Out-of-pocket estimate from your own dental plan figures
insurance_out_of_pocketUse this when the user has a private dental plan or a Medicare Advantage plan with dental benefits, knows its figures (deductible left, annual maximum left, coinsurance per procedure or per class), and asks what they would still pay for dental work in a US state. Every plan parameter comes from the user; the tool assumes none and names no insurer. Returns, per line, the state cash band (observed or estimated badge) and an estimated split (deductible, plan share, user share) on the low, average and high of the band, with the formula written out; a line missing a parameter is not computed and says which one. Phrasings: "my plan has 50 dollars of deductible left and 1,200 of annual max, coinsurance 50% on crowns, what would a crown in Ohio leave me to pay", "estimate my share for a root canal and a crown with my Medicare Advantage dental benefit in Florida", "¿cuánto me tocaría pagar por un implante con mi seguro dental si me quedan 800 del máximo anual?", "¿cuál sería mi parte de una endodoncia con coaseguro del 20% en Texas?". Do not use for: diagnosis, treatment choice, a named insurer's plan price, dentist recommendations, countries other than the US and Canada. Observed market research with a source URL and period on every figure; not a quote, not medical advice.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| lang | No | Response language for labels/notes: "en" (default) or "es". | en |
| lines | Yes | Lines in the order the user expects them to be billed (1-10). | |
| state | Yes | Two-letter US state code (or DC). One of: AL, AR, MS, KY, WV, IA, KS, OK, IN, SD, LA, NE, SC, GA, MO, TN, ND, OH, NC, MI, NM, WI, UT, ID, MN, TX, WY, AZ, FL, MT, CO, VA, IL, ME, PA, CT, OR, VT, DE, NV, RI, MD, WA, NH, NJ, MA, DC, AK, HI, NY, CA. | |
| coverage | Yes | Coverage category only (no plan or insurer name). | |
| no_annual_maximum | No | true only if the user's plan document states no annual maximum. | |
| coinsurance_by_class | No | The user's coinsurance in percent per class label they provide, e.g. their plan's own class names. | |
| annual_max_remaining_usd | No | Annual maximum still available this benefit year, in US dollars. Required unless no_annual_maximum is true. | |
| deductible_remaining_usd | No | Deductible still to meet this benefit year, in US dollars (0 if met). Required to compute. |