Employer Health Plan Cost Estimator
Plan Cost Estimator
Estimate your health plan costs based on workforce demographics, region, industry, and plan design — and compare funding strategies side by side.
What this tool does: This estimator calculates a market-based cost range for your employer health plan using actuarial cost indices for your region, industry, workforce age, coverage tier, and plan design. It then compares five common funding and plan-type combinations side by side so you can see the cost difference between fully-insured, level-funded, and self-funded arrangements. Use it to benchmark your current costs, prepare for renewal conversations, or build a business case for exploring alternative funding strategies.
Step 1 — Who is covered
Workforce Profile
Total employees enrolled in your health plan.
Average age of your enrolled workforce. Find this in your carrier's demographic report.
Select the coverage tier that represents most of your enrolled employees.
Step 2 — Where and what you do
Organization Profile
Where most of your employees are located. Costs vary 15–25% across regions.
Your primary industry. Affects risk profile and cost index.
Step 3 — How the plan is structured
Plan Design
How claims risk is shared between your organization and the insurance carrier.
The network and access model for your plan.
Your plan's individual deductible range. Higher deductibles = lower premiums.
Additional benefits included in your total package. Adds fixed PEPM to the estimate.
Total Annual Cost
$2,275,744
employer + employee
Total PEPM
$1,264
per employee per month
Employer Annual
$1,706,808
75% employer share
Employee Annual
$568,936
25% employee share
Medical PEPM
$995
medical only
Rx PEPM
$219
pharmacy (~22% of medical)
How to read these results
Total PEPM — the blended per-employee per-month cost across all benefit lines. This is your primary benchmarking metric. Compare it to your actual carrier invoice to see if you're above or below market.
Employer vs. Employee Annual — assumes a 75%/25% employer/employee split, which is near the national average. Adjust your actual split in the inputs to see the true employer cost.
Rx PEPM — pharmacy costs are estimated at 22% of medical PEPM, consistent with national benchmarks. Actual Rx costs vary significantly based on specialty drug utilization and PBM contract terms.
PEPM and share of total
Cost Breakdown by Benefit Line
Annual cost across five common approaches
Funding Strategy Comparison
These five scenarios use your workforce profile (region, age, industry, tier) but vary the funding arrangement and plan type. Your currently selected combination is highlighted. The difference between the most and least expensive options represents your potential savings opportunity.
Bar lengths are proportional to cost — longer bars mean higher cost. The gap between the top and bottom scenarios represents the maximum potential savings from optimizing your funding strategy and plan design.
Important: These are market-based estimates, not quotes
Estimates are based on 2025–2026 actuarial benchmarks and regional cost indices. Actual costs vary significantly based on your specific claims experience, carrier, network, and plan design. The funding strategy comparison assumes identical benefits across all scenarios — actual self-funded savings depend on TPA fees, stop-loss premiums, and claims experience. Use for planning and benchmarking purposes only — not as a substitute for carrier quotes or actuarial analysis.
Get an accurate cost projection
The 126-Point Benefits Benchmark uses your actual plan data and claims history to produce precise cost projections and funding strategy recommendations.
Your Analysis Is Ready
Estimated total plan cost: $1,791,593
Your PDF includes
What should I do next?
Estimated total plan cost
$1,791,593
Benchmark against peers
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Independent review
Corry Hull, REBC® CSFS®
Independent benefits consultant · Health Rosetta Advisor
Want a second set of eyes on this?
Your estimated savings opportunity is $1,791,593.28/year.
Corry Hull, REBC® CSFS®, reviews results like these with employers regularly. Independent analysis, fully disclosed compensation — just an honest read on what the numbers mean for your plan.
Send Corry a noteNo vendor affiliations · Independent analysis · Fully disclosed compensation
Frequently Asked Questions
How is employer health plan cost estimated?
Health plan cost estimation uses actuarial factors including: employee demographics (age, gender distribution), geographic region (cost varies significantly by market), industry (some industries have higher-risk workforces), plan design (deductible, OOP max, coinsurance), and funding strategy (fully-insured vs. self-funded). This estimator applies published actuarial factors and regional cost indices to build a projected cost model for your specific workforce.
How much does employer health insurance cost per employee?
The national average employer health plan cost is approximately $8,500–$10,000 per employee per year for single coverage and $22,000–$25,000 for family coverage (employer + employee combined). Self-funded employers with strong cost containment programs typically achieve 10–20% below these averages. Costs vary significantly by region, industry, plan design, and workforce demographics.
What is the cost difference between fully-insured and self-funded health plans?
Self-funded health plans typically cost 10–20% less than equivalent fully-insured coverage for employers with 100+ employees. The savings come from eliminating carrier profit margins (typically 8–12% of premium), state premium taxes (2–3%), and risk charges. Self-funded employers also benefit from cash flow advantages and access to claims data. The cost advantage narrows for smaller groups due to higher stop-loss costs and administrative complexity.
What is a level-funded health plan and how does it compare in cost?
A level-funded plan is a hybrid between fully-insured and self-funded. The employer pays a fixed monthly amount (like a premium), but unused funds are returned at year-end if claims are favorable. Level-funded plans typically cost 5–15% less than fully-insured for groups of 10–100 employees, while providing some of the data access and cost containment benefits of self-funding. They are often a stepping stone to full self-funding.
How does geographic region affect health plan costs?
Health plan costs vary dramatically by region — sometimes by 30–50% for equivalent benefits. High-cost markets include the Northeast (particularly New York, Massachusetts, Connecticut), California, and major metropolitan areas. Lower-cost markets include parts of the South and Midwest. Regional cost differences reflect provider pricing power, market concentration, and utilization patterns. This estimator applies regional cost indices to adjust projections for your location.
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Tool outputs are for informational and comparison purposes only. Results do not constitute a recommendation or endorsement of any vendor or approach. Verify all data independently and consult a qualified benefits advisor before making procurement or plan decisions. AI policy
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