ODP - WellBalanced Benefits

Meet Hannah

Hannah is married. She and her husband don't use tobacco products and they get their annual physicals. They use in-network doctors and pharmacies. Her husband is diagnosed with a health condition that requires ongoing treatment and medication.

Let's take a look…

Cost

They both get their physicals.

$125 visit x 2

100% paid by the company!

Hannah and her husband take generic medications year-round. They fill their prescriptions through mail order.

$70 generic mail order x 2 x 4

After not feeling well for a few weeks, her husband goes to the primary care doctor. The doctor orders lab work from an outside facility.

$125 visit x 1

$75 labs x 1

He is diagnosed with a health condition and prescribed one generic and two name-brand medications. He fills them at the pharmacy.

$25 generic x 1

$275 preferred brand x 2

Cost

Hannah gets sick and goes to her primary care doctor. The doctor gives her two generic prescriptions that she fills at the pharmacy.

$125 visit x 1

$25 generic x 2

Her illness worsens over the weekend, so she goes to urgent care. She's prescribed a new generic medication that she fills at the pharmacy.

$250 visit x 1

$25 generic x 1

Hannah's husband also takes a turn for the worse. His doctor hospitalizes him for two days to monitor his condition.

$3,000 hospital stay x 2 days

When he leaves the hospital his medication is changed to two generic medications that he fills twice through mail order.

$70 generic mail order x 2 x 2

Hannah's total expenses

Hannah has incurred a total of $8,315 in expenses from providers and services. Now, let's see which plan would have been better for Her!

$8,315

in total expenses

Wait!

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

Remember, Hannah incurred $8,315 in total expenses from providers and services.

In the HSA Basic, her husband reaches his individual out-of-pocket maximum, so the plan covers the rest of his care at 100% for the remainder of the year. In the HSA Plus, they meet the family deductible, then pay coinsurance. In the PPO, she pays copays for most of their care.

HSA Basic

HSA Plus

PPO

Costs paid by Hannah

$6,730

$6,457

$3,423

Paycheck contributions

$3,478

$4,416

$8,652

Hannah's HSA contributions

$500

$1,000

N/A

Company HSA contributions

($500)

($1,000)

N/A

And the winner is...

The HSA Basic is the winner for Hannah!