Cost by Site of Care
What a therapy costs the plan and the patient at each site of care.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Administrations in the plan year
- 6
- Deductible still to meet
- 500 USD
- Out-of-pocket maximum still to meet
- 4000 USD
- Site 1 name
- Hospital outpatient
- Site 1 allowed amount per administration
- 9000 USD
- Site 1 coinsurance or copay
- Coinsurance (percent)
- Site 1 coinsurance percent or copay dollars
- 20
- Site 2 name
- Home infusion
- Site 2 allowed amount per administration
- 5200 USD
- Site 2 coinsurance or copay
- Copay per administration (dollars)
- Site 2 coinsurance percent or copay dollars
- 50
Result: Lowest total cost: Home infusion, $31,200.00 a year against $54,000.00 at Hospital outpatient (a difference of $22,800.00). Lowest for the patient: Home infusion, $800.00 a year.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Administrations in the plan year
- Deductible still to meet
- Out-of-pocket maximum still to meet
- Site 1 name
- Site 1 allowed amount per administration
- Site 1 coinsurance or copay
- Site 1 coinsurance percent or copay dollars
- Site 2 name
- Site 2 allowed amount per administration
- Site 2 coinsurance or copay
- Site 2 coinsurance percent or copay dollars
The other 8 fields
- Site 3 name
- Site 3 allowed amount per administration
- Site 3 coinsurance or copay
- Site 3 coinsurance percent or copay dollars
- Site 4 name
- Site 4 allowed amount per administration
- Site 4 coinsurance or copay
- Site 4 coinsurance percent or copay dollars
How this is calculated
Citation
Compares each site's allowed amount and cost sharing, entered by the reader, over the plan year, applying the deductible and a non-grandfathered plan's out-of-pocket maximum (45 CFR 156.130) the same way at every site. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.