Hey y'all, so I (24 Male, single) recently just accepted a full-time offer from the company i was interning with and needed help deciding what medical plan to go with.
The employer pays 100% of the premium for the HDHP, and the PPO would cost $13.20 weekly for a single person. They also contribute $750 each year to an HSA. I would also like to note that I am relatively healthy and have no health issues.
Here are the details:
Deductibles
PPO
In-network individual: $1,500
In-network family: $3,000
Out-of-network individual: $3,000
Out-of-network family: $6,000
HDHP
In-network individual: $3,400
In-network family: $6,800
Out-of-network individual: $6,800
Out-of-network family: $13,600
Out-of-pocket maximums
PPO
In-network individual: $4,000
In-network family: $8,000
Out-of-network individual: $8,000
Out-of-network family: $16,000
HDHP
In-network individual: $5,000
In-network family: $10,000
Out-of-network individual: $10,000
Out-of-network family: $20,000
Coinsurance
PPO
In-network: 80% plan pays
Out-of-network: 60% plan pays
HDHP
In-network: 100% plan pays
Out-of-network: 70% plan pays
Office visits
PPO in-network
Primary care: $25 copay
Specialist: $50 copay
Urgent care: $50 copay
ER: $250 copay
HDHP in-network
Primary care: Deductible, then $25
Specialist: Deductible, then $50
Urgent care: Deductible, then $50
ER: Deductible, then $250
Prescriptions
For the PPO, prescriptions are copays before deductible:
30-day generics: $10
30-day formulary: $35
30-day non-formulary: $60
30-day specialty: $60
90-day generics: $25
90-day formulary: $87.50
90-day non-formulary: $150
90-day specialty: Not covered
For the HDHP, prescriptions are generally:
Deductible first, then the same copays
Out-of-network prescriptions are not covered
Need help deciding: HDHP or PPO
byu/Affectionate-Test548 inpersonalfinance
Posted by Affectionate-Test548
2 Comments
> I would also like to note that I am relatively healthy and have no health issues.
Then with $0 expected healthcare expenses (or close to it), you would generally be better off with the HDHP.
> They also contribute $750 each year to an HSA.
Since you’d have access to an HSA, you should prioritize making HSA contributions in addition.
Priority of HSA is on the high side.
* https://www.reddit.com/r/personalfinance/wiki/commontopics
If you’re 24 and healthy, HDHP sounds perfect for you. If you can, max out your HSA for the year. (You are limited on how much you contribute based on how many months you’re eligible and how much your employer puts in.)