Sharon
Sharon found out last year that she had cancer. The reality of cancer hit Sharon and her family hard, emotionally and financially. Sharon’s husband also has some on-going medical conditions. Last year, Sharon’s family paid the following in out-of-pocket medical expenses.
• Deductible $ 500
• Co-Insurance $2,500
• Dr. Co-pays $ 450
• Rx Co-pays $ 980
TOTAL $4,430
Sharon is responding to her cancer treatments, but will continue to require frequent doctor visits, prescriptions, and expensive procedures this year. By selecting a High Deductible Health Plan (HDHP) with 100% co-insurance, Sharon will be able to cap her out-of-pocket expenses at less than half of last year’s total. Unlike a traditional plan, Sharon’s H.S.A. compatible HDHP will count Sharon’s office and prescriptions expenses toward the Deductible/Out-of-pocket maximum. Once the Deductible/Out-of-pocket maximum is reached, the insurance plan will pay 100% of her covered expenses including doctor visits and prescriptions.
BEFORE the OUT-OF-POCKET MAX:
Individual pays 100% of discounted network costs for covered medical expenses, office visits and prescriptions.
BEFORE the OOP Max Individual Pays:
• Office Visits 100%
• Prescriptions 100%
• Out-Patient Costs 100%
• In-Patient Costs 100%
• Emergency Room 100%
• Urgent Care 100%
Out-of-pocket Max (Family) $2,200
AFTER the OUT-OF-POCKET MAX:
Insurance company pays 100% of discounted network costs for covered medical expenses, office visits and prescriptions.
AFTER the OOP Max Individual Pays:
• Office Visits $ 0
• Prescriptions $ 0
• Out-Patient Costs $ 0
• In-Patient Costs $ 0
• Emergency Room $ 0
• Urgent Care $ 0
SAVINGS COMPARISON:
• Traditional PPO Plan $4,430
• Estimated Payroll Tax on
• OOP Expenses* $1,108
TOTAL $5,538
• H.S.A. Plan $2,200
• Estimated Payroll Tax
• Savings on H.S.A. funds $ -550
TOTAL $1,650
TOTAL SAVINGS $3,888
*Assumes 15% Federal, 2.35% State, 7.65 FICA