CAR-T Therapy Out-of-Pocket Cost Planner

Forecast the cash you will need to cover a CAR-T cell therapy episode once deductibles, coinsurance, plan allowances, and travel logistics are factored in. Enter the billed charge, remaining deductible, and coinsurance rate, then optionally add the plan's allowed percentage, the out-of-pocket cap left for the year, and caregiver travel costs to see patient responsibility versus plan payment.

Total hospital and drug charges expected for the CAR-T admission.
Amount of deductible you still owe before the plan begins sharing costs.
Member share applied to allowed charges once the deductible is satisfied.
Defaults to 100% when blank. Lower numbers reflect plan allowable schedules for CAR-T codes.
Defaults to unlimited when blank. Enter the cap left before the plan pays 100% of allowed charges.
Defaults to $0 if blank. Add caregiver lodging, airfare, or per diem costs tied to treatment.

Insurance benefits vary by carrier, plan design, and network participation. Confirm coverage details with your insurer and treatment center before making financial decisions.

Examples

  • $480,000 charge, $3,500 deductible, 10% coinsurance, 85% allowed, $4,500 OOP cap, $2,800 travel ⇒ Patient cash requirement: $79,300.00 USD • Plan payment on allowed charges: $403,500.00 USD • Amount applied to deductible: $3,500.00 USD • Patient coinsurance after deductible: $40,450.00 USD • Uncovered balance above allowance: $72,000.00 USD • Travel & lodging add-on: $2,800.00 USD • Allowed percentage used: 85.00% • Coinsurance rate: 10.00% (out-of-pocket maximum hit)
  • $410,000 charge, deductible met, 20% coinsurance, plan allows 100%, $0 travel ⇒ Patient cash requirement: $0.00 USD • Plan payment on allowed charges: $410,000.00 USD • Amount applied to deductible: $0.00 USD • Patient coinsurance after deductible: $82,000.00 USD • Uncovered balance above allowance: $0.00 USD • Travel & lodging add-on: $0.00 USD • Allowed percentage used: 100.00% • Coinsurance rate: 20.00% (out-of-pocket maximum hit)

FAQ

Does the calculator include facility and physician fees?

Yes. Combine drug and hospital claims into the billed charge input so the tool can model the entire episode, including inpatient care.

How do prior authorizations change the result?

Prior authorizations influence whether the plan uses an in-network allowance. Update the allowed percentage to mirror the negotiated rate tied to an approved authorization.

Can I account for foundation grants or copay assistance?

Subtract external support from the deductible or travel fields before running the calculation so the remaining amounts reflect what you must fund personally.

What if my out-of-pocket maximum is already satisfied?

Set the remaining out-of-pocket maximum to 0. The calculator will shift allowed charges entirely to the plan while still showing any non-allowed balances and travel costs due.

Additional Information

  • Allowed percentage trims the billed charge to the plan allowance before deductibles and coinsurance are applied.
  • Out-of-pocket maximum applies only to allowed charges; any balance above the allowance remains the patient's responsibility.
  • Travel and lodging costs are added after insurance calculations to surface the full cash plan for the treatment journey.
  • Coinsurance defaults to the member share; enter 0% if your plan covers allowed charges in full once the deductible is met.

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