Our Medical Plans in Action
How different needs shape different plans.
Choosing a medical plan becomes easier when you can see how it works for people like you. These examples are for illustrative purposes only and intended to show you how individuals in different situations may go about choosing coverage that fits their needs and budget.
Family
Angela is married with two teenagers. She and her family are in good health, but she anticipates an emergency room visit and three urgent care visits. In addition, her husband takes a generic migraine medication.
| Anthem High Deductible PPO | Kaiser CA HMO | Anthem HMO | |
|---|---|---|---|
| Annual Premium | $3,336 | $7,716 | $9,684 |
| Preventive Care | $0 | $0 | $0 |
| Emergency Room Visit Angela falls and hits her head and goes to the ER. The bill is $3,000. |
$3,000 She pays the full cost since she hasn’t met the deductible. |
$250 Angela pays a copay. |
$250 She pays the copay. |
| Urgent Care Visit Angela’s kids visit urgent care for sports injuries, and her husband goes due to a high fever. Each visit is $225. |
$675 She pays the full cost because she hasn’t met the deductible. |
$75 She pays a $25 copay for each visit. |
$75 She pays a $25 copay for each visit. |
| Prescription Angela’s husband receives migraine medication. The generic prescription is $15 for a 30-day supply or $180/year. |
$180 Since she hasn’t met the family deductible, she pays the full cost of the generic drug. |
$180 This plan covers generic drugs at $15 for a 30-day supply. |
$180 Generic drugs cost $15 for a 30-day supply. |
| Total Expense | $3,655 | $505 | $505 |
| Total Annual Spend Out-of-pocket expenses + premiums |
$7,191 | $8,221 | $10,189 |
Based on Angela’s situation, the Anthem High Deductible PPO Plan offers the lowest cost option. Since she is saving money on premiums, she’s going to direct the savings into her HSA.
Employee + Spouse
Sanna is generally health and a non-smoker. She’s married, and her husband receives regular allergy shots. Sanna will have a brief hospital stay this year.
| Anthem High Deductible PPO | Kaiser CA HMO | Anthem HMO | |
|---|---|---|---|
| Annual Premium | $2,124 | $4,968 | $6,240 |
| Preventive Care | $0 | $0 | $0 |
| Hospital Stay She stays at a hospital for two nights and the bill is $8,000. |
$4,320 She pays her $3,400 individual deductible and then pays 20% of the remaining cost. |
$250 She pays the copay. |
$250 She pays the copay. |
| Allergy Treatment Her husband receives monthly allergy shots that cost $1,740. |
$1,740 Her husband pays the full cost because they haven’t met the family deductible. |
$35 The treatments are 100% covered. There is a $35 copay for an allergy test. |
$0 The treatments are covered 100%. |
| Total Expense | $6,060 | $285 | $250 |
| Total Annual Spend Out-of-pocket expenses + premiums |
$8,184 | $5,253 | $6,490 |
Based on her situation, the Kaiser CA HMO Plan is the most affordable option for Sanna.
Employee Only
Darren is single with no kids and lives an active lifestyle as a rock climber. He is generally health and only visits the doctor for his annual preventive checkup.
| Anthem High Deductible PPO | Kaiser CA HMO | Anthem HMO | |
|---|---|---|---|
| Annual Premium | $888 | $2,040 | $2,544 |
| Preventive Care | $0 | $0 | $0 |
| Prescription He takes a generic medication for high cholesterol. |
$120 $80 for a 90-day supply ($120 for the full year). |
$120 $80 for a 90-day supply ($120 for the full year). |
$120 $80 for a 90-day supply ($120 for the full year). |
| Total Annual Spend | $1,008 | $2,160 | $2,664 |
Darren’s lowest-cost option is the Anthem High Deductible PPO Plan. He saves money on premiums, so he also takes advantage of the HSA and contributes $1,000 for future expenses.