What counts toward the out-of-pocket maximum?

Deductible payments, coinsurance, and copays for covered in-network services all count. Monthly premiums, out-of-network costs, and services not covered by your plan do not count toward the OOP max.

What is the difference between the deductible and the out-of-pocket maximum?

The deductible is the amount you pay before insurance starts sharing costs. The OOP max is the ceiling on everything you pay in a year — it includes the deductible plus all subsequent copays and coinsurance. Once the OOP max is reached, the insurer covers 100% of covered services.

Coinsurance is the percentage of a covered bill you pay after your deductible is met. With 20% coinsurance, you pay 20% and your insurer pays 80% until you reach the OOP maximum.

Does this calculator work for family plans?

Family plans have both individual and family deductibles and OOP maximums. Run this calculator once per family member (using individual limits) to track each person, or enter the family-level limits to track the household as a whole.

What is the "allowed amount" I should enter?

The allowed amount is the negotiated rate your insurer accepts for a service — shown on your Explanation of Benefits (EOB) as the "plan allowed amount" or "negotiated rate." It is usually less than what the provider originally billed.

Why might my actual bill differ from this estimate?

This calculator applies a single coinsurance rate to all bills. Real plans can have different cost-sharing rules for different service types (e.g., specialist vs. primary care, generic vs. brand drugs). Always verify with your EOB.

Out-of-Pocket Max Calculator

Name: Out-of-Pocket Max Calculator
Availability: InStock
Author: Nham Vu

Enter your plan limits and add medical bills to see your running total, remaining deductible, and how far you are from your out-of-pocket maximum.

Your Plan Settings

Annual Deductible ($)

Coinsurance Rate (%)

Your share after deductible (e.g. 20 means you pay 20%).

Out-of-Pocket Maximum ($)

Deductible Already Paid ($)

Amount paid toward deductible before these bills.

OOP Max Already Paid ($)

Total already counted toward OOP max this plan year.

Add a Medical Bill

Description (optional)

Allowed Amount ($)

Copay ($)

Total You Owe

$0.00

across all bills

Deductible Left

—

remaining this year

OOP Max Left

—

until insurer pays 100%

Insurance Covers

$0.00

across all bills

Out-of-Pocket Progress 0%

$0 of $0 met

Bill Breakdown

Description	Allowed	Copay	To Deductible	Coinsurance	You Owe	Ins. Pays
Total

Fill in your plan settings above, then add a bill to see your cost breakdown.

Summary