How much critical illness coverage do you need?
A critical illness policy pays a lump sum when a covered condition is diagnosed, not a reimbursement of receipts. Sizing it means adding two very different numbers: the share of medical bills you actually pay, and the income you lose while you are out of work.
Because a compliant health plan caps your share of covered in-network care at the annual out-of-pocket maximum, this calculator uses the lower of your billed total and that cap for the medical side. It then multiplies the monthly gap between household expenses and income during treatment by the months off work, adds travel, childcare and home care, and subtracts coverage you already hold.
Basis and date — the out-of-pocket maximum for non-grandfathered plans is limited annually by HHS under the Affordable Care Act, and those limits change every plan year. Content reflects September 2026; check your own Summary of Benefits and Coverage.
This tool is a planning estimate and is not a recommendation to buy any particular policy. Covered conditions, waiting periods, partial benefits for early-stage diagnoses and pre-existing condition clauses vary widely, so read the policy before relying on a figure.
Frequently asked questions
For covered in-network care your plan stops charging you once you reach that cap for the year, so the billed total matters less than the cap. Out-of-network care and non-covered services sit outside it, so add those under other costs.
No. A critical illness policy pays a lump sum on diagnosis of a listed condition, while disability insurance replaces income month by month for a wider range of causes. Many households use the two for different parts of the same gap.
Treatment depends on who paid the premiums and whether they were paid with pre-tax dollars. Benefits from a policy you bought with after-tax money are commonly received tax-free, but employer-paid arrangements can differ, so ask a tax adviser.