Tool
Family deductible simulator
Last reviewed · Educational use only
Add a year of claims for a family and watch each person's deductible and out-of-pocket meters fill. Switch between embedded and aggregate to see who starts paying coinsurance when.
Claims in the order they are processed
Amounts are allowed amounts for covered, in-network care subject to the deductible. Example family loaded.
#1
#2
#3
#4
#5
#6
#7
Family meters
Family
Deductible$4,000 / $4,000
Out-of-pocket$7,480 / $10,000
Parent A
Individual deductible$800 / $2,000
Individual OOP$1,600 / $5,000
Parent B
Individual deductible$1,200 / $2,000
Individual OOP$1,460 / $5,000
Child 1
Individual deductible$2,000 / $2,000
Individual OOP$4,300 / $5,000
Child 2
Individual deductible$0 / $2,000
Individual OOP$120 / $5,000
Ledger
| # | Member | Allowed | To deductible | Coinsurance | Family pays | Plan pays | What happened |
|---|---|---|---|---|---|---|---|
| 1 | Child 1 | $3,000.00 | $2,000.00 | $200.00 | $2,200.00 | $800.00 | Child 1 met individual deductible |
| 2 | Parent A | $800.00 | $800.00 | $0.00 | $800.00 | $0.00 | |
| 3 | Child 1 | $1,500.00 | $0.00 | $300.00 | $300.00 | $1,200.00 | |
| 4 | Parent B | $2,500.00 | $1,200.00 | $260.00 | $1,460.00 | $1,040.00 | Family deductible met |
| 5 | Child 2 | $600.00 | $0.00 | $120.00 | $120.00 | $480.00 | |
| 6 | Parent A | $4,000.00 | $0.00 | $800.00 | $800.00 | $3,200.00 | |
| 7 | Child 1 | $9,000.00 | $0.00 | $1,800.00 | $1,800.00 | $7,200.00 | |
| Total | $21,400.00 | $4,000.00 | $3,480.00 | $7,480.00 | $13,920.00 |
With an aggregate deductible instead, the same claims would cost the family $7,220.00 (less: $260.00 difference).