Meet Gabrielle

Gabrielle is married. She and her husband don't smoke and they get their annual physicals. They use in-network doctors and pharmacies. This is a rough year for the couple.

Let's take a look…

Cost

They both get their physicals.

$125 x 2 = $250
100% paid by the Company!

Her husband sees his doctor to renew his generic blood pressure prescription for the year. He uses mail order to fill it.

$125  visit x 1
$70 generic preventive mail order x 4

Gabrielle goes to the doctor three times for knee pain. She fills a generic prescription twice at the pharmacy.

$125 visit x 3
$25 generic x 2

Gabrielle's husband is in a car accident and is taken to the ER.

$2,500 visit

He is sent home from the ER, but a few weeks later, he ends up having surgery due to his injuries.

$20,000 surgery

Cost

Gabrielle's knee continues to bother her, so she goes to see a specialist several times. He prescribes her a generic medication for the pain that she fills at the pharmacy and refills once.

$200  visit x 4
$25 generic x 2

Gabrielle goes to physical therapy for a few months for her knee issue.

$115 visit x 8

Physical therapy doesn’t help, so her doctor schedules her for out-patient surgery.

$8,000

After her surgery, Gabrielle sees the specialist two more times and goes to physical therapy for a few months to recover.

$200 visit x 2
$115 visit x 8

Gabrielle's total expenses:

Gabrielle has incurred a total of $36,670 in expenses from providers and services. Now, let’s see which plan would have been better for Her!

$36,670

in total expenses

Wait!
We also need to remember that Gabrielle has been paying for medical coverage from Her paycheck too. We'll add that in.
Remember, Gabrielle incurred $36,670 in total expenses from providers and services.

In the Silver and Bronze plans, Gabrielle pays for her care out-of-pocket, while in the Gold plan, she pays copays for most of her care. In the Gold and Silver plans, Gabrielle meets the family deductible and pays coinsurance and copays for the reminder of her care. In the Bronze plan, she meets the family out-of-pocket maximum, so her care for the remainder of the year is covered at 100%.

Gold
Silver
Bronze
Costs paid by
 
Gabrielle
$6,900
$9,964
$12,730
Paycheck contributions
$9,560
$4,808
$2,592
Company contributions
$0
($1,000)
($1,000)

And the winner is...

The Silver plan is the winner for Gabrielle!

In the Silver and Bronze plans, Gabrielle pays for her care out-of-pocket, while in the Gold plan, she pays copays for most of her care. In the Gold and Silver plans, Gabrielle meets the family deductible and pays coinsurance and copays for the reminder of her care. In the Bronze plan, she meets the family out-of-pocket maximum, so her care for the remainder of the year is covered at 100%.

Gold
Silver
Bronze
Costs paid by
 
Gabrielle
$6,900
$9,964
$12,730
Paycheck contributions
$9,560
$4,808
$2,592
Company contributions
$0
($1,000)
($1,000)
Gabrielle
's
 total cost
$16,460
$13,772
$14,322
To see a more detailed breakdown of Gabrielle's care, click here. Remember, this is an example; your costs may vary.