Let’s look at three hypothetical Capital One associates, learn about their medical needs, and see what their total costs are under each medical plan option. Can you identify with any of them? This may help you with your own decision process.

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. He 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 2022 Services
Service (in-network) Fee CDHP Basic PPO Enhanced PPO
Annual physical $150 $0 $0 $0
2 generic prescriptions $30 $30 (2 x $15) (towards deductible) $20 (2 x $10 co-pay) $20 (2 x $10 co-pay)
Primary care sick visit $150 $150 (towards deductible) $0 $0
Generic antibiotic prescription $20 $20 (towards 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 2022 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 (towards 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 (towards deductible) $0 $0
4 generic antibiotic prescriptions (2 per son) $80 $80 (4 x $20) (towards deductible) $40 (4 x $10 co-pay) $40 (4 x $10 co-pay)
ER visit (including x-ray and cast) $1,500 $1,500 (towards deductible) $1,500 (towards deductible) $1,100 ($1,000 towards deductible; 20% coinsurance x remaining $500)
2 orthopedic visits $400 $400 (towards deductible) $120 (2 X $60 co-pay) $80 (2 X $40 co-pay)
Cost of care for the year $2,580 $1,760 $1,320
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* $6,085.88 $8,123.42

*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 2022 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) (towards deductible) $20 (2 x $10 co-pay) $20 (2 x $10 co-pay)
2 primary care sick visits (in-network) $200 $200 (towards deductible) $0 $0
Heart surgery $130,000 $5,940 ($2,770 towards deductible; 20% coinsurance x remaining $127,230 until he hits the $6,400 out-of-pocket maximum) $7,960 ($2,000 towards deductible; 30% coinsurance x remaining $128,000 until he hits the $8,000 out-of-pocket maximum) $5,960 ($1,000 towards deductible; 20% coinsurance x remaining $129,000 until he hits the $6,000 out-of-pocket maximum)
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 $8,000 $6,000
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* $11,048.24 $10,726.80

*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.