Insurance Deductible / Out-of-Pocket Calculator
See what you pay and what the insurer pays on a claim, using your own policy terms.
Insurance Deductible / Out-of-Pocket Calculator
You pay this first before the insurer shares costs.
Spent earlier in the policy year.
Share of the remaining cost you pay after the deductible.
Fixed amount you pay before coinsurance applies.
Maximum the insurer pays on this claim.
Cap on your deductible, copay and coinsurance.
You Pay
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Insurer Pays
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Your Share of the Claim
Who pays what
Split by Claim Size
Your claim scaled from 0.1× to 4× under the same policy terms. Red is your share, green is the insurer's.
| Claim size (₹) | You pay (₹) | Insurer pays (₹) | Your share | You vs insurer |
|---|
Assumptions & method
- Order of costs: you pay the unmet deductible first, then any fixed copayment, then your coinsurance share of what remains. The insurer pays the rest.
- Out-of-pocket maximum: if deductible + copay + coinsurance exceed the maximum, your cost sharing is capped at it and the insurer pays the difference. A value of 0 means no maximum.
- Coverage limit: the insurer pays at most the limit for this claim. Anything above it is paid by you and does not count toward the out-of-pocket maximum. A value of 0 means no limit.
- Each row in the table is a separate single claim with the same deductible already met. It does not model several claims in one year.
- Premiums, non-covered services, network rules, waiting periods and sub-limits are not included. Actual policies differ, so use the terms in your policy document.
Results are estimates based on the figures you enter. They are not guarantees and not financial advice.
How do deductibles, copays and coinsurance work together?
A deductible is the amount you cover before the insurer starts sharing costs. After it, coinsurance splits the remaining bill by percentage, and a copayment is a flat fee for a service or claim. Many policies add an out-of-pocket maximum that stops your cost sharing at a cap, and a coverage limit that caps what the insurer will pay. This calculator applies those pieces in a clear order using the numbers you give it, then repeats the calculation for smaller and larger claims. The table shows why small claims often fall mostly on you, while large claims hit the out-of-pocket maximum and flip the balance toward the insurer, until a coverage limit puts the excess back on you.