Health insurance makes more sense when you can see the math.
Understand what premiums, deductibles, copays, coinsurance and the out-of-pocket max actually do — then run a procedure through your own plan assumptions.
Premium
What you pay to keep coverage. It generally does not count toward your deductible or out-of-pocket max.
Deductible
What you pay for many covered services before the plan starts sharing more of the cost.
Copay / coinsurance
A copay is a fixed dollar amount. Coinsurance is a percentage of the plan’s allowed amount.
Out-of-pocket max
A ceiling on covered in-network cost sharing for the plan year. Premiums and many out-of-network/non-covered costs do not count.
Know which health-cost rule you are modeling.
HSA strategy, plan cost sharing and Medicare income surcharges solve different problems. These guides explain the rule before you put numbers into the simulator.
Medical cash needs, tax advantages and market risk
Read guide LearnHSA vs FSAEligibility, ownership, taxes and unused-balance rules
Read guide LearnDeductible vs Coinsurance vs Out-of-Pocket MaxHow health-plan cost sharing works together
Read guide LearnMedicare IRMAAHow income can raise Part B and Part D premiums
Read guideOut-of-pocket procedure simulator
Every number is editableChoose a sourced national benchmark as a starting point, then replace any number with your insurer or hospital estimate. The in-network allowed amount is what drives the model.
Sourced starting point · 2018 employer-plan claims
$7,595
Observed comparison range in the cited analysis: $4,655–$11,219
National average outpatient meniscus-repair cost was $7,595. Metro averages in the analysis included about $4,655 in Detroit and $11,219 in New York City.
Source: Peterson-KFF Health System TrackerEditable. Use the sourced benchmark to explore, but your insurer's allowed amount or hospital price estimate is more relevant to your actual bill.
Leave at $0 if your plan uses deductible + coinsurance without a separate copay.
Estimated patient share
$3,519
for outpatient knee meniscus surgery
Allowed amount
$7,595
Plan pays, modeled
$4,076
Remaining deductible
$2,500
Remaining OOP room
$6,200
What does “pre-tax health care” save?
Employer health premiums, HSA payroll contributions and FSA salary reductions can lower taxable wages when the arrangement qualifies. Enter your own marginal rates for a rough savings estimate.
2026 IRS HSA limit: $4,400 before applicable catch-up contributions. Source ↗
Total HSA contributions from you and your employer generally share the annual limit.
2026 IRS health FSA salary-reduction limit: $3,400. HSA eligibility generally conflicts with a general-purpose health FSA.
7.65% is a common employee FICA assumption below applicable wage limits; your actual treatment can differ.
Illustrative annual tax savings
$2,564
on $7,400 of modeled pre-tax health spending/contributions at a combined 34.65% assumed tax rate.
Benchmarks are a starting point. Your negotiated price is better.
MFA’s suggested amounts come from published claims analyses and are labeled with their data period. Health prices vary sharply by geography, facility and insurer, so do not treat a national benchmark as a quote. Ask your insurer for an in-network out-of-pocket estimate or allowed amount. CMS also requires hospitals to publish standard charges and consumer-friendly pricing for shoppable services.
MFA Takeaway
The deductible is only one piece of the bill.
Your real exposure depends on what the plan recognizes as the allowed amount, how much deductible you have left, the coinsurance or copay after that, and how close you already are to the out-of-pocket maximum.
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