InsuranceCalculatorHub

Claim Cost Tool

Apply a deductible, coinsurance, an out-of-pocket maximum and a coverage limit to a claim to see what it would leave you paying.

Last reviewed

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Free · No sign-up · Runs in your browser

A policy does not pay a claim minus the deductible. Four separate mechanisms apply in a specific order, and each one operates on the result of the previous - which is why the answer is rarely what people assume.

This tool applies all four in the standard sequence for any claim size, and reports what each stage costs so the structure of the policy becomes visible before a claim rather than during one.

Your numbers

Results update as you type. Nothing is sent anywhere.

Enter zero if the policy has none.

Enter zero if the limit is far above any plausible claim.

Result

You pay

$3,800

Insurer pays

$11,200

Deductible applied
$1,000
Coinsurance share
$2,800
Above the limit
$0
Your share
25.33%
Insurer share
74.67%
Capped by
None

This is an estimate based on the values you entered. Actual premiums, coverage, eligibility and pricing vary by provider and by individual circumstances.

Order of operations matters: the deductible comes off first, coinsurance applies to what remains, and any amount above the coverage limit stays with you.

Policy wording differs. Some policies apply the deductible per claim, others per year, and a few apply it per item.

How to use the claim cost tool

  1. Enter a claim size that is realistic for your situation.
  2. Enter the deductible and the coinsurance percentage.
  3. Enter the out-of-pocket maximum if the policy has one, and the coverage limit.
  4. Read your share, the insurer’s share, and which cap applied.

What people use this for

  • Understanding a policy before you need it.
  • Comparing two policies at a realistic claim size rather than at the premium.
  • Checking whether a coverage limit is adequate for a plausible bad case.
  • Working out the cash reserve a policy structure actually requires.

Worked examples

Every figure below is produced by running this calculator against the example inputs, so the numbers always match the tool.

Deductible then coinsurance

A $15,000 claim with a $1,000 deductible, 20% coinsurance and a $6,000 out-of-pocket maximum.

You pay
$3,800
Insurer pays
$11,200
Coinsurance share
$2,800

A claim above the coverage limit

A $75,000 claim with a $1,000 deductible, no coinsurance, and a $40,000 limit.

You pay
$35,000
Above the limit
$34,000
Capped by
Coverage limit

Order of operations

The deductible comes off first. Coinsurance applies to what remains, not to the original claim - so 20% coinsurance on a $15,000 claim with a $1,000 deductible is 20% of $14,000.

An out-of-pocket maximum then caps your total, where the policy has one. Anything above the coverage limit is added back to your share and no cap protects against it.

The limit is the exposure worth checking

A deductible is a known, budgetable number. An amount above a coverage limit is uncapped, and it is the failure mode with genuinely unbounded consequences.

Checking the limit against a plausible worst case is worth more than optimising the deductible by a few hundred dollars - and it is the check least often made.

Methodology and assumptions

What this calculator does, and what it deliberately does not do.

  • Deductible first, then coinsurance on the remainder, then any excess above the coverage limit, then the out-of-pocket maximum where no limit excess applies.
  • Policy wording governs. Some policies apply the deductible per claim, some per year and some per item.
  • All figures are estimates produced from the values you enter. This site has no rate feed and no carrier data, so it cannot quote or price a policy.
  • Nothing you type is transmitted or stored - the calculation runs entirely inside your browser.

This calculator provides an estimate based on the information you enter. Actual insurance premiums, coverage, eligibility and pricing vary by provider and individual circumstances.

This website is not an insurance company, an insurance agency or a licensed broker. It does not sell insurance, does not provide insurance quotes, and is not authorised to give advice about which policy you should buy.

No result produced here is an offer of insurance or a guarantee of coverage. Only a licensed insurer or agent, working from your verified details, can quote or bind a policy.

Frequently asked questions

Which policies have an out-of-pocket maximum?

Health policies routinely do. Property and auto policies usually do not, which means the deductible applies in full to each separate claim.

What happens above the coverage limit?

The insurer stops paying and the remainder is yours, regardless of any other cap in the policy.

Is coinsurance the same as a copayment?

No. A copayment is a fixed amount per service; coinsurance is a percentage of the remaining cost.

Will my insurer calculate it this way?

This is the standard sequence, but your policy wording controls. Use this to understand the mechanics and to ask precise questions.

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