Perferred Plan

Randy and Susan have two sons, Dylan and Tyler, and two daughters, Gabby and Kelly. While they are all fairly healthy, they know with their big family, trips to the doctor are frequent. They always get their annual checkups, which are covered in full. But Tyler has a condition that requires monthly trips to the doctor’s office and medication. Susan makes sure to save money by using generic medications and comparing prices on where to fill Tyler’s prescriptions. Let’s take a look at how the plans compare for Randy and Susan based on their usage:

ServiceUMR Average Approved AmountPreferred PlanPOSHSA*
Inpatient Hospital Stay (Employee)$52,495.00$0$4,500.00$3,600.00
($1,000 deductible + $750 copay + $2,750 coinsurance)($2,700 deductible + $900 coinsurance)
Outpatient Surgery (Spouse)$10,568.00$0$3,313.60$3,600.00
($1,000 deductible + $ 500 copay + $1,813.60 coinsurance)($2,700 deductible + $900 coinsurance)
Annual Physical – 6 visits
(employee, spouse, and 4 children)
Specialist Office Visit – 4 visits (3 employee and 1 child) $388.00$80.00
Primary Care Office Visit – 5 visits (employee, spouse, and 3 children)$390.00$50.00
Tier 1 Prescription – 1 Preventive Prescription (child) $92.52
($7.71 x 12)*
Tier 2 Prescription – 2 Non-Preventive Prescription (child)$8.32$16.64$16.64$0
Tier 2 Prescription – 1 Non-Preventive Prescription (spouse)$222.84
($18.57 x 12)*
Total Medical Expense Out of Pocket$369.48$8,533.08$7,200.00
Employee Annual Premium**$4,810.00$7,358.00$3,632.98
TOTAL ANNUAL COST$5,179.48$15,891.08$10,832.98

* 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, Randy and Susan realize the Preferred Plan would offer the best value. While Susan may pay more from her paycheck, she likes the peace of mind knowing that her out-of-pocket costs would be the lowest. But the family may consider the HSA plan. Many of their providers are not in the Preferred Network and the additional out-of-pocket costs may be worth the additional flexibility to continue seeing doctors that they have already established relationships.

Take a moment to use the Medical Plan Cost Estimator to see how the plans compare for you.