See How Others Decide

What’s important to you in a medical plan? Choosing what’s best for you and your family is essential. Use the scenarios below to see how our medical plans can meet your needs. Remember that these are for illustrative purposes only, so be sure to review your plan options carefully before deciding which is the best fit.

  • Brooke – moderate health care user, age 39, married, 3 children
  • Jason – low health care user, age 31, single, no children
  • Rick – high health care user, age 44, married, no children
  • Maria – high health care user, age 47, married, 2 children

Meet Brooke: 39 years old, married, 3 children.

With three children under the age of eight, Brooke has her fair share of doctor visits—dealing with ear infections, coughs, sports physicals, and more keeps her busy. She makes sure to follow all preventive care guidelines to keep her family healthy, but with kids, you can’t account for everything.

Brooke is currently enrolled in the Aetna PPO plan, but is taking a look at the Aetna HDHP Premium plan. She’s looking for ways to save more money pretax and likes the added benefits of the health savings account—especially the ability to use it for medical expenses now or in the future.

Here’s how the plans compare for Brooke. In this scenario, Brooke has the lowest annual out-of-pocket costs (premiums plus healthcare costs) with the HDHP Premium plan. However, she spends all of the money in her HSA.

 

Aetna PPO

Aetna HMO

Aetna HDHP Premium Plan

Brooke’s Annual Premiums

Employee + family coverage

$4,800

$5,230

$2,460

Brooke’s Health Savings Account Contribution

Brooke pays less in annual premiums with the Aetna HDHP Premium plan. She can save that money and put it into her HSA.

N/A

N/A

$2,340 in annual savings compared to the PPO; $2,770 in annual savings compared to the HMO.

Salesforce's HSA contribution

N/A

N/A

$1,500

Brooke’s Out-of-Pocket Costs

Annual Deductible

Brooke can use the contribution from Salesforce to cover 50% of the Aetna HDHP Premium plan annual deductible.

$1,500

$400

$3,000

Preventive care

Brooke pays nothing for her family’s preventive care. All plans cover preventive care at 100% in-network.

$0

$0

$0

Doctor visits

Brooke visits her in-network PCP 4 times during the year. When her kids get sick, she takes them to their in-network PCP 6 times.

Under the Aetna PPO and HMO, Brooke pays copays for doctor visits.

Under the Aetna HDHP Premium plan, Brooke pays all costs until she meets the annual family deductible.

$15 copay x 10 = $150

$15 copay x 10 = $150

$120 per visit x 10 = $1,200*

* Paid from her HSA

Prescriptions

Brooke needs a 30-day supply of 3 non-preventive generic prescriptions for her family.

Under the Aetna PPO and HMO, Brooke pays $25 copays for a 30-day supply.

Under the Aetna HDHP Premium plan, Brooke pays 100% until she meets the annual family deductible.

$25 copay x 3 = $75

$25 copay x 3 = $75

$43 per prescription x 3 = $129*

*Paid from her HSA

Non-preventive prescriptions are subject to the deductible and coinsurance. The amount shown is Brooke’s responsibility.

ER Visits

Brooke’s son kicks a soccer ball a little too hard; she takes him to the ER to treat a broken toe.

$75 copay

$75 copay

$650 x 1 = $650*

*$171 is paid from her HSA and $479 is paid by Brooke

Brooke’s Total Costs

Premiums + out-of-pocket costs

$5,100

$5,530

$2,939

Amount left over in HSA

N/A

N/A

$0

Back to top

Meet Jason: 31 years old, single, no children.

Jason is an avid hiker and trail runner. He loves being outdoors. But last year, a nasty trip on the trail had him sidelined for eight weeks while he recovered from a severe ankle sprain and stress fracture. He’s thankful for the physical therapy that got him back running on the trails.

After last year’s ankle injury, Jason wants to focus on staying healthy. Jason wants a medical plan that covers him in case of a major illness or injury, but otherwise he doesn’t foresee having to use the plan all that much. He’ll need his seasonal allergy medication, especially if he wants to hit the trails hard. He’s also looking for ways to save more money pre-tax and to maximize his savings potential now, while he’s single.

Here’s how the plans compare for Jason. Assuming he receives the healthcare services described below, Jason has the lowest annual costs (premiums plus healthcare costs) under the Aetna HDHP Premium plan. Plus, he has $587 in his HSA at the end of the year.

 

Aetna PPO

Aetna HMO

Aetna HDHP Premium Plan

Jason’s Annual Premiums

Employee-only coverage

$960

$1,200

$420

Jason’s Health Savings Account Contribution

Jason pays less in annual premiums with the Aetna HDHP Premium plan. He can save that money and put it into his HSA.

N/A

N/A

$540 in annual savings compared to the PPO; $780 in annual savings compared to the HMO.

Salesforce’s HSA contribution

N/A

N/A

$750

Jason’s Out-of-Pocket Costs

Annual Deductible

Jason can use the contribution from Salesforce to cover 50% of the Aetna HDHP Premium plan annual deductible.

$500

$200

$1,500

Preventive care

Jason pays nothing for his preventive care. All plans cover preventive care at 100% in-network.

$0

$0

$0

Doctor visits

Jason visits his doctor once.

Under the Aetna PPO and HMO, Jason pays copays for in-network doctor visits.

Under the Aetna HDHP Premium plan, Jason pays all costs until he meets the annual deductible.

$15 copay

$15 copay

$120 x 1 = $120*

* Paid from his HSA

Prescriptions

Jason needs a 30-day supply of 1 non-preventive generic prescription.

Under the Aetna PPO and HMO, Jason pays $10 copays for a 30-day supply.

