision felt clear, not stressful. Note: Plan details vary by state and year. This reflects one customer's specific options at a point in time.

Your Expected Usage This Year

Specialist Visits

Hospital Stays

Number of stays

Billed per stay ($)

Generic Drug Fills / month

Outpatient Surgery / Procedure

Number of procedures

Billed per procedure ($)

Preferred Drug Fills / month

Specialty Drug Fills / month

Out-of-network providers are not covered under any of these plans. Specialist copays and drug costs do not count toward the deductible.

Estimated Annual Cost by Plan

Annual premium + copays + your share of medical costs, capped at each plan's out-of-pocket maximum.

Cost Comparison

Plan Details

Premiums, Deductibles & Out-of-Pocket Maximums

Item	Bronze Preferred	Silver Select Extra	Silver	Gold
Monthly Premium	$864.57	$1,211.57	$1,110.67	$1,409.44
Annual Premium	$10,374.84	$14,538.84	$13,328.04	$16,913.28
Deductible	$7,500	$6,000	$5,800	$2,000
Out-of-Pocket Maximum	$10,000	$8,900	$7,650	$8,200

Copays & Coinsurance Rates

Service	Bronze Preferred	Silver Select Extra	Silver	Gold
Primary Care	$50	$40	$60	$30
Specialist	$100	$80	$110	$60
Urgent Care	$75	$60	$45	$45
Emergency Room	50% after ded.	40% after ded.	35% after ded.	25% after ded.
Hospital Stay	50% after ded.	—	35% after ded.	25% after ded.
Outpatient Surgery	50% after ded.	—	35% after ded.	25% after ded.
Diagnostic / Imaging	50% after ded.	40% after ded.	35% after ded.	25% after ded.
Mental Health	$50 copay	—	$60 copay	30% after ded.
Rehabilitation	$50 copay	—	35% after ded.	30% after ded.

Drug Costs (30-day supply)

Drug Type	Bronze Preferred	Silver Select Extra	Silver	Gold
Generic (Tier 1)	$25	$4	—	$15
Non-preferred Generic	—	$20	—	—
Preferred Brand (Tier 3)	$100	—	$100	$30
Non-preferred Brand (Tier 4)	$300	—	$150	$60
Specialty (Tier 5)	$500	40%	—	$250