Charles doesn’t need a lot of medical care. He’s generally healthy and makes sure to get his annual physical, which is covered in full. He usually sees his primary care doctor a few times during the year for minor illnesses and he gets one prescription filled. Let’s take a look at how the plans compare for Charles based on his usage:
|Service||UMR Average Approved Amount||Preferred Plan||POS||HSA*|
|Annual Physical – 1 visit||$190.00||$0||$0||$0|
|Specialist Office Visit – 1 visit||$97.00||$20.00||$70.00||$97.00|
|Primary Care – 1 visit||$78.00||$10.00||$40.00||$78.00|
|Tier 2 Prescription – 1 Prescription (Non-preventative)||$8.32||$5.00||$5.00||$8.32|
|Total Medical Expense Out of Pocket||$35.00||$115.00||$183.32|
|Employee Annual Premium||$1,196.78||$3,639.96||$1,196.78|
|TOTAL ANNUAL COST||$1,231.78||$3,754.96||$1,380.10|
* Employee can use Health Savings Account funds to pay out-of-pocket expenses
When he compares his plan options, Charles realizes the Preferred Plan would offer the best value. Because he doesn’t use a lot of care during the year, he has lower out-of-pocket costs (what he pays when he receives services). Charles realizes when he compares his plan options, that the total annual costs are so close between the Preferred and HSA Plans. Charles wants to enroll in the HSA plan so that he can contribute to his HSA. Over the longer term, contributing to his HSA could help him pay for eligible out-of-pocket medical costs with tax free dollars.
Take a moment to use the Medical Plan Cost Estimator to see how the plans compare for you.