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With health coverage turned on, CoastMath adds each person’s medical budget and any long-term-care budget to spending, together with premiums, as one Health coverage amount. Every budget is entered in plan-start dollars and grows at medical inflation from the plan’s start year. For long-term care, only the share you don’t mark as covered is paid from your plan.
These costs are always paid in full; flexible spending rules never reduce them. They aren’t deducted on your tax return.
- Use shared settings: premiums only, from the plan’s marketplace and Medicare settings. No out-of-pocket or long-term-care budget.
- Coverage premiums + optional budget: premiums from this person’s own marketplace and Medicare choices, plus Out-of-pocket budget ($ per year, optional) for every year the person is alive in the plan, including years before Medicare.
- Itemized medical budget: one annual amount that replaces this person’s premiums and out-of-pocket costs. It starts in the birthday month of Medical budget starts at age and stops before the birthday month of the optional end age.
- Off: no medical costs for this person.
How premiums are calculated is covered in Marketplace coverage and premium tax credits and Medicare premiums and IRMAA.
Cost in a year=Entered annual amount×(1 + medical inflation)years since plan start×share of the year covered
The rate is the person’s Medical inflation (% per year, optional) if set, otherwise the plan’s Medical cost inflation (% per year, optional), otherwise plan inflation. Growth counts from the plan’s start year even for a budget that begins later.
| Entered annual amount | $7,200 | |
|---|---|---|
| × | Months at 65 or older in 2026, April–December | 9 ÷ 12 |
| = | Cost in 2026 | $5,400 |
| Full year in 2027$7,200 × 1.05 | $7,560 | |
| Full year in 2031$7,200 × 1.05⁵ | $9,189 |
Turn on Include a long-term-care budget after choosing any method other than Use shared settings; choose Off to model care without other medical costs. You enter a monthly cost, a duration in months and a start, either a calendar year and month or a number of months before the end of the person’s modeled lifetime.
Paid from your plan=Monthly cost×growth since the reference year×months in care this year×(1 − covered share)
Months in care this year stop at the earlier of the duration’s end and the person’s death.
Care costs grow at LTC inflation (% per year, optional) if you enter it, otherwise at that person’s medical inflation. The monthly cost is in dollars of the plan’s start year unless you set LTC amount reference year; a different reference year requires an LTC inflation rate.
- Paid from your plan
- Covered
Care runs July 2040 through June 2043, so the first and last years hold six months each.
Show data
| Year | Paid from your plan | Covered | Gross cost |
|---|---|---|---|
| 2040 | $70,133 | $23,378 | $93,511 |
| 2041 | $145,876 | $48,625 | $194,502 |
| 2042 | $151,711 | $50,570 | $202,282 |
| 2043 | $78,890 | $26,297 | $105,187 |
| Monthly cost, 2026 dollars | $9,000 | |
|---|---|---|
| × | Growth for 14 years at 4% | 1.7317 |
| = | Monthly cost in 2040 | $15,585 |
| × | Months in care, July–December | 6 |
| = | Gross cost, 2040 | $93,511 |
| − | Covered share, 25% | $23,378 |
| = | Paid from your plan, 2040 | $70,133 |
Medical costs are deducted only when you check Plan detailsDeduct medical expenses. Then every modeled cost counts as a medical expense: premiums after the premium tax credit (marketplace, Medicare Parts A, B and D, IRMAA and Medigap), out-of-pocket and itemized budgets, and net long-term care. Costs an HSA reimbursed tax free that year are left out. The part above 7.5% of AGI joins your other itemized deductions, and CoastMath itemizes only if the total beats the standard deduction; see Itemized deductions.
| Medical costs | $30,000 | |
|---|---|---|
| − | 7.5% of AGI | $4,500 |
| = | Itemized medical deductionBeats the $16,100 standard deduction | $25,500 |
With self-employment income, the same setting deducts premiums above the line instead, up to your net business profit (profit less the deductible half of self-employment tax and self-employed retirement contributions). That lowers AGI, which raises any premium tax credit and so lowers the premium; CoastMath repeats the two calculations until they agree. Premiums deducted this way aren’t itemized too.
Your modeled medical costs, including the net long-term-care cost, also set how much an HSA can pay tax-free each year; see Health savings accounts.
Each year’s cash flow shows one Health coverage line: premiums after credits, medical budgets and net long-term care, for both people. It’s treated as essential spending. The yearly total also appears in the Total cost column of the health coverage table; see Use the tax tools.