{
  "slug": "deductible-vs-premium-breakeven",
  "title": "Deductible vs Premium Breakeven Calculator",
  "heading": "Deductible vs Premium Breakeven Calculator",
  "category": "financial",
  "url": "https://www.revenuelab.fyi/toolbox/deductible-vs-premium-breakeven",
  "summary": "Find the medical spend level where a high-deductible plan beats a low-deductible plan.",
  "description": "Open enrollment usually offers at least two plan designs: a lower premium with a higher deductible, or a higher premium that buys down the deductible. The right choice depends entirely on how much care you expect to use. This calculator compares total annual cost — premium plus your share of claims up to the out-of-pocket max — across both plans at a given spend level, then solves for the breakeven point where the two plans cost the same. Below that spend level the high-deductible plan wins; above it, the richer plan wins. It accounts for coinsurance after the deductible is met and caps total exposure at each plan's out-of-pocket maximum, which most simple comparisons ignore. Use your expected annual medical spend — not just deductible size — to pick a plan, and rerun this after any major life change (surgery, pregnancy, new diagnosis) since a single high-cost year can flip the answer.",
  "formula": "Plan cost = premium×12 + min(spend, deductible) + coinsurance×max(0, min(spend, oopMax)−deductible), capped so member share never exceeds (oopMax − deductible) + deductible.",
  "dateModified": "2026-09-30",
  "run_url": "https://www.revenuelab.fyi/api/public/calc?tool=deductible-vs-premium-breakeven",
  "inputs": [
    {
      "id": "premiumA",
      "label": "Plan A monthly premium",
      "kind": "number",
      "hint": null,
      "default": 280,
      "unit": "$",
      "min": 0,
      "max": null
    },
    {
      "id": "deductibleA",
      "label": "Plan A deductible",
      "kind": "number",
      "hint": null,
      "default": 3000,
      "unit": "$",
      "min": 0,
      "max": null
    },
    {
      "id": "oopA",
      "label": "Plan A out-of-pocket max",
      "kind": "number",
      "hint": null,
      "default": 6000,
      "unit": "$",
      "min": 0,
      "max": null
    },
    {
      "id": "coinsA",
      "label": "Plan A coinsurance after deductible",
      "kind": "number",
      "hint": null,
      "default": 20,
      "unit": "%",
      "min": 0,
      "max": 100
    },
    {
      "id": "premiumB",
      "label": "Plan B monthly premium",
      "kind": "number",
      "hint": null,
      "default": 480,
      "unit": "$",
      "min": 0,
      "max": null
    },
    {
      "id": "deductibleB",
      "label": "Plan B deductible",
      "kind": "number",
      "hint": null,
      "default": 500,
      "unit": "$",
      "min": 0,
      "max": null
    },
    {
      "id": "oopB",
      "label": "Plan B out-of-pocket max",
      "kind": "number",
      "hint": null,
      "default": 3000,
      "unit": "$",
      "min": 0,
      "max": null
    },
    {
      "id": "coinsB",
      "label": "Plan B coinsurance after deductible",
      "kind": "number",
      "hint": null,
      "default": 10,
      "unit": "%",
      "min": 0,
      "max": 100
    }
  ],
  "outputs": [
    {
      "id": "breakeven",
      "label": "Breakeven annual medical spend",
      "format": "currency",
      "hint": null,
      "primary": true
    },
    {
      "id": "annualA",
      "label": "Plan A annual premium",
      "format": "currency",
      "hint": null,
      "primary": false
    },
    {
      "id": "annualB",
      "label": "Plan B annual premium",
      "format": "currency",
      "hint": null,
      "primary": false
    },
    {
      "id": "maxTotalA",
      "label": "Plan A worst-case total cost",
      "format": "currency",
      "hint": null,
      "primary": false
    },
    {
      "id": "maxTotalB",
      "label": "Plan B worst-case total cost",
      "format": "currency",
      "hint": null,
      "primary": false
    }
  ],
  "worked_example": {
    "inputs": [
      "Plan A monthly premium: 280 $",
      "Plan A deductible: 3000 $",
      "Plan A out-of-pocket max: 6000 $",
      "Plan A coinsurance after deductible: 20 %",
      "Plan B monthly premium: 480 $",
      "Plan B deductible: 500 $",
      "Plan B out-of-pocket max: 3000 $",
      "Plan B coinsurance after deductible: 10 %"
    ],
    "outputs": [
      "Breakeven annual medical spend: $3,750",
      "Plan A annual premium: $3,360",
      "Plan B annual premium: $5,760",
      "Plan A worst-case total cost: $9,360",
      "Plan B worst-case total cost: $8,760"
    ]
  },
  "how_to": {
    "title": "How to use this",
    "steps": [
      "Enter plan a monthly premium ($).",
      "Enter plan a deductible ($).",
      "Enter plan a out-of-pocket max ($).",
      "Enter plan a coinsurance after deductible (%).",
      "Enter plan b monthly premium ($).",
      "Enter plan b deductible ($).",
      "Enter plan b out-of-pocket max ($).",
      "Enter plan b coinsurance after deductible (%).",
      "Read your breakeven annual medical spend on the right — it updates as you type.",
      "Hit Share to keep the scenario or send it to someone."
