Out-of-Pocket Maximum Remaining Calculator

Track how close you are to your health plan's out-of-pocket limit and model an upcoming bill. The calculator separates what you still owe toward the cap from what the insurer will pay once the maximum is reached.

Your plan's out-of-pocket limit for the year.
Deductibles, coinsurance, and copays you've paid toward the maximum.
Defaults to $0. Add a bill to see how much hits the max and what the plan covers.

Benefits vary by plan. Confirm network rules, exclusions, and accumulator timing with your insurer before making payment decisions.

Examples

  • $9,000 max, $4,250 paid, $3,200 bill ⇒ Remaining toward max: $4,750.00 • Portion you pay from the upcoming bill: $3,200.00 • Plan covers (after max): $0.00 • Remaining before max: $1,550.00.
  • $8,700 max, $8,200 paid, $1,500 bill ⇒ Remaining toward max: $500.00 • Portion you pay from the upcoming bill: $500.00 • Plan covers (after max): $1,000.00 • Maximum reached after paying $500.00 of the upcoming bill.

FAQ

Should I include premiums?

No. Premiums do not count toward the out-of-pocket maximum—use only deductibles, copays, and coinsurance you've paid.

Does the maximum combine medical and pharmacy?

Many plans have a combined max; others separate medical and pharmacy. Use the appropriate maximum for the benefit you're modeling.

What if I expect multiple bills?

Run the calculator with the largest bill first. Once the remaining amount hits zero, additional covered costs should be paid by the plan for the rest of the year.

Additional Information

  • Remaining amount is capped at zero so you never see negative balances after the maximum is met.
  • Upcoming bill is optional; leave it blank to view the remaining maximum by itself.
  • All amounts are formatted in USD with two decimals to match typical explanation-of-benefits statements.

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