Deductible vs Premium Breakeven Calculator — Rex's Toolbox

Rex says

Money math without the spreadsheet headache. Plug in your numbers and I'll show you exactly where the dollars land.

Try a scenario

Click to load — tweak from there.

Inputs

Plan A monthly premium($)

Plan A deductible($)

Plan A out-of-pocket max($)

Plan A coinsurance after deductible(%)

Plan B monthly premium($)

Plan B deductible($)

Plan B out-of-pocket max($)

Plan B coinsurance after deductible(%)

Result

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

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How to use this

1Enter plan a monthly premium ($).
2Enter plan a deductible ($).
3Enter plan a out-of-pocket max ($).
4Enter plan a coinsurance after deductible (%).
5Enter plan b monthly premium ($).
6Enter plan b deductible ($).
7Enter plan b out-of-pocket max ($).
8Enter plan b coinsurance after deductible (%).
9Read your breakeven annual medical spend on the right — it updates as you type.
10Hit Share to keep the scenario or send it to someone.

About this calculator

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.

FormulaPlan cost = premium×12 + min(spend, deductible) + coinsurance×max(0, min(spend, oopMax)−deductible), capped so member share never exceeds (oopMax − deductible) + deductible.

Worked example

Using the values the calculator loads with:

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 %

Results

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

What each field means

Inputs

Plan A monthly premium ($): The plan a monthly premium used in the calculation, measured in $. Starts at 280 $ so you have a working example on load.
Plan A deductible ($): The plan a deductible used in the calculation, measured in $. Starts at 3000 $ so you have a working example on load.
Plan A out-of-pocket max ($): The plan a out-of-pocket max used in the calculation, measured in $. Starts at 6000 $ so you have a working example on load.
Plan A coinsurance after deductible (%): The plan a coinsurance after deductible used in the calculation, measured in %. Starts at 20 % so you have a working example on load. Accepted range: 0–100 %.
Plan B monthly premium ($): The plan b monthly premium used in the calculation, measured in $. Starts at 480 $ so you have a working example on load.
Plan B deductible ($): The plan b deductible used in the calculation, measured in $. Starts at 500 $ so you have a working example on load.
Plan B out-of-pocket max ($): The plan b out-of-pocket max used in the calculation, measured in $. Starts at 3000 $ so you have a working example on load.
Plan B coinsurance after deductible (%): The plan b coinsurance after deductible used in the calculation, measured in %. Starts at 10 % so you have a working example on load. Accepted range: 0–100 %.

Results

Breakeven annual medical spend: Returned as a money amount in US dollars and shown as the headline result. It recalculates instantly whenever you change an input, so you can compare scenarios without reloading.
Plan A annual premium: Returned as a money amount in US dollars. It recalculates instantly whenever you change an input, so you can compare scenarios without reloading.
Plan B annual premium: Returned as a money amount in US dollars. It recalculates instantly whenever you change an input, so you can compare scenarios without reloading.
Plan A worst-case total cost: Returned as a money amount in US dollars. It recalculates instantly whenever you change an input, so you can compare scenarios without reloading.
Plan B worst-case total cost: Returned as a money amount in US dollars. It recalculates instantly whenever you change an input, so you can compare scenarios without reloading.

FAQ

Which side of breakeven should I plan for?

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.

Does this include HSA tax savings?

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.

Why does worst-case cost matter more than average cost?

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.

Should family and individual deductibles be modeled separately?

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.

Accuracy and 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.

Related tools

HSA vs PPO Total Cost Calculator

Compare true after-tax cost of an HSA-eligible plan against a traditional PPO.

Out-of-Pocket Max Exposure Calculator

See your worst-case annual medical bill across deductible, coinsurance, and copays.

Cite this calculator

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APA

RevenueLab. (2026). Deductible vs Premium Breakeven Calculator. Retrieved from https://www.revenuelab.fyi/toolbox/deductible-vs-premium-breakeven

HTML

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Markdown

Source: [Deductible vs Premium Breakeven Calculator — RevenueLab](https://www.revenuelab.fyi/toolbox/deductible-vs-premium-breakeven) (2026).