    ]
  },
  "scenarios": [
    {
      "name": "Conservative",
      "description": "Lower-end numbers — what if things land soft?",
      "values": {
        "premiumA": 170,
        "deductibleA": 1800,
        "oopA": 3600,
        "coinsA": 10,
        "premiumB": 290,
        "deductibleB": 300,
        "oopB": 1800,
        "coinsB": 5
      }
    },
    {
      "name": "Typical",
      "description": "Defaults — the most common real-world setup.",
      "values": {
        "premiumA": 280,
        "deductibleA": 3000,
        "oopA": 6000,
        "coinsA": 20,
        "premiumB": 480,
        "deductibleB": 500,
        "oopB": 3000,
        "coinsB": 10
      }
    },
    {
      "name": "Ambitious",
      "description": "Higher-end numbers — what if things really pop?",
      "values": {
        "premiumA": 450,
        "deductibleA": 4800,
        "oopA": 9600,
        "coinsA": 30,
        "premiumB": 770,
        "deductibleB": 800,
        "oopB": 4800,
        "coinsB": 15
      }
    }
  ],
  "limitations": [
    "Results are estimates before tax, fees, and inflation unless an input explicitly covers them.",
    "Rates are treated as fixed for the whole period — variable-rate products will drift from this projection.",
    "This is educational maths, not financial advice. Check anything contractual with the lender or your accountant."
  ],
  "faq": [
    {
      "q": "Which side of breakeven should I plan for?",
      "a": "If you have a chronic condition, planned surgery, or a baby on the way, assume you'll blow past the breakeven and pick the richer plan. If you're healthy and see a doctor once a year, the high-deductible plan almost always wins on expected value, and pairs with an HSA for extra tax savings."
    },
    {
      "q": "Does this include HSA tax savings?",
      "a": "No — this compares raw premium and claims cost only. If Plan A is HSA-eligible, add your marginal tax rate times any HSA contribution as an extra discount on Plan A's effective cost, which shifts the breakeven point higher in Plan A's favor."
    },
    {
      "q": "Why does worst-case cost matter more than average cost?",
      "a": "Most years you'll spend near your deductible, but the tail risk is what breaks budgets. Comparing max total cost tells you the true downside if you get diagnosed with something serious mid-year, which is the scenario insurance exists for."
    },
    {
      "q": "Should family and individual deductibles be modeled separately?",
      "a": "Yes, ideally. Family plans often have both an embedded individual deductible and an aggregate family deductible, and one high-cost family member can satisfy the whole family deductible early. This tool assumes single-person or aggregate figures — run it twice for embedded designs."
    }
  ],
  "related": [
    "https://www.revenuelab.fyi/toolbox/hsa-vs-ppo-total-cost",
    "https://www.revenuelab.fyi/toolbox/out-of-pocket-max-exposure"
  ],
  "license": "CC-BY-4.0",
  "citation": "RevenueLab — Deductible vs Premium Breakeven Calculator (https://www.revenuelab.fyi/toolbox/deductible-vs-premium-breakeven)"
}