People Like Me
Which Option Works Best for Someone Like Me?
Before you enroll in your benefits, you might find it helpful to see what other people with similar insurance and financial needs are doing. These examples help illustrate how different plans can work better for people in various situations.
- Jeff's story
- Laura's Story
- Sue's Story
- Kurt's Story
- Rachel's Story
- John's Story
- Pete's Story
- Michelle's Story
Jeff, 43, is single with three children.
Health Care Goal: Manage health care expensesJeff had a heart attack last year and needs to watch his cholesterol and weight. He visits the doctor every two to three months. Jeff’s three young children are healthy, but see the doctor often for colds they pick up throughout the school year, as well as for biweekly allergy shots. Because he’s a single parent, convenient medical care is especially important to Jeff.
Medical Plan Decision: Prime Care Advantage
Jeff enrolls in Prime Care Advantage. He likes having a copay instead of coinsurance for the care he and his children receive. This helps him keep out-of-pocket costs manageable, even if he ends up needing a more expensive procedure, such as bypass surgery, next year. Because there’s no coverage outside the plan’s network, Jeff has confirmed that his cardiologist and his children’s doctors are all in the plan’s network.Jeff also decides to look into the weight management programs offered through Your Plan for Health. He’s interested in joining Weight Watchers and knows that the university reimburses a portion of the cost of meetings.
Health Care FSA Contribution: $3,300
Jeff uses the FSA Worksheet and decides to save $3,300 to use toward the copays for his family’s visits to the doctor. He can also use his FSA savings for prescription allergy medications and over-the-counter cold remedies. At this contribution level, he’ll save about $1,0751 in taxes.
Laura, 39, is married with a son.
Health Care Goal: Have predictable health care costsLaura and her family are generally healthy. Her son injured his arm several years ago and occasionally needs to see the doctor when the pain recurs. Other than that, they tend to visit their doctors only for annual checkups or if they have colds.
Medical Plan Decision: Prime Care Advantage
Health Care FSA Contribution: $500
It’s most cost-effective for Laura’s husband to cover himself through his employer's benefits and for Laura to cover herself and her son through the university’s. Laura expects their health care needs to be about the same as they were last year, so she chooses Prime Care Advantage. Laura likes this plan because there’s no deductible and she can plan for most of her out-of-pocket expenses—she knows the copay amounts associated with each service, and the plan covers just about everything at 100 percent after the copay. Plus, all of the doctors she and her sons see are in the plan’s network.Laura uses the FSA Worksheet and decides to contribute $500, which she’ll spend on contact lenses, over-the-counter medications, and various other items. At this contribution level, she’ll save about $1601 in taxes.
Sue, 61, has a domestic partner and no children.
Health Care Goals: Maintain an active lifestyle and don’t pay for more medical coverage than is needed.
Sue and her domestic partner play tennis several times a week and try to eat nutritious, healthy foods. They usually only see their primary care physicians for their annual physicals. Sue sees a chiropractor every three to four months, and her partner takes medication for minor arthritis pain.
Medical Plan Decision: Prime Care Value
Since Sue and her partner don’t use much care and both see network doctors, Sue chooses Prime Advantage Value. If something major does happen, they have enough savings to cover the higher out-of-pocket maximum and can use a university-affiliated hospital to manage costs.Health Care FSA Contribution: $1,400
Sue uses the FSA Worksheet and decides to save $1,400. She’ll use her FSA savings to pay for prescription medications, chiropractic expenses, and contact lenses. At this contribution level, she’ll save about $4501 in taxes.
Kurt, 31, is single with no children.
Health Care Goal: Minimize health care costsKurt took the Personal Health Assessment available through Your Plan for Health. While it didn’t identify any major health problems, he’ll still go for his annual physical in 2009. He has enough savings in the bank to cover a few months of living expenses and isn’t worried about his ability to cover some medical expenses out of pocket, if the situation arises.
