The two biggest questions when purchasing health insurance are:
- How much does it cost?
- What do I get?
Many people tend to just look at the monthly price to decide what’s affordable. But that’s not the whole picture. A cheaper plan may not cost less in the end if your health care needs aren’t covered. Here’s another approach to choosing a health plan for your health care and financial needs.
For any health plan, you will have out-of-pocket costs in addition to the monthly premium, which include:
- Health service costs prior to meeting your health plan’s deductible amount
- Copays or set amounts you pay when receiving medical care
- Co-insurance which is the percentage you pay for health services after meeting your deductible
- Excluded health services not covered by your health insurance
If you don’t need regular medical care or prescriptions for those you cover, a high deductible plan may work best. Let’s look at how the BCBSND SimplyBlue health plan (a high-deductible plan) vs. BlueCare (a traditional plan) would work for Alyssa during the course of a year.
Alyssa is 25 and enrolls as single, non-smoking and living in North Dakota. For her needs, a high-deductible plan will offer her less out of pocket costs.
Health service |
SimplyBlue |
BlueCare |
Annual cost of monthly premiums* |
$2,536.92 |
$3,903.96 |
Preventive care annual doctor visit |
100% covered by health plan |
100% covered by health plan |
Quarterly refill for generic prescription + |
$40 |
$20 |
Flu shot |
100% covered by health plan |
100% covered by health plan |
Doctor visit for skin rash |
$40 copay |
$20 copay |
Skin cream prescription for rash+ |
$20 copay |
$5 copay |
Total out-of-pocket cost |
$2,636.92 |
$3,948.96 |
*Premium costs will vary based on age, tobacco use and plan enrollment.
+ Cost estimated for example
Now, let’s consider how this would change if Alyssa had diabetes and asthma requiring regular doctor visits and prescriptions. With these needs, the traditional plan would work best to cover more of her health care costs.
Health service |
SimplyBlue |
BlueCare |
Annual cost of monthly premiums* |
$2,536.92 |
$3,903.96 |
Preventive care annual doctor visit |
100% covered by health plan |
100% covered by health plan |
Quarterly refill for generic prescription+ |
$40 |
$20 |
Flu shot |
100% covered by health plan |
100% covered by health plan |
Doctor visit for skin rash |
$40 copay |
$20 copay |
Skin cream prescription for rash+ |
$20 copay |
$5 copay |
Monthly primary care visit+ |
$1,440 ($120 per visit+) |
$240 ($20 copay per visit) |
Quarterly specialist visit+ |
$1,200 ($300 per visit+) |
$240 ($20 copay per visit) |
Monthly inhaler prescription refill+ |
$480 ($40 copay per refill) |
$60 ($5 copay per refill) |
Monthly insulin prescription refill+ |
$1,200 (40% of $250 monthly charge+) |
$600 ($50 copay per refill) |
Emergency room visit |
$240 (40% of $600 charge+) |
$200 copay |
Total out-of-pocket cost |
$7,196.92 |
$5,288.96 |
*Premium costs will vary based on age, tobacco use and plan enrollment.
+ Cost estimated for example
What’s right for you?
Weighing options for a health plan is important to ensure you make the best choice for your needs. Our independent agents are trained to walk you through financial and wellness goals to determine your best health coverage options. Also, our decision guide shows you considerations to make before picking a health plan.
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