I want to thank everyone who took the time to comment on my last post about my upcoming health plan choice. A number of commenters inspired me to sit down and do some actual math. (This is pretty rare around here, so trust me, you were really motivational.)
Scenario 1: Physical Therapy
Everyone tells me that your late 30s is when you go off a cliff. So, let’s say I wrench my knee and need physical therapy that costs about $2000 over 5-10 sessions.
HDP: Yearly premium=$132, deductible=$1500, (employer kicks in $500), 15% coinsurance after deductible met=$75. Total cost to me: $1207.
PPO: Premium=$660, co-pay for 10 sessions of in-network physical therapy=$300. Total cost to me: $960.
Scenario 2: “Unexpected surgery”
This one was suggested by the decision guide my HR department gave me, which suggested that this might be a total charge of $6500. I assume we’re not talking about open-heart surgery at that cost, but something more like getting a torn ligament repaired.
HDP: Premium=$132, deductible=$1500, (employer kicks in $500), 15% coinsurance=$750. Total cost to me: $1882.
PPO: Premium=$660, deductible=$400, 15% coinsurance=$915. Total cost to me: $2000.
Scenario 3: Car accident, ambulance, ER visit, hospital stay, physical therapy
I pulled a number for this frankly out of thin air: $20,000.
HDP: Premium=$132, deductible=$1500, (employer kicks in $500), 15% coinsurance after deductible=$2775. This plan also includes “accident insurance” which reimburses you for various things stemming from an accident. Let’s assume I get $500-1000 back from this. Total cost to me would then be $2982-3482.
PPO: Premium=$660, deductible=400, 15% coinsurance after that but we very quickly hit the out of pocket maximum, which is $1950. So the total cost to me would be $2610.
Those numbers are closer than I thought they would be, actually. I’d come out ahead in two of the three scenarios if I had the PPO, but the HDP wins the “minor surgery” scenario. Even the car accident scenario isn’t too catastrophic with the HDP…if I can manage to stay in-network anyway. If there were an HSA associated with the HDP, I think that would tip the scales definitively that way.
As it is, I’m still on the fence. I have to make up my mind this week. I’m thinking it might be the PPO, but I’m definitely going to ask the HR people about the absence of an HSA.