Insurance, HSA & FSA: what you will actually pay

Health plans

You pay the deductible first, then your coinsurance share, until you reach the out-of-pocket maximum. Our estimators use: your share = min(out-of-pocket max remaining, deductible portion + coinsurance × the rest).

Dental plans

Dental plans usually pay a percentage after a small deductible, up to an annual maximum (orthodontics often has a separate lifetime maximum). Large treatments like implants often exceed the maximum, so the plan’s share is capped.

HSA and FSA in 2026

• HSA contribution limit: $4,400 self-only, $8,750 family, plus $1,000 catch-up at 55+ (IRS Rev. Proc. 2025-19).
• Health FSA salary-reduction limit: $3,400 (IRS 2026 inflation adjustments).
• Eligible expenses follow IRS Publication 502: LASIK, hearing aids, dental treatment and infertility procedures qualify; cosmetic surgery generally does not.
• Tax saved ≈ amount paid from the account × your marginal tax rate. Payroll-deducted HSA contributions can also avoid FICA tax.

Uninsured or self-pay

Under the No Surprises Act, providers must give uninsured or self-pay patients a Good Faith Estimate on request or when scheduling. If the final bill is $400 or more above it, you may dispute it.

Sources

1. Rev. Proc. 2025-19 (2026 HSA limits), IRS, 2025. Accessed 2026-10-23.
2. IRS 2026 inflation adjustments (health FSA limit), IRS, 2025. Accessed 2026-10-23.
3. Publication 502, Medical and Dental Expenses, IRS, 2025 edition. Accessed 2026-10-23.
4. No Surprises Act: Good Faith Estimates for uninsured/self-pay patients, CMS. Accessed 2026-10-23.