Tested Templates & Toolstested before it ships

● Free tool · health costs

Medical bill calculator: what you should owe after your deductible and coinsurance

Enter your plan's deductible, coinsurance and out-of-pocket maximum, then each claim from your Explanation of Benefits in date order. See what you should owe on each one, how much of your deductible and out-of-pocket maximum is left, and which bills don't match.

✓ TestedSame calculation as the tested spreadsheet

Claims in date order. Allowed = the plan's allowed amount on the EOB, not the provider's list price. Leave Billed empty if you have no bill yet.

You should owe on these claims–
Deductible still to go
Out-of-pocket max still to go
Total allowed / your plan paid
Bills that don't match
Overbilled by
ClaimYou oweBilled − owe

Rules, as on most plans: a Deductible-type claim is yours until the deductible is met, then your coinsurance share of the rest. A copay counts toward the out-of-pocket maximum but not the deductible. Preventive care is covered in full. Once the out-of-pocket maximum is reached you owe nothing more for covered, in-network care. Some plans differ (for example copays that apply only after the deductible): check your plan's documents before disputing a bill.

How it works

Claims are processed in date order, the way your insurer does it. On a claim that goes toward the deductible, you pay the plan's allowed amount until the deductible is met, then your coinsurance share of the rest. A copay counts toward the out-of-pocket maximum but not the deductible, preventive care is free, and once you reach the out-of-pocket maximum you owe nothing more for covered care. In the example, seven claims with $12,900 allowed on a $3,000 deductible, 20% coinsurance plan come to $4,932 you should owe. The lab bill asks for $310 when $62 is due, because it was billed at the full allowed amount after the deductible was already met. The spreadsheet tracks up to 200 claims for the year and which ones you have paid.

Worked examples