Legacy Investing CalculatorsShow

Claim out-of-pocket cost

What would a covered loss cost after deductible and coverage limits?

Your numbers

$
$
$

Your out-of-pocket

$5,000

Insurer pays$10,000

Tip. A loss above the limit becomes your problem quickly. Check limits before you need them.

Assumptions

  • Insurer pays min(max(0, loss − deductible), limit).
  • Out-of-pocket = loss − insurer pay.
  • Estimate only. Real policies add exclusions, sub-limits, waiting periods, and network rules that this page does not model.

Explore the numbers

Examples and charts

Start with a scenario, then read the response curve to see which input actually moves the answer.

Example 1

Small claim

Mostly deductible territory, where claiming may not even be worth it.

Your out-of-pocket

$1,000

Example 2

Mid-size claim

Above the deductible and comfortably inside the limit, which is the case coverage handles best.

Your out-of-pocket

$1,000

Example 3

Loss above the limit

Where the out-of-pocket cost jumps because the policy has stopped paying.

Your out-of-pocket

$8,000

Sweeps loss amount from half to one and a half times your value, holding everything else fixed.

Response curve

How loss amount moves the result

Your out-of-pocket

$5,000

$2.0k$4.0k$6.0k$8.0k$10k$12k$10k$15k$20k
Chart axis: Loss amountNow $15k → $5.0k

What this calculates

Estimates what you pay on a covered loss once the deductible and the coverage limit are applied. The response curve shows the point where the limit stops helping and every additional dollar of loss becomes yours.

How to use it

  1. Start with loss amount and work down the form, or load an example to begin from a realistic case.
  2. Read the headline result alongside the supporting rows, which show the intermediate figures behind it.
  3. Check the assumptions. They decide what the number includes and, more importantly, what it leaves out.
  4. Sweep loss amount on the response curve to see how much it actually moves the answer.
  5. Run a cautious case as well as an optimistic one before using the estimate in a decision.

Common mistakes

  • Assuming coverage is unlimited once the deductible is met.
  • Overlooking a separate, higher deductible for specific perils such as wind or hurricane.
  • Filing a small claim without checking what it does to the renewal.

Formula

Insurer pays min(max(0, loss − deductible), limit); your out-of-pocket = loss − insurer payment

Inputs

  • Loss amount
  • Deductible
  • Coverage limit

FAQ

What about depreciation?

An actual cash value policy pays the depreciated amount rather than replacement cost, which can be far less. Enter the payable loss your adjuster would actually use rather than what a new replacement costs.

Should I claim a loss just above the deductible?

Often not. A small claim can raise premiums for years and may count against claim-free discounts, which frequently costs more than the payout.

Do sub-limits change this?

Yes, and they catch people out. Categories like jewellery, electronics, or water damage often carry their own much lower limit inside the overall one. Enter the applicable sub-limit rather than the headline figure.

How much will I pay out of pocket on an insurance claim?

Start with the deductible, then apply any coinsurance and the coverage limit. The calculator shows how a loss divides between the insurer and you, and health plans cap the total at the out-of-pocket maximum.

What happens if my claim exceeds the coverage limit?

The insurer pays up to the limit and the rest is yours. That is the cliff on the response curve, and it is why limits should be reviewed against current rebuild or replacement costs.

Should I file a small claim?

Not always. A small claim can raise your premium for years and cost more than paying the loss yourself. Ask your insurer whether a claim would affect your rate before you file.

Are these numbers financial advice?

No. They are educational estimates based on the inputs and assumptions on this page. Confirm important decisions with a qualified professional and your own documents.

Read the full guideWhat an insurance claim costs out of pocket

Related calculators

The questions people usually ask next.