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Use this tool to estimate your annual costs and make an informed decision about which medical plan is right for you.
Think about the amount of medical care you and any covered family members may need in the coming year. You can select a "Quick Scenario" using the dropdown menu(s) below. (For definitions of low, medium or high usage, please view these healthcare usage assumptions.) Or, you can create your own scenario under the "My own scenario" tab by customizing the frequency of each type of service. View the cost assumptions that were used.
See the impact of using your HSA |
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| A Health Savings Account (HSA) can help you save on taxes when paying for care and planning ahead for future expenses. | |||||||||||||||||||||||||||||||
| Apply available funding (including company funding) toward the cost of care. | I wish to apply available funding (including company funding) toward the cost of care. I do not wish to apply available funding (including company funding) toward the cost of care. | ||||||||||||||||||||||||||||||
| The maximum amount you can contribute is limited by the IRS. If you are 55 or older, check this box to allow up to an additional $1,000 in contributions. | |||||||||||||||||||||||||||||||
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Slide the bar to change your desired HSA contribution amount.
My desired HSA contribution: .
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Use this calculator to see the benefits of contributing to a tax-advantaged account. Select from the dropdown menu below.
Use the sliders above to estimate your eligible out‑of‑pocket medical expenses for the upcoming plan year.
| Income tax filing status: | |
| Number of dependents: | |
Welcome to the Medical Plan Cost Estimator tool. The purpose of this tool is to assist you in choosing a medical plan and understanding the advantages of tax-free accounts by helping you estimate your annual medical expenses.
We respect your privacy. None of the information you use to calculate your out-of-pocket costs can be collected or tracked, including your expected annual medical care expenses. When you navigate away from the Medical Plan Cost Estimator tool, your information is automatically discarded. You can print your selections and criteria from the Medical Plan Cost Estimator tool. Please keep your printouts secure and use caution when printing to shared printers.
By using this tool, you are automatically agreeing that you understand and accept the following:
Estimates are based on national average medical costs. Because costs can vary by provider and not all service details are included, actual costs may differ from what is shown in the Medical Plan Cost Estimator. Actual costs may also vary based on the order in which services are incurred and by the specific family member using a service (if applicable). In the event of any contradiction between the information contained in this tool and the Plan Documents, the Plan Documents shall govern in all cases.
If you do not accept these terms, you will not be able to access the site.
This tool is designed to help you choose the medical plan that is right for you in two easy steps:
Then, you'll be able to see an estimate of what you'll spend annually for the upcoming year under each medical plan option. You can also use the Health Savings Account (if you elect the PPO/HSA Plan) section to consider how much you should contribute on a pre-tax basis to cover your expected medical expenses.
Optimal Viewing
This tool is designed for optimal performance in Internet Explorer 9 and later, and recent versions of Mozilla Firefox and Google Chrome. If you are using an earlier version or a web browser not listed, you may experience errors or be unable to use the tool correctly. In this case, please access the tool again using one of the listed web browser versions.
For optimal viewing, set the screen resolution to 1024 x 768 or higher.
The following cost assumptions were used in the tool:
| Routine physical / GYN exam (ages 18 to 39) |
$189 |
| Diagnosis / treatment office visit | $214 |
| Specialist office visit (minor problems) |
$167 |
| Blood test | $24 |
| X-ray | $129 |
| Emergency room visit | $2,701 |
| MRI scan | $1,241 |
| Two-day inpatient stay | $26,096 |
| Retail - generic prescription (30-day supply) |
$23 |
| Retail - preferred brand name prescription (30-day supply) |
$1,146 |
| Mail order - preferred brand name prescription (90-day supply) |
$5,570 |
Please note that the estimates are based on average healthcare costs. Because costs can vary by provider and by region, your actual costs may differ from the national averages used by this Cost Estimator. In the event of any discrepancy between the information contained in this tool and official plan documents, the latter shall govern in all cases.
To qualify for favorable deductions, both of the following must be true for you:
A premium surcharge applies if any of the individuals use tobacco.
Example incentive #3
Low healthcare usage means that you and your family typically only use your medical coverage for preventive care (i.e., some lab tests and preventive prescription drugs) and one or two doctor visits a year.
Medium healthcare usage means that you and your family see the doctor a few times a year for an illness, an injury or a chronic condition and incur prescription drug costs.
High healthcare usage means that you and your family use your medical coverage to manage a complex condition, injury or procedure that requires a number of doctors' visits, prescription drugs on a regular basis and perhaps an inpatient hospital stay, including a birth (regular or Caesarean delivery).
