Meet Matt – enrolling in coverage for the first time
Matt is 26 and enrolling in coverage for the first time. He is unmarried with no children, and is generally healthy and doesn't need a lot of medical care:
- He gets his annual physical
- Refills a generic prescription a couple times during the year
- Visits his primary care provider (PCP) when he is sick and gets prescribed antibiotics
Here’s how Matt’s health care would be covered with each of the plans:
| Matt’s Total Annual Costs for Health Care Usage for 2023 Services | ||||
|---|---|---|---|---|
| Service (in-network) | Fee | CDHP | Basic PPO | Enhanced PPO |
| Annual physical | $150 | $0 | $0 | $0 |
| 2 generic prescriptions | $30 | $30 (2 x $15) (toward deductible) | $20 (2 x $10 co-pay) | $20 (2 x $10 co-pay) |
| Primary care sick visit | $150 | $150 (toward deductible) | $0 | $0 |
| Generic antibiotic prescription | $20 | $20 (toward deductible) | $10 ($10 co-pay) | $10 ($10 co-pay) |
| Cost of care for the year | $200 | $30 | $30 | |
| Less Capital One’s $500 Contribution to HSA | -$200 (Matt uses $200 to cover his cost of care for the year and saves $300 for future use) | N/A | N/A | |
| Annual Contributions | $687.44 ($26.44 X 26) |
$687.44 ($26.44 X 26) |
$1,486.68 ($57.18 X 26) |
|
| Total Annual Costs (Contributions + Cost of Care) | $687.44* | $717.44 | $1,516.68 | |
*This number represents the total annual cost after using $200 of the Capital One Health Savings Account contribution.
Meet Sirena – covering the whole family
Sirena has a husband and two sons. She and her family are generally healthy, however, her sons get sick a few times, and one of her sons injures his arm playing sports:
- All family members get annual physicals
- Her husband refills a preferred brand prescription a couple times during the year
- The two sons visit their primary care provider (PCP) when they are sick and get prescribed antibiotics
- One son visits the emergency room and receives an X-ray and cast, then has two follow up visits with an orthopedic
Here’s how Sirena and her family’s health care would be covered with each of the plans:
| Sirena’s Total Annual Costs for Health Care Usage for 2023 Services | ||||
|---|---|---|---|---|
| Service (in-network) | Fee | CDHP | Basic PPO | Enhanced PPO |
| 4 annual physicals (in-network) | $600 | $0 | $0 | $0 |
| 2 preferred brand prescriptions | $200 | $200 (toward deductible) | $100 (2 x $50 co-pay) | $100 (2 x $50 co-pay) |
| 4 primary care sick visits (2 visits per son) (in-network) | $400 | $400 (toward deductible) | $0 | $0 |
| 4 generic antibiotic prescriptions (2 per son) | $80 | $80 (4 x $20) (toward deductible) | $40 (4 x $10 co-pay) | $40 (4 x $10 co-pay) |
| ER visit (including x-ray and cast) | $1,500 | $1,500 (toward deductible) | $1,150 ($1,000 toward deductible; 30% coinsurance x remaining $500) | $700 ($500 toward deductible; 20% coinsurance x remaining $1,000) |
| 2 orthopedic visits | $400 | $400 (toward deductible) | $120 (2 X $60 co-pay) | $80 (2 X $40 co-pay) |
| Cost of care for the year | $2,580 | $1,410 | $920 | |
| Less Capital One’s $1,000 Contribution to HSA | -$1,000 | N/A | N/A | |
| Annual Contributions | $4,325.88 ($166.38 X 26) |
$4,325.88 ($166.38 X 26) |
$6,803.42 ($261.67 X 26) |
|
| Total Annual Costs (Contributions + Cost of Care) | $5,905.88* | $5,735.88 | $7,723.42 | |
*This number represents the total annual cost after using the full Capital One Health Savings Account contribution.
Meet Raj – living with a chronic condition
Raj has heart disease and requires a lot of care. His wife is generally healthy; however, Raj requires heart surgery, as well as regular check-ups with a cardiologist throughout the year:
- He and his wife get annual physicals
- His wife refills a generic prescription a couple times during the year
- He and his wife visit their primary care provider (PCP) when they are sick
- He has heart surgery and is also prescribed heart medication
- He visits the cardiologist three times
Here’s how Raj and his wife’s health care would be covered with each of the plans:
| Raj’s Total Annual Costs for Health Care Usage for 2023 Services | ||||
|---|---|---|---|---|
| Service (in-network) | Fee | CDHP | Basic PPO | Enhanced PPO |
| 2 annual physicals (in-network) | $300 | $0 | $0 | $0 |
| 2 generic prescriptions | $30 | $30 (2 x $15) (toward deductible) | $20 (2 x $10 co-pay) | $20 (2 x $10 co-pay) |
| 2 primary care sick visits (in-network) | $200 | $200 (toward deductible) | $0 | $0 |
| Heart surgery | $130,000 | $5,940 ($2,770 toward deductible; 20% coinsurance x remaining $127,230 until he hits the $6,400 out-of-pocket maximum) |
$3,980 ($1,000 toward deductible; 30% coinsurance up to the out-of-pocket maximum of $4,000) |
$2,980 ($500 toward deductible; 20% coinsurance up to the out-of-pocket maximum of $3,000) |
| Heart medication (4 90-day brand supply) | $1,200 | $0 (out-of-pocket maximum is met) | $0 (out-of-pocket maximum is met) | $0 (out-of-pocket maximum is met) |
| 3 cardiologist visits | $900 | $0 (out-of-pocket maximum is met) | $0 (out-of-pocket maximum is met) | $0 (out-of-pocket maximum is met) |
| Cost of care for the year | $6,400 | $4,000 | $3,000 | |
| Less Capital One’s $1,000 Contribution to HSA | -$1,000 | N/A | N/A | |
| Annual Contributions | $3,048.24
($117.24 X 26) |
$3,048.24
($117.24 X 26) |
$4,726.80
($181.80 X 26) |
|
| Total Annual Costs (Contributions + Cost of Care) | $8,448.24* | $7,048.24 | $7,726.80 | |
*This number represents the total annual cost after using the full Capital One Health Savings Account contribution.
Access even more real life examples in the CDHP + HSA Interactive Guide and PPO + Health Care FSA Interactive Guide.
Assumptions: The costs for medical services used in the examples are for illustrative purposes only. Actual costs will differ by type of care of services received, physician and prescription drug fees, and location. The profiles also assume that the associates remain covered as benefits-eligible associates for the entire plan year and use only in-network providers.
You may want to consider the CDHP if you know you will reach your out-of-pocket maximum and can afford to pay for your medical expenses until your HSA funds build up. If you consistently reach your deductible due to high health care expenses and prefer to have those costs spread throughout the year in the form of co-pays and coinsurance, you may want to consider one of the PPO plans. Use the Medical Plan Selector Tool and review other resources to ensure you choose the right plan for you.