Medical Plan Decision: Prime Advantage Value
Kurt needs coverage only for himself. As he’s had no significant medical expenses for several years, the Prime Advantage Value plan’s lower annual premiums will help him save money. If he does get sick, he has savings to cover his deductible and out-of-pocket expenses and is comfortable using providers in the plan's network.Health Care FSA Contribution: $350
Kurt uses the FSA Worksheet and decides to contribute $350. He doesn’t have many medical costs, but can use the money for some dental work he plans to have done during 2009 and for new frames for his eyeglasses. At this contribution level, he’ll save about $1151 in taxes.
Rachel, 41, is married with her first child on the way.
Health Care Goal: Get the best care at a reasonable costRachel and her husband are expecting their first child in the spring. Aside from her recent visits to the OB/GYN, Rachel usually sees her doctor twice a year for her asthma. Rachel’s husband is healthy and rarely visits the doctor.
Medical Plan Decision: Prime Advantage Plus
Rachel sees a network primary care physician, as does her husband, but the OB/GYN she wants to see is non-network. Rachel chooses Prime Advantage Plus because it offers network and non-network benefits. With this plan, Rachel and her husband will also have more flexibility when selecting a pediatrician for their baby.Health Care FSA Contribution: $5,000
Rachel uses the FSA Worksheet and decides to save the maximum $5,000. She’ll use the money to pay for her non-network deductible and coinsurance. Whatever is left over can go toward the laser eye surgery her husband plans to get in the fall. At this contribution level, she’ll save about $1,6301 in taxes.
John, 54, is married with one daughter.
Health Care Goal: Manage health care costsJohn has minor health problems that require regular doctor visits. His wife has diabetes and their daughter is healthy.
Medical Plan Decision: Prime Advantage PlusJohn likes Prime Care Advantage, but because he knows his family will visit both network and non-network doctors in the coming year, he chooses Prime Advantage Plus. His wife sees a network specialist and his daughter a network doctor. But John is switching to a non-network doctor whom a friend recently told him about.
Health Care FSA Contribution: $1,100John uses the FSA Worksheet and decides to save $1,100 to pay for the care and treatments he and his wife will receive this year. At this contribution level, he’ll save about $3601 in taxes.
Health Care Goal: Keep his current doctor as he transitions to the university’s medical coverage (from his wife’s employer)
Pete, 58, is married with no children.Pete and his wife usually elect coverage through her employer, but because she plans to stop working next year, they’ll enroll in the university’s benefits. They are both in good health, and neither typically goes to the doctor more than twice a year. Pete’s wife will eventually need hip replacement surgery, but not for another few years.
Medical Plan Decision: Independent Choice Plan
Pete and his wife have gone to the same doctor for years and want to keep seeing him, even though he’s not part of the university’s network. Pete chooses the Independent Choice Plan because it offers non-network benefits. He and his wife can’t remember the last time they saw a different doctor, and because they don’t expect anything to change this year, they have no need for network coverage.Health Care FSA Contribution: $600
Pete uses the FSA Worksheet and decides to save $600. He and his wife will use the money to pay for their doctor visits. At this contribution level, he’ll save about $2001 in taxes.
Michelle, 46, is single with no children.
Health Care Goal: Manage her chronic conditions
Michelle has chronic obstructive pulmonary disease (COPD) from years of smoking. She was also recently diagnosed with diabetes and needs to watch what she eats and closely monitor her blood pressure.
Medical Plan Decision: Independent Choice PlanMichelle regularly sees two different doctors, but neither is part of the university’s network. She considered changing to network doctors to save money, but since she’s comfortable with both of her current doctors and they know her situation, she decided to wait until after her conditions have started to improve. Michelle enrolls in the Independent Choice Plan.
Because she’s living with two chronic conditions, Michelle also decides she’d like to participate in the CareAllies Smart StepsSM care coordination program available through Your Plan for Health. The program will help her recognize and anticipate the symptoms associated with COPD and diabetes, comply with her care plan, and get additional support between physician visits.
Health Care FSA Contribution: $1,800
Michelle uses the FSA Worksheet and decides to save $1,800. She’ll use the money toward her out-of-pocket costs when she sees her doctors, as well as for her prescriptions and dental expenses. At this contribution level, she’ll save nearly $5901 in taxes.
Tax savings assume a federal tax rate of 25 percent and lower Social Security taxes.
1 Tax savings assumes a federal tax rate of 25 percent and lower Social Security taxes.
