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Note: All scenarios assume that you stay in networkScenario 1Scenario 2
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You're pretty healthy, but you have a small accident (like spraining your ankle) and need to go to the ER once. You then get a few prescriptions for pain meds, but otherwise aren't spending much the rest of the year.You have a chronic condition and require two medication monthly. Your condition causes you to have multiple hospital visits
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Insurance AInsurance BNumber of prescriptions5Number of prescriptions24
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Monthly payments$49.47$51.23Cost per prescription$400Cost per prescription$400
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Deductible$100.00$0.00Hospital visit1Hospital visit5
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Max OOP$1,700.00$1,000.00
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Drugs Preferred Post Deductible5%$30.00Plan APlan BPlan APlan B
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Drugs Non-Preferred Post Deductible15%$40.00OOP costOOP costOOP costOOP cost
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Prescription Drug Deductible$100.00$0.00Prescription 1$115.00$30Prescription 1$115.00$30
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Prescription Drug Max OOP$1,700.00$1,000.00Prescription 2$20.00$30Prescription 2 through 24 total$460.00$690
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Hospitalization5%$140.00Prescription 3$20.00$30
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Prescription 4$20.00$30
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Prescription 5$20.00$30
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Total OOP Cost$195$150Total OOP Cost$575$720
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Total year monthly payments$593.64$614.76Total year monthly payments$593.64$614.76
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Hospitalization cost$25.00$140.00Hospitalization cost$125.00$700.00
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Yearly overall cost$813.64$904.76Yearly overall cost pre-max OOP$1,293.64$2,034.76
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Hit max OOP?NoNoHit max OOP?NoYes
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Yearly overall cost post-max OOP$813.64$904.76Yearly overall cost post-max OOP$1,293.64$1,000.00
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