Cochlear Implant Insurance Gap Calculator
Size the cash you will owe for a cochlear implant after your health plan pays its share. Provide the surgical quote and the percentage your insurer covers once the deductible is met, then optionally include any remaining deductible and out-of-pocket maximum to see the patient responsibility.
For planning only. Confirm benefits with your insurer and surgeon before scheduling.
Examples
- Quote $58,000, plan covers 80%, $1,500 deductible remaining, $4,500 OOP cap ⇒ patient cost $4,500.00 (capped by OOP maximum).
- Quote $42,000, plan covers 70%, no deductible remaining and no OOP cap provided ⇒ patient cost $12,600.00.
FAQ
What if my plan has a separate surgical deductible?
Enter the amount of the surgical deductible still owed in the Deductible Remaining field so the calculator includes it before applying coinsurance.
Does the tool consider bilateral implants?
Yes. Use the combined quote for both ears and adjust the coverage percentage if your insurer reimburses differently for the second implant.
How do manufacturer rebates or charity funds factor in?
Subtract expected third-party assistance from the procedure quote before running the calculation to avoid overstating your out-of-pocket amount.
Can I include travel or rehab expenses?
This tool isolates medical billing. Add travel, therapy, or processor upgrade costs separately to build a full financial plan.
Additional Information
- Patient responsibility equals any remaining deductible plus coinsurance on the balance, capped by the remaining out-of-pocket maximum if provided.
- Most commercial plans require preauthorisation; approvals can change the contracted amount. Update the quote when the negotiated rate arrives.
- Medicare Advantage and Medicaid managed care plans may have different deductibles and maximums—enter the values specific to your policy.
- Combine this gap estimate with HSA balances, FSAs, or medical payment plans to decide how to cover the surgery without surprises.