Worked cost examples
Illustrative numbers only, not real plan prices. Your plan's actual costs will differ.
| Plan A (Bronze-style) | Plan B (Gold-style) | |
|---|---|---|
| Monthly premium | $350 | $550 |
| Deductible | $7,000 | $1,500 |
| Coinsurance | 40% | 20% |
| Doctor copay | $60 after deductible | $25 |
| Out-of-pocket max | $9,000 | $6,000 |
Example 1: Healthy year (3 doctor visits at $150 each)
Plan A: premiums $4,200 + visits $450 (deductible not met, so you pay full price) = $4,650
Plan B: premiums $6,600 + 3 × $25 copays = $75, total $6,675
Plan B: premiums $6,600 + 3 × $25 copays = $75, total $6,675
➡️ In a light-use year, the low-premium plan wins by about $2,000.
Example 2: Outpatient surgery ($12,000 bill)
Plan A: $7,000 deductible + 40% × $5,000 = $2,000, so you owe $9,000, which equals the $9,000 out-of-pocket max. Plus premiums $4,200 = $13,200
Plan B: $1,500 deductible + 20% × $10,500 = $2,100, so you owe $3,600. Plus premiums $6,600 = $10,200
Plan B: $1,500 deductible + 20% × $10,500 = $2,100, so you owe $3,600. Plus premiums $6,600 = $10,200
➡️ With a big bill, the higher-premium plan saves about $3,000.
Example 3: Hospital stay ($80,000 bill)
Plan A: you pay the $9,000 out-of-pocket max + $4,200 premiums = $13,200
Plan B: you pay the $6,000 out-of-pocket max + $6,600 premiums = $12,600
Plan B: you pay the $6,000 out-of-pocket max + $6,600 premiums = $12,600
➡️ The out-of-pocket max protects you. Without insurance this would be $80,000.
Takeaway
Estimate your likely use, then compare premiums + expected costs and the worst case (premiums + out-of-pocket max). Try the Plan Picker.