AI Health Insurance Plan Explainer
Paste in the jargon from your plan's summary and get plain-English definitions. Enter your premium, deductible, and copays and get verified cost math, line by line. Free, no signup, nothing leaves your browser.
Your Plan Details
Enter the flat copays from your plan's summary. Leave any you do not know at 0.
Your Plan, Decoded
Educational only. This tool decodes terms and does the math on numbers you enter. It does not recommend a plan and is not insurance advice. For enrollment decisions, check healthcare.gov or talk to a licensed broker.
Crunching the numbers...
Term Decoder: Plain-English Cards
Every term this tool recognizes, decoded. Click a highlighted term in your pasted text above to jump straight to its card.
Deductible
What you pay out of pocket each year before the plan starts paying its share for most services. Copays and preventive care often skip the deductible. A $3,500 deductible means the first $3,500 of covered bills are yours.
Out-of-Pocket Maximum
The most you pay in a year for covered, in-network care: deductible + copays + coinsurance, added up. After you hit it, the plan pays 100% of covered costs for the rest of the year. Premiums do not count toward it.
Coinsurance
Your percentage share of a bill after the deductible. 20% coinsurance on a $1,000 covered bill means you pay $200 and the plan pays $800.
Copay / Copayment
A flat fee you pay at the visit or pharmacy, like $30 for a primary-care visit. Usually counts toward the out-of-pocket maximum, usually does not count toward the deductible.
In-Network vs Out-of-Network
In-network providers have a contract with your plan: lower negotiated prices, and your spending counts toward the deductible and out-of-pocket max. Out-of-network care costs more and may not count at all; some plans cover almost none of it.
Prior Authorization
Your plan's advance permission for certain services, drugs, or procedures. Without it the claim can be denied even when the care itself is covered in theory. Your doctor's office usually files it.
Formulary
The plan's list of covered drugs, split into tiers. Generic tier = cheapest copay; brand and specialty tiers cost more. A drug not on the formulary may cost you full price.
HSA / FSA
HSA (Health Savings Account): a tax-advantaged account paired with high-deductible plans; the money rolls over and is yours. FSA (Flexible Spending Account): a similar tax break through an employer, but funds usually expire each year ("use it or lose it"). Both can pay deductibles, copays, and coinsurance.
Preventive Care
Screenings, vaccines, and annual checkups that most plans must cover at $0 before the deductible: no copay, no coinsurance, as long as the visit is in-network and coded as preventive.
Saved Plans: Side-by-Side Comparison
Plans you save are stored on this device only, in your browser. Save up to 3 to compare their numbers and year scenarios side by side. This is a neutral comparison of your own numbers, not a recommendation.
How It Works
Step 1: Enter the plan basics. Plan name, monthly premium, annual deductible, annual out-of-pocket maximum, and the coinsurance percentage you pay after the deductible. These come straight from the plan's summary page.
Step 2: Enter the common copays. What a primary-care visit, specialist visit, ER visit, urgent care visit, and generic or brand prescription cost you out of pocket. Unknowns can stay at 0.
Step 3: Decode the jargon. Paste the dense paragraph from your Summary of Benefits. Known terms get highlighted; click any highlighted term to jump to its plain-English card below. Set a sample bill amount and hit "Explain My Plan".
Read the verified math. Every number is computed in your browser from the numbers you entered, with each arithmetic step shown: annual premium total, what a sample bill does to your deductible, the out-of-pocket cap, and three year scenarios (quiet, typical, rough). Assumptions are printed next to the math, not buried.
Save, print, download. Save up to 3 plans to compare side by side, print the results as a PDF, or download a plain-text summary to bring to a broker or HR meeting.
Frequently Asked Questions
Is this health insurance plan explainer giving me insurance advice?
No. This tool is educational only. It decodes insurance terms into plain English and does the arithmetic on the numbers you enter. It does not recommend a plan and is not insurance advice. For enrollment decisions, check healthcare.gov or talk to a licensed broker.
Is the information I enter into the tool private?
Yes. This tool runs 100% in your browser with zero network requests: no fetch calls, no AI service, no tracking of your inputs. Nothing you type leaves your device. Saved plans live in your browser's localStorage, on your device only.
What is the difference between a deductible and an out-of-pocket maximum?
The deductible is what you pay first each year before the plan starts sharing costs. The out-of-pocket maximum caps everything you pay in cost-sharing for covered in-network care in a year: deductible plus copays plus coinsurance. After you hit it, the plan pays 100% of covered costs for the rest of the year. Premiums count toward neither.
Do copays count toward the deductible?
On most ACA marketplace plans, no: copays count toward the out-of-pocket maximum but do not satisfy the deductible. Some plans work differently, so your plan's Summary of Benefits and Coverage is the final word. This tool prints its assumptions next to the math so you can check them against your plan.
How are the quiet, typical, and rough year totals computed?
Deterministic arithmetic, shown line by line. A quiet year is annual premiums plus two PCP copays. A typical year is premiums plus six PCP visits, three specialist visits, and twelve generic prescriptions, with cost-sharing capped at the out-of-pocket maximum. A rough year assumes a $25,000 surgery bill: the deductible applies first, then your coinsurance percentage on the remainder, plus the ER copay, capped at the out-of-pocket maximum.
Is this tool free?
Yes. 100% free with no accounts and no signup required.
Comparing plans for open enrollment? Start with How to Compare Health Insurance Plans. On Medicare? Use the Medicare Cost Calculator and read How to Choose Between Medicare Advantage and Medigap.