How to use the personal cost calculator

The cost calculator draws on information about what patients with commercial insurance have paid across the state to estimate what you may pay for this procedure, taking into account the terms of your insurance coverage. 

Go to the Cost Calculator Using the Link "Estimate What You Might Pay" while you are looking at a procedure

Change the amounts in the boxes if you know your insurance coverage. Your insurance coverage – and what you might pay -- can differ a lot from these estimates.

You Might Pay Estimate: this cost estimate gives you a start in seeing how much it could cost you for the medical service you selected. Your actual cost will be different – the price and your share of it depends on your insurance coverage and even on the doctor, hospital, or other provider.

Though many people have insurance coverage similar to the amounts listed here, there are thousands of insurance products with very large differences in the amounts people pay when getting care.

The steps in calculating this cost estimate:

  • Estimated Cost: This cost estimate starts with the typical price for the medical service at the healthcare facility or in the area you selected. The price has been adjusted, using an inflation factor, to estimate the amount paid in this current year.  Then, your share of the price is estimated by applying typical insurance coverage amounts in Washington.
  • Deductible: the deductible ($2,500) is the amount the patient pays before the insurance coverage begins for any yearly coverage period.  Change this amount if you know your deductible.
  • Co-insurance: the co-insurance (20%) is the share of the cost that the patient pays.  For example, if a doctor office visit is $100 then the patient pays $20 and the health insurer pays $80. Remember, the co-insurance applies after a patient pays for all medical care costs up to the deductible amount.  Change this amount if you know your co-insurance.
  • Co-pay: for some insurance plans, the patient pays a flat dollar amount for certain medical service – like $20 for each doctor visit or prescription.  Enter a co-pay amount if you have insurance coverage with a co-pay for the type of medical service you selected.
  • Maximum You Pay: this is the most a patient pays in a year for medical services covered under their plan. The yearly maximum amount for a person with insurance just for themselves is different than for a family. Some people pay more than this during the year because they buy medical services that are not covered by their insurance plan.  Change this amount if you know your yearly maximum.