Free tool
Enter a medical bill, your remaining deductible, your coinsurance, any copay, and your remaining out-of-pocket maximum to see what you pay, what the plan pays, and how each piece gets there.
Built for Texas life and health exam prep and consumersUse the amount the plan allows, not the provider's list price.
Enter the bill and your plan details to see the split.
Deductibles, coinsurance, and stop-loss limits show up all over a life and health licensing exam - Encodr turns them into spaced-repetition review so they stay put.
Get started freeCost sharing runs in a fixed order. Any copay is paid first. You then pay the bill until your remaining deductible is used up. After that, you pay your coinsurance percentage of what's left and the plan pays the rest. Everything you pay counts toward your out-of-pocket maximum, and once you reach it the plan pays 100% of covered costs for the rest of the plan year. Exam materials sometimes call that cap a stop-loss limit.
Worked example: a $10,000 bill, $1,500 of deductible remaining, 20% coinsurance, no copay, and $5,000 left before the out-of-pocket maximum. You pay the $1,500 deductible, leaving $8,500. Your 20% of $8,500 is $1,700, so you pay $1,500 + $1,700 = $3,200 and the plan pays $6,800. On a $50,000 bill the same math gives $1,500 + $9,700 = $11,200, which is over the $5,000 cap - so you pay $5,000 and the plan pays $45,000.
Plans differ on copays: some copay services skip the deductible entirely, and some plans stack them. This calculator applies the copay first and runs the rest through the deductible and coinsurance, so check your plan's summary of benefits for a real bill. Studying for the license exam? See the Texas life and health exam deck and the exam pass score calculator.
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