Proton Therapy Insurance Gap Calculator

Prepare for proton therapy costs by blending your treatment quote with plan coverage rules. Enter the comprehensive cost, your post-deductible coverage percentage, and the deductible remaining to surface how much you will pay, how much the insurer covers, and whether the out-of-pocket maximum will cap your exposure.

Comprehensive proton therapy quote including facility, physician, and imaging charges.
Percentage your insurer pays on allowed charges once the deductible is met.
Portion of your annual deductible still unpaid before treatment begins.
Optional. Defaults to $9,100 if blank (2025 ACA individual cap). Enter remaining room before the plan pays 100%.
Optional. Defaults to $0. Used to highlight how much tax-advantaged cash can cover the patient share.

Outputs assume the treatment cost entered is fully authorised by your insurer and subject to a single coinsurance tier. Confirm benefits with your carrier before scheduling care.

Examples

  • $86,500 plan cost, 80% coverage, $3,200 deductible, $6,750 OOP max, $4,200 HSA ⇒ Patient responsibility after coverage: $6,750.00 USD • Insurer payment: $79,750.00 USD • Deductible applied during course: $3,200.00 USD • Coinsurance owed after deductible: $3,550.00 USD • HSA/FSA funds suggested: $4,200.00 USD • Coverage split — Insurer: 92.20%, Patient: 7.80% Out-of-pocket maximum reached; remaining authorised expenses assumed paid by the plan.
  • $52,000 plan cost, 70% coverage, $1,500 deductible, $25,000 OOP max, HSA blank ⇒ Patient responsibility after coverage: $16,650.00 USD • Insurer payment: $35,350.00 USD • Deductible applied during course: $1,500.00 USD • Coinsurance owed after deductible: $15,150.00 USD • HSA/FSA funds suggested: $0.00 USD • Coverage split — Insurer: 67.98%, Patient: 32.02% $8,350.00 USD of your out-of-pocket maximum remains after this course.

FAQ

What if the provider is out of network?

Enter the amount your plan considers allowed for out-of-network services and reduce the coverage percentage to match your policy's reimbursement rate for that tier.

Can I include travel or lodging stipends?

Add non-medical expenses to the treatment cost input so the calculator reflects the full budget you need to cover during therapy.

How do secondary insurance policies factor in?

First run the calculator with your primary plan. Then subtract the patient responsibility the secondary policy covers and rerun the calculation with the reduced deductible or coinsurance to isolate what remains.

Additional Information

  • Deductible dollars are charged before the plan begins sharing costs through coinsurance.
  • Proton therapy coverage percentages vary by diagnosis; verify pre-authorization to confirm the allowed amount the calculator should use.
  • ACA-compliant plans cap in-network out-of-pocket liability; leaving the field blank assumes the 2025 individual limit of $9,100.

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