Meet Simone

Simone's and her family get their annual physicals, and they don't smoke. They use in-network doctors and pharmacies. But this is a tough year due to serious health conditions and a sports injury. 

Let's take a look…

Cost

All of the family members get their physicals and the kids get their immunizations.

$125 visit x 5

100% paid by the company!

Everyone gets sick a few times. Each time they receive multiple generic prescriptions to help them get better.

$100 visit x 10
$20 generic x 25

Simone, her husband and her two sons all see specialists regularly for ongoing conditions. To treat their conditions, she fills three preferred brand medications by mail order and refills them 3 more times. (3-month supply).

$140 visit x 24
$340 preferred brand mail order x 3 x 4 (12)

Cost

Simone's infant daughter has a serious case of bronchitis and is taken to the ER. They keep her in the hospital for two days of observation.

$2,000 visit x 1
$6,000 hospital stay

Her husband's specialist schedules him for inpatient surgery, as his condition is getting worse. The surgery results in two days in the ICU.

$25,000 surgery

$6,000 ICU x 2 days

Her oldest son is injured badly during a soccer tournament. He goes to physical therapy 12 times for the injury.

$115 visit x 12

Her oldest son is also prescribed a new preferred brand drug to treat his injury during recovery. Simone fills it twice at the pharmacy and then twice though mail order (3-month supply).

$275 preferred brand x 2
$340 preferred brand mail order x 2

Simone's total expenses:

Simone has incurred a total of $56,530 in expenses from providers and services. Now, let’s see which plan would have been better for Her!

$56,530

in total expenses

Wait!
We also need to remember that Simone has been paying for medical coverage from Her paycheck too. We'll add that in.
Remember, Simone incurred $56,530 in total expenses from providers and services.

In the HSA plan, Simone pays for Her care out-of-pocket, while in the PPO plan, She pays copays for most of Her care.

PPO
HSA
Costs paid by
 
Simone
$7,000
$13,000
Paycheck contributions
$9,864
$6,852
Company contributions
N/A
($500)

And the winner is...

The PPO plan is the winner for Simone!

In the HSA plan, Simone pays for Her care out-of-pocket, while in the PPO plan, She pays copays for most of Her care.

PPO
HSA
Costs paid by
 
Simone
$7,000
$13,000
Paycheck contributions
$9,864
$6,852
Company contributions
N/A
($500)
Simone
's
 total cost
$16,864
$18,852