DeductibleTools

Deductible & Out-of-Pocket Calculator

Apply a deductible, coinsurance, an out-of-pocket maximum and a coverage limit to a specific claim to see what you would actually pay.

Last reviewed

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Free · No sign-up · Runs in your browser

People plan for the deductible and are surprised by everything after it. A policy applies the deductible first, then takes a coinsurance share of what remains, then stops paying entirely above the coverage limit - and only some policies cap your total with an out-of-pocket maximum.

This calculator applies all four in the standard sequence for a claim size you choose, and shows how much each stage costs you.

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

$5,600

Insurer pays

$14,400

Deductible applied
$2,000
Coinsurance share
$3,600
Above the limit
$0
Your share of the claim
28%
Insurer share
72%
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 deductible & out-of-pocket calculator

  1. Enter a claim size that is realistic for your situation - a plausible bad case rather than the worst imaginable.
  2. Enter the deductible and the coinsurance percentage from your policy.
  3. Enter the out-of-pocket maximum if there is one, and the coverage limit.
  4. Read your share, the insurer’s share, and which cap actually applied.

What people use this for

  • Understanding a policy before a claim rather than during one.
  • Deciding whether a coverage limit is adequate for a plausible bad case.
  • Comparing two policies at a realistic claim size rather than at the premium.
  • 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 plus coinsurance

A $20,000 claim with a $2,000 deductible, 20% coinsurance and a $7,500 out-of-pocket maximum.

You pay
$5,600
Insurer pays
$14,400
Capped by
None

A claim above the limit

A $90,000 claim with a $2,000 deductible, no coinsurance, and a $50,000 coverage limit.

You pay
$40,000
Above the limit
$38,000
Your share of the claim
44.44%

The sequence is what people get wrong

Coinsurance applies to what remains after the deductible, not to the whole claim. On a $20,000 claim with a $2,000 deductible and 20% coinsurance, the coinsurance share is 20% of $18,000, not of $20,000 - a $400 difference in this example, and much larger on bigger claims.

The out-of-pocket maximum then caps your total, where one exists. Property and auto policies usually do not have one, which is why a per-claim deductible on those lines applies in full to every separate loss.

The limit is the exposure that matters

A deductible is a known, budgetable number. An amount above a coverage limit is neither: it is uncapped, and no out-of-pocket maximum protects against it.

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 people are least likely to make.

Methodology and assumptions

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

  • Deductible first, coinsurance on the remainder, any excess above the coverage limit added to your share, then the out-of-pocket maximum applied where no limit excess exists.
  • 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

Is coinsurance the same as a copayment?

No. A copayment is a fixed amount per service; coinsurance is a percentage of the remaining cost. Health policies often use both.

Do property policies have out-of-pocket maximums?

Rarely. They are standard on health policies and unusual elsewhere, which means the deductible applies in full to each separate property claim.

What if the claim is smaller than my deductible?

The insurer pays nothing and you cover it all. Reporting such a claim is usually counterproductive, since it can appear on your claims history with no benefit.

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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