Sofia and Ricardo
HSA PLAN
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)* | $0 | $0 | $0 |
| Subtotal | $878.92 | |||
| 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.