Immunotherapy Coinsurance Exposure Calculator

Model how much immunotherapy coinsurance will cost across an infusion regimen. Provide the allowed charge per infusion, your coinsurance percentage, and the number of cycles to surface total patient spend, insurer share, and the per-cycle average. Optional deductible and out-of-pocket remaining fields reveal when key thresholds are met or whether additional exposure remains.

Total allowed amount per infusion after network discounts.
Percentage you owe on the allowed amount after the deductible is met.
Number of infusions scheduled in the regimen.
Optional. Defaults to $0. Enter how much deductible is left before coinsurance applies.
Optional. Defaults to no cap if left blank. Enter what you still owe before your plan pays 100%.

Medical benefits vary by carrier and plan design. Confirm results with your insurer's cost estimator before scheduling treatment.

Examples

  • $28,500 per infusion, 20% coinsurance, 6 cycles, $1,200 deductible left, $4,500 out-of-pocket remaining ⇒ Total patient responsibility: $5,700.00 • Insurer-paid amount: $165,300.00 • Average patient cost per cycle: $950.00 • Deductible satisfied during cycle 1. • Out-of-pocket maximum reached by cycle 5.
  • $18,400 per infusion, 10% coinsurance, 8 cycles, no deductible remaining, OOP max blank ⇒ Total patient responsibility: $14,720.00 • Insurer-paid amount: $132,480.00 • Average patient cost per cycle: $1,840.00 • No deductible entered. • Plan did not reach the out-of-pocket maximum.

FAQ

Does the tool handle copay assistance cards?

Enter the portion you expect the manufacturer to cover as a reduced per-infusion charge so the coinsurance math reflects the copay assistance.

What if the regimen extends past the plan year?

Run separate scenarios for each plan year with the deductible and out-of-pocket resets to understand exposure if treatment crosses into a new benefit period.

Can I include facility fees billed separately?

Yes. Add facility and professional components together for the per-infusion charge so the result mirrors the full allowed amount that coinsurance applies to.

Does this cover oral immunotherapy drugs?

The calculator is geared to infusion billing. For oral specialty medications, pair the monthly cost with your pharmacy coinsurance schedule instead.

Additional Information

  • Coinsurance applies after any remaining deductible is met; the calculator subtracts the deductible amount first, then applies the coinsurance percentage to the rest of the allowed charge.
  • Out-of-pocket tracking stops patient costs once the remaining maximum is reached, shifting later cycles fully to the insurer.
  • Charges reflect the allowed amount, not the provider's list price. Obtain the negotiated rate from your insurer or infusion center.

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