Sofia doesn’t go to the doctor that often, but Ricardo is monitored for a chronic condition. They both get annual physicals, which are covered in full. Ricardo goes to the doctor for frequent check-ups to monitor his high blood pressure, and his doctor expects that medication will be needed in the near future. Let’s take a look at how the plans compare for Sofia and Ricardo based on their usage:
|Service||UMR Average Approved Amount||Preferred Plan||POS||HSA*|
|Annual Physical – 2 visits (employee and spouse)||$380.00||$0||$0||$0|
|Primary Care Office visit – 1 visit (spouse)||$78.00||$10.00||$40.00||$78.00|
|Specialist Office Visit – 2 visits (employee and spouse)||$200.00||$40.00||$140.00||$200.00|
|Tier 1 Prescription – 12 Preventive Prescriptions (spouse)||$220.92|
($18.41 x 12)*
|Total Medical Expense Out of Pocket||$50.00||$180.00||$278.00|
|Employee Annual Premium||$3,510.00||$5,590.00||$2,292.52|
|TOTAL ANNUAL COST||$3,560.00||$5,770.00||$2,570.52|
* Preferred and HSA enrolled employees purchase preventive Rx at an MIHS pharmacy to take advantage of $0 generic preventive Rx program
** Employee can use Health Savings Account funds to pay out-of-pocket expenses
When they compare their plan options, Sofia and Ricardo realize the HSA Plan would offer the best value. Even though they pay a little more out-of-pocket (what they pay when they receive services), the amount Sofia pays in her premium (the amount taken out of her paycheck) more than offsets the higher out-of-pocket costs. And Sofia knows that she can contribute to her HSA so she can use those dollars to pay for eligible out-of-pocket costs.
Take a moment to use the Medical Plan Cost Estimator to see how the plans compare for you.