I have posted most (if not all of this before) but still I get calls from folks on this forum who want to know how I make presentations that result in 95% of my clients buying HDHP plans. Most of my clients are families, most are women, but I do have a few that are men.
Here is info from a shared lead that came in earlier in the week.
Male 41, female 40, 2 kids (youngest is 3).
Currently have a Copay Select and paying $640 per month. He feels like he is throwing away his money since "GR doesn't pay for anything". He is on chol meds which are ridered. The meds run $90 monthly bringing his total outlay to $730.
He wanted a lower deductible for less money.
Like that is going to happen . . .
I priced a few plans that are similar to GR, with deductibles in the $2000 - $2500 range.
Aetna had a $2000 deductible copay plan (limit 6 visits at $40 each) for $460.
He liked the $180 savings.
That savings gap would close once Aetna rated up for chol meds as the premium would increase to around $480. Still, a savings of $140 monthly.
I then walked through a side by side comparison, showing him Copay Select, Aetna 2000, and . . . Aetna HSA 3000.
We talked about the 6 visit limit and what would happen if he used up his limit.
We also talked about the $40 rate up . . . and the $200 Rx deductible.
For his $90 med he pays an extra $240 over the remaining months plus the full cost of the med for the next 2+ months until he satisfies the $200 Rx deductible. Once he satisfies the deductible he pays a $40 copay.
So . . .
For the next 6 months his med costs $600 under the Aetna copay plan . . . the same as he currently is paying.
Next year his med will cost him $1260 (premium + deductible + copays).
So where is the benefit of the copay?
It does not exist.
Now what happens on a major claim?
His Copay Select has $4500 OOP (including deductible) + copays.
The Aetna copay plan has $4000 OOP (including deductible) + copays.
But what about the HSA plan?
For the $3000 HSA the premium is $351 before loads; about $380 after loads. That's an $80 savings vs the copay plan from Aetna.
What does he get with his $80 savings?
When he does go to the doc he pays $60 instead of the $40 copay.
What about his Rx?
It cost's $1330 including the added premium.
Net savings?
About $900.
OOP on a major claim?
$3000 vs. $4000.
If he opted for the $5000 HSA his net savings would be another $1000 per year.
Bottom line is, he went with the $3000 HSA.
I have yet to find a situation where the HSA does not beat the copay plan. It's all a matter of educating the client.
Here is info from a shared lead that came in earlier in the week.
Male 41, female 40, 2 kids (youngest is 3).
Currently have a Copay Select and paying $640 per month. He feels like he is throwing away his money since "GR doesn't pay for anything". He is on chol meds which are ridered. The meds run $90 monthly bringing his total outlay to $730.
He wanted a lower deductible for less money.
Like that is going to happen . . .
I priced a few plans that are similar to GR, with deductibles in the $2000 - $2500 range.
Aetna had a $2000 deductible copay plan (limit 6 visits at $40 each) for $460.
He liked the $180 savings.
That savings gap would close once Aetna rated up for chol meds as the premium would increase to around $480. Still, a savings of $140 monthly.
I then walked through a side by side comparison, showing him Copay Select, Aetna 2000, and . . . Aetna HSA 3000.
We talked about the 6 visit limit and what would happen if he used up his limit.
We also talked about the $40 rate up . . . and the $200 Rx deductible.
For his $90 med he pays an extra $240 over the remaining months plus the full cost of the med for the next 2+ months until he satisfies the $200 Rx deductible. Once he satisfies the deductible he pays a $40 copay.
So . . .
For the next 6 months his med costs $600 under the Aetna copay plan . . . the same as he currently is paying.
Next year his med will cost him $1260 (premium + deductible + copays).
So where is the benefit of the copay?
It does not exist.
Now what happens on a major claim?
His Copay Select has $4500 OOP (including deductible) + copays.
The Aetna copay plan has $4000 OOP (including deductible) + copays.
But what about the HSA plan?
For the $3000 HSA the premium is $351 before loads; about $380 after loads. That's an $80 savings vs the copay plan from Aetna.
What does he get with his $80 savings?
When he does go to the doc he pays $60 instead of the $40 copay.
What about his Rx?
It cost's $1330 including the added premium.
Net savings?
About $900.
OOP on a major claim?
$3000 vs. $4000.
If he opted for the $5000 HSA his net savings would be another $1000 per year.
Bottom line is, he went with the $3000 HSA.
I have yet to find a situation where the HSA does not beat the copay plan. It's all a matter of educating the client.