7 / 10
Your plan this year
Premium$400 / month
Deductible$2,000
Primary care copay$30
Coinsurance20%
Out-of-pocket max$6,000
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Situation 7 · Budgeting
You want to know the most this plan could cost you in one year, assuming everything is covered and in network.
What is the real ceiling?
Correct!
Not quite.
Add two numbers: the out-of-pocket maximum and a full year of premiums. $6,000 plus $4,800 is $10,800. The deductible is not added on top, because it is already counted inside the out-of-pocket maximum. This total is the fairest single figure for comparing two plans. A plan with a low premium and a very high out-of-pocket maximum can have a worse ceiling than one that looks more expensive each month.