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Alexander Smith is a 55-years-old man. Here is the information from his healthcare insurance card: XYZ Hospital Plan Group No. 89881772 Subscriber Name: Alexander Smith

Alexander Smith is a 55-years-old man. Here is the information from his healthcare insurance card:

XYZ Hospital PlanGroup No. 89881772
Subscriber Name: Alexander SmithRx Bin/Group 08081323
Subscriber ID: ED345XY
Copay for 30-day supply:In Network Member Responsibility
Generic Rx $12Primary $30
Preferred Brand Rx $40Specialist $70
Nonpreferred Brand Rx $65PT/OT/ST/CHIRO $52
MH/SA $52
Urgent Care $87
ER $233

This year, Alexander saw his in-network primary care provider (a family practice physician). His primary care provider (PCP) ordered a colonoscopy. Alexander had the colonoscopy at an in-network ambulatory surgery center. There were some concerns and his PCP recommends he have another colonoscopy next year. He sees his PCP once annually.

Alexander has a chronic skin condition. Each year, he sees his dermatologist four times in order to have his prescription renewed. The prescription for his daily medication is a common antibiotic for which his physician orders the generic equivalent.

He is a former high-school and college quarterback. He currently exercises 60 to 90 minutes per day, alternating daily between cardiovascular and free-weight routines. Last year, his hip started to “catch” sporadically. He saw a physical therapist twice. The physical therapist (PT) gave him two sets of exercises to strengthen the muscles supporting the hip joint. He will follow up again next year with the PT for two visits.

  • Premium: $21.72 per month (employer pays $197.45 per month)
  • Benefit year deductible: $1,400 for out-of-network
  • Cost of visit to primary care physician: $79
  • Colonoscopy facility costs to Alexander after insurance payment: $664 (total was $2,346)
  • Colonoscopy physician costs to Alexander after insurance payment: $400 (total was $667)
  • Colonoscopy anesthesiologist costs: $100 (total was $250)
  • Cost of visit to dermatologist: $85
  • Cost of visit to physical therapist: $75
  • Cost of medications $15 (30-day supply)

Alexander is considering changing his health insurance from this current one he has now to a high-deductible plan with a health savings account. The new high deductible insurance will cost him $10 a month, but the deductible will be $1000. If he switches to this high-deductible plan, his employer will give contribute $2500 to an HSA account. Should Alexander switch? Why or why not? HINT: In order to determine this, you will need to calculate how much he will currently pay out of pocket and how much he will pay out of pocket for his new plan.

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