Under the Aetna HDHP Premium plan, Jason pays 100% until he meets the annual deductible. 

$10 copay

$10 copay

$43 x 1 = $43*

*Paid from his HSA

Non-preventive prescriptions are subject to the deductible and coinsurance. The amount shown is Jason’s responsibility.

Jason's Total Costs

Premiums + out-of-pocket costs

$985

$1,225

$420

Amount left over in HSA

N/A

N/A

$587*

* Amount rolls over to next year

Back to top

Meet Rick: 44 years old, married, no children.

Rick tries to follows the “rules.” He regularly schedules annual preventive care exams and tries to stay active and eat healthy. But no matter what he does, his cholesterol is high. He’s tried numerous medications and regularly sees his doctor. He knows that if he doesn’t manage his cholesterol, he could be susceptible to serious health problems down the road.

Rick wants a medical plan that covers all of his and his wife’s needs. He knows he’ll have to pay out-of-pocket for some costs.

Rick’s annual out-of-pocket costs are lowest if he selects the HDHP Premium plan.  With the PPO, he pays a higher monthly contribution, but lower costs when he receives care.  With the HDHP Premium plan, Rick’s monthly contributions are lower than the PPO, and he generally pays more for services received, but Salesforce contributes $1,500 to his HSA which helps to offset the additional costs.

 

Aetna PPO

Aetna HMO

Aetna HDHP Premium Plan

Rick’s Annual Premiums

Employee + Spouse coverage

$2,910

$3,250

$1,440

Rick’s Health Savings Account Contribution

Rick pays less in annual premiums with the Aetna HDHP Premium plan. He can save that money and put it into his HSA.

N/A

N/A

$1,470 in annual savings compared to the PPO; $1,810 in annual savings compared to the HMO

Salesforce’s HSA contribution

N/A

N/A

$1,500

Rick’s Out-of-Pocket Costs

Annual Deductible

Rick can use the contribution from Salesforce to cover 50% of the Aetna HDHP Premium plan annual deductible.

$1,500

$400

$3,000

Preventive care

Rick pays nothing for his preventive care. All plans cover preventive care at 100% in-network.

$0

$0

$0

Doctor visits

Rick visits his in-network PCP 5 times and an in-network specialist 6 times.

Under the Aetna PPO and HMO, Rick pays copays for doctor visits.

Under the Aetna HDHP Premium plan, Rick pays all costs until he meets the annual family deductible.

$15 copay x 11 = $165

$15 copay x 11 = $165

5 x $120 PCP

+ 6 x $180 Specialist = $1,680*

*$1,500 paid is from his HSA and $180 is paid by Rick.

Prescriptions

Rick needs to refill a 90-day supply of mail-order preventive drug prescription 4 times a year.

Under the Aetna PPO and HMO, Rick pays $50 copays for a 90-day supply.

Under the Aetna HDHP Premium plan, Rick pays 100% until he meets the annual family deductible. 

$50 copay x 4 = $200

$50 copay x 4 = $200

$50 copay x 4 = $200

If the required drug is not listed in the Preventive Drug List [PDF] you pay 100% until the deductible is met.

Rick’s Total Costs

Premiums + out-of-pocket costs

$3,275

$3,615

$1,820

Amount left over in HSA

N/A

N/A

$0

Back to top

Meet Maria: 47 years old, married, two children.

Unfortunately, Maria and her two daughters were in a serious auto accident this year, resulting in long hospital stays for each of them. They’re recuperating well now and will make a full recovery, but have incurred large health care bills.

Because of the high volume and cost of services they’ve received, the HMO would be the best option for Maria and her family. While the HMO has the highest premiums, it also has the lowest cost for services.

 

Aetna PPO

Aetna HMO

Aetna HDHP Premium Plan

Maria’s Annual Premiums

Employee + family coverage

$4,800

$5,230

$2,460

Maria’s Health Savings Account Contribution

Maria pays less in annual premiums with the Aetna HDHP Premium plan. She can save that money and put it into her HSA.

N/A

N/A

$2,340 in annual savings compared to the PPO; $2,770 in annual savings compared to the HMO.

Salesforce’s HSA contribution

N/A

N/A

$1,500

Maria’s Out-of-Pocket Costs

Annual Deductible

Maria can use the contribution from Salesforce to cover 50% of the Aetna HDHP Premium plan annual deductible.

$1,500

$400

$3,000

Preventive care

Maria pays nothing for her family’s preventive care. All plans cover preventive care at 100% in-network.

$0

$0

$0

Doctor visits

Maria and her family visit their in-network PCPs 12 times.

Under the Aetna PPO and HMO, she pays copays for doctor visits.

Under the Aetna HDHP Premium plan, Maria pays all costs until she meets the annual family deductible.

$15 copay x 12 = $180

$15 copay x 12 = $180

12 x $120 = $1,440*

*$1,440 is paid from her HSA.

Hospitalization

Maria and her daughters were rushed to the hospital where they were treated for five days.

Under the HDHP Premium plan, they pay 100% until they meet the annual family deductible.

$20,000 a day x 5 days x 3 people = $300,000

10% coinsurance after deductible = $30,000

Maria will pay $3,000 of this then reach the out-of-pocket maximum

$0

$20,000 a day x 5 days x 3 people = $300,000

10% coinsurance after deductible cost = $30,000

Maria will pay $4,560 and then reach the out-of-pocket maximum

Maria’s Total Costs

Out-of-pocket Maximum

$4,500

$4,400

$6,000

Premiums + out-of-pocket costs

$9,300

$5,410

$8,460

Amount left over in HSA

N/A

N/A

$0

Back to top