Health Insurance Cost Explorer
Follow a medical bill. Compare two plans. See how changing healthcare use changes what you pay.
HES100 • Fictional individual plans • One plan year • Covered, in-network care
Start here: what do these terms mean?
- Premium
- Payment for coverage, even when you receive no care. Annual premiums = monthly premium × 12.
- Deductible
- Amount you pay toward services subject to the deductible before the plan begins sharing those costs.
- Copay
- A fixed payment for a covered service. Whether the deductible applies depends on the plan.
- Coinsurance
- Your percentage of eligible costs after the applicable deductible. A 20% patient share means the plan pays the other 80%, until the maximum changes the split.
- Allowed amount
- The amount recognized by the plan for a service. This can differ from the provider's billed price.
- Out-of-pocket maximum
- A limit on eligible spending for covered, in-network care in the plan year. Premiums are separate.
Before changing the values, predict: how much of this bill will you pay? This service uses deductible then coinsurance, with no copay.
Same healthcare use under two plans
Predict which plan will cost less, then vary healthcare use. All amounts are fictional examples.
Rules used in this comparison
Both plans use fixed office-visit copays before the deductible. These copays count toward the out-of-pocket maximum, but do not reduce the deductible. Other medical expenses use the deductible, then patient coinsurance. Office visits are processed first, followed by the other medical expenses.
Office visits represent the visit copay only; additional tests or procedures belong in other medical expenses. The same allowed amounts apply to both plans. Actual plans can have different visit rules, allowed amounts, coverage, networks, or separate deductibles.
Model limits and research sources
This is a simplified teaching model, not a quote for a real plan. It excludes family coverage, out-of-network and noncovered care, separate drug deductibles, subsidies, employer contributions, and tax effects. Certain preventive services may be covered without cost sharing; they are not included in these charged visits.
The annual comparison begins with no deductible or eligible spending paid and 12 months of coverage. The single-bill view lets you explore spending already paid. The out-of-pocket limit does not include premiums or noncovered expenses. Provider access, benefits, and affordability matter alongside modeled cost.
- HealthCare.gov: Deductible (opens in new tab)
- HealthCare.gov: Coinsurance and allowed amounts (opens in new tab)
- HealthCare.gov: Out-of-pocket maximum (opens in new tab)
Sources reviewed October 2, 2026. Example values are illustrative, not market prices or statutory limits.