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 x 5 = $625
100% paid by the Company!

All three kids get sick a few times. Each time, they receive multiple generic prescriptions to help them get better.

$125 visit x 9
$25 generic x 18

Simone's husband and her oldest son both see a specialist monthly for ongoing conditions. To manage their conditions, they are prescribed three preferred brand medications. Simone fills the prescriptions through mail order.

$200 visit x 24
$400 preferred brand mail order x 2 x 4 (8)

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.

$2,500 visit x 1
$4,000 hospital stay

Her husband's specialist schedules him for in-patient surgery given his condition is getting worse. The surgery results two days in the ICU.

$25,000 surgery
$12,000 ICU

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

$115 visits x 12

Her oldest son is also prescribed a generic pain medication during his recovery. Simone fills it twice at the pharmacy and then twice though mail order.

$25 generic x 2
$70 generic x 2

Simone's total expenses:

Simone has incurred a total of $55,270 in expenses from providers and services. Now, let’s see which plan would have been better for Her!

$55,270

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 $55,270 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.

Gold
Silver
Bronze
Costs paid by
 
Simone
$7,256
$11,000
$14,000
Paycheck contributions
$12,303
$5,524
$3,018
Company contributions
$0
($1,000)
($1,000)

And the winner is...

The Silver 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.

Gold
Silver
Bronze
Costs paid by
 
Simone
$7,256
$11,000
$14,000
Paycheck contributions
$12,303
$5,524
$3,018
Company contributions
$0
($1,000)
($1,000)
Simone
's
 total cost
$19,559
$15,524
$16,018
To see a more detailed breakdown of Simone's care, click here. Remember, this is an example, your costs may vary.