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.

Simone meets the deductible in all three plans. In the Silver and Bronze plans she meets the family out-of-pocket max, so the family's care for the rest of the year is covered at 100%.

Gold
Silver
Bronze
Costs paid by
 
Simone
$7,256
$11,000
$14,000
Paycheck contributions
$12,373
$5,536
$3,003
Company contributions
$0
($1,000)
($1,000)

And the winner is...

The Silver plan is the winner for Simone!

Simone meets the deductible in all three plans. In the Silver and Bronze plans she meets the family out-of-pocket max, so the family's care for the rest of the year is covered at 100%.

Gold
Silver
Bronze
Costs paid by
 
Simone
$7,256
$11,000
$14,000
Paycheck contributions
$12,373
$5,536
$3,003
Company contributions
$0
($1,000)
($1,000)
Simone
's
 total cost
$19,629
$15,536
$16,003
To see a more detailed breakdown of Simone's care, click here. Remember, this is an example; your costs may vary.