Tested Templates & Toolstested before it ships

● Free tool · open enrollment

Family health coverage calculator: my plan, my spouse's, or split?

Two jobs, two health plans. Enter both plans' premiums by tier, any spousal surcharge, deductibles and out-of-pocket maximums, and what you expect each person's care to cost. See what each way of covering the family costs for the year: everyone on one plan, everyone on the other, or split between them.

✓ TestedSame calculation as the tested spreadsheet

Expected care next year, before insurance (allowed amounts; include copays)

Cheapest for the year–
How to cover the familyPremiumsOut of pocketEmployer HSA/HRANet costWorst case

Premiums: the tier's monthly premium × 12, plus the spousal surcharge when the plan holder's spouse is on it. Care: each person pays toward the deductible up to the individual deductible (embedded), or everyone's bills count toward the family deductible (aggregate); with two or more people, deductible payments stop at the family deductible. Then coinsurance on the rest, up to each person's out-of-pocket maximum, with the family maximum as the cap. Net cost = premiums + care − employer HSA/HRA money. Worst case = premiums + out-of-pocket maximums − employer money. Not included: out-of-network care, the order bills arrive in, tax saved on premiums and HSA contributions.

How it works

When both parents can get coverage at work, there are four common ways to cover the family: everyone on one plan, everyone on the other, or one of two splits. Each way puts people in a different premium tier, and a spousal surcharge only applies when the plan holder's spouse is on the plan. For care, each person pays toward the deductible up to the individual amount on an embedded plan; on an aggregate plan, everyone's bills count toward one family deductible. Then coinsurance, up to each person's out-of-pocket maximum and the family maximum. In the example, everyone on the PPO costs $11,320 ($7,920 of premiums including the $1,200 surcharge, and $3,400 of care), but putting the spouse on the other job's HDHP drops the surcharge and the premiums to $5,280: $10,340 for the year after $750 of employer HSA money, even though care costs more.

Worked examples