InsuranceCoverageTools

Out-of-Pocket Estimator

Work out what a specific claim would actually cost you once the deductible, coinsurance, out-of-pocket maximum and coverage limit are applied.

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Free · No sign-up · Runs in your browser

A policy does not simply pay a claim minus the deductible. The deductible comes off first, coinsurance takes a share of what remains, an out-of-pocket maximum may cap your total, and anything above the coverage limit is yours regardless.

The order those apply in changes the answer substantially, and it is rarely explained on a quote. This estimator applies them in the standard sequence and shows what each stage costs.

Your numbers

Results update as you type. Nothing is sent anywhere.

Enter zero if the policy has no maximum.

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

Result

You pay

$3,600

Insurer pays

$8,400

Deductible applied
$1,500
Coinsurance share
$2,100
Amount above the limit
$0
Your share of the claim
30%
Insurer share of the claim
70%
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 out-of-pocket estimator

  1. Enter the size of the claim you want to model.
  2. Enter your deductible and your coinsurance percentage - the share of the remainder you pay.
  3. Enter your 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 a claim rather than during one.
  • Comparing two policies at a realistic claim size.
  • Deciding whether a coverage limit is high enough for the exposure.
  • Working out how much cash to hold against a plausible claim.

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 $12,000 claim with a $1,500 deductible, 20% coinsurance, a $6,000 out-of-pocket maximum and no limit issue.

You pay
$3,600
Insurer pays
$8,400
Coinsurance share
$2,100

A claim above the coverage limit

A $60,000 claim with a $1,500 deductible, no coinsurance, and a $30,000 coverage limit.

You pay
$30,000
Amount above the limit
$28,500
Capped by
Coverage limit

The order of operations

Deductible first: it comes off the claim before anything else. Coinsurance then applies to what remains, so a 20% coinsurance on a $12,000 claim with a $1,500 deductible is 20% of $10,500, not of $12,000.

The out-of-pocket maximum caps your total for the period, where the policy has one. The coverage limit caps what the insurer pays - and that excess falls on you no matter what any other cap says.

Where the real exposure usually is

For most people the deductible is the number they worry about and the coverage limit is the number that could actually hurt them. A deductible is a known, budgetable amount; an uncapped excess above a limit is not.

That is why checking the limit against a plausible worst case matters more than optimising the deductible by a few hundred dollars.

Methodology and assumptions

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

  • Deductible is applied first, coinsurance to the remainder, then any amount above the coverage limit is added to your share, then the out-of-pocket maximum is applied if one exists and no limit excess applies.
  • Policy wording varies. 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

What is coinsurance in this context?

The percentage of a covered claim you pay after the deductible. It is different from the property coinsurance clause, which is a penalty for insuring below a required value.

Do all policies have an out-of-pocket maximum?

Health policies normally do. Property and auto policies usually do not - which means the deductible applies to every separate claim.

What happens above the coverage limit?

The insurer stops paying and the remainder is yours. No out-of-pocket maximum protects against it.

Is this how my insurer will calculate my claim?

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

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