ODP - WellBalanced Benefits

Meet Anna

Anna is married, but her husband has medical coverage with his employer, so she will elect Employee Only coverage. She doesn't smoke and gets her annual physical. She uses in-network doctors and pharmacies, but she's had a bit of a bumpy year.

Let's take a look…

Cost

She gets her free annual physical

$125 visit x 1

100% paid by the company!

She starts having trouble with a condition that hasn't bothered her in years. She goes to her primary care doctor four times.

$125 visit x 4

Her doctor prescribes several generic medications that she fills at the pharmacy.

$25 generic x 3

Her condition worsens and she goes to the ER.

$2,500 visit x 1

Cost

She sees a specialist four times and the specialist sends her to get a round of tests and prescribes a couple of generic medications that Anna fills through mail order.

$200 visit x 4

$75 labs x 1

$70 generic mail order x 2

The specialist decides Anna needs to have surgery. The surgery is performed at an outpatient facility.

$7,000 outpatient surgery

She sees a physical therapist six times to recover from her surgery.

$115 visit x 6

Anna's total expenses

Anna has incurred a total of $11,905 in expenses from providers and services. Now, let's see which plan would have been better for Her!

$11,905

in total expenses

Wait!

We also need to remember that Anna has been paying for medical coverage from Her paycheck too and contributing to her HSA in those plans. We'll add that in.

Remember, Anna incurred $11,905 in total expenses from providers and services.

In the HSA Basic, she pays out of her pocket until she reaches the out-of-pocket max, then the rest of her care is covered at 100%. In the HSA Plus, she meets her deductible and then pays 20% coinsurance. In the PPO, she meets her deductible and pays copays and coinsurance for the rest of her care.

HSA Basic

HSA Plus

PPO

Costs paid by Anna

$6,000

$4,778

$4,173

Paycheck contributions

$525

$912

$4,776

Anna's HSA contributions

$250

$500

N/A

Company HSA contributions

($250)

($500)

N/A

And the winner is...

The HSA Plus is the winner for Anna!