Tool

Total cost of care calculator

Pull the numbers off your plan's Summary of Benefits and your typical year of doctor visits + prescriptions. We'll show what the year actually costs — premium, deductible, copays, and drugs combined, capped at the plan OOP max.

Plan cost-share

From the plan's Summary of Benefits.

Monthly premium ($)

Annual deductible ($)

Primary care visit copay ($)

Specialist visit copay ($)

Out-of-pocket maximum ($)

Inpatient hospital copay per day ($)

Your typical year

How much you actually use the plan.

Primary care visits per year

Specialist visits per year

Annual prescription cost (your share, $)

Estimate: 30-day copay × 12 × number of regular meds. Capped at $2,100 by the IRA in 2026.

Inpatient hospital stays per year

Most years this is 0. Set to 1 to model what a hospital stay would cost.

Avg days per stay

Estimated annual total

$670/ year

About $56 per month, all-in.

+Premium $0
+Medical $70
+Drugs $600

What this excludes: out-of-network care (most MA plans charge way more for this), services that require prior authorization that's denied, dental / vision / hearing unless specifically covered as extras, and IRMAA premium surcharges for higher-income beneficiaries.

Where we're generous: we apply the OOP cap to all medical spending in this calculator. In reality, plans differentiate in-network / out-of-network OOP caps, and Original Medicare has no OOP cap at all — Medigap is what fills that gap.

For real numbers: compare specific WI plans through our Medicare questionnaire, which uses the plan's real cost-share fields and your prescription list to give a per-plan annual cost.