Darcie covers herself and her spouse under the BCBSIL PPO (with HRA). They both see their doctors regularly, and with a baby on the way, Darcie values having flexibility in her care—including the option to use out-of-network doctors. They’ve also accumulated $5,000 in their HRA, which can help them manage upcoming health care expenses.
Everyone has their own unique circumstances and preferences, which factor into their health care decisions. See how some of our neighbors made theirs.
Darcie’s living her best life
Which plan does Darcie choose?
Darcie chooses to stay in the BCBSIL PPO (with HRA).
- With a baby on the way, a large HRA balance will help them pay for their deductible and out-of-pocket expenses.
- Darcie wants to continue to see her current ob-gyn. Her doctor is not included in the network of the BCBSIL QHDHP (with HSA) plan, so she would have to select a new ob-gyn if she moved to the new health care plan.
- Darcie’s spouse needs knee surgery and can receive services through Lantern at no cost.
- Darcie is more comfortable paying more per paycheck and paying copays for her family’s prescriptions.
John’s a family man
John has family coverage in the BCBSIL PPO (with HRA). He and his partner expect to use a lot of health care and anticipate reaching the out-of-pocket maximum. John prefers a lower monthly contribution and is comfortable paying more when he needs care.
Which plan does John choose?
John selects the BCBSIL QHDHP (with HSA).
- John knows his HRA funds will be forfeited when he and his family move to the BCBSIL QHDHP (with HSA).
- John checked the BCBSIL provider finder network and determined that the providers that he and his partner see are in-network.
- John likes having a Health Savings Account (HSA) with State Farm’s contribution to help him pay for his out-of-pocket expenses.
- John likes the option of contributing to his HSA to reduce his taxable income and likes knowing that the funds are his to keep.
Erick’s flying solo
Erick has employee-only coverage under the BCBSIL PPO (with HRA) plan. They mainly use preventive care and have one monthly medication. Erick doesn’t need out-of-network coverage, and because they had an HSA previously, they like knowing they can take their HSA funds with them.
Which plan does Erick pick?
Erick selects the BCBSIL QHDHP (with HSA) plan.
- Erick prefers lower monthly premiums and is okay with paying from savings if something comes up.
- They like the idea of contributing tax-free to their HSA and receiving State Farm contributions.
- After going to caremark.com, Erick knows their prescription will cost them $50 per month.
Jessica’s a single mom
Jessica covers herself and her daughter under the BCBSIL PPO (with HRA) plan. Her daughter sees a couple of specialists regularly and takes several medications, including a specialty medication. Jessica likes having the option to use out-of-network doctors and is not comfortable with a high deductible.
Which plan does Jessica pick?
Jessica stays in the BCBSIL PPO (with HRA) plan.
- Jessica has some money left in her HRA balance that will roll over next year. It will help pay for her (and her daughter’s) deductible and out-of-pocket expenses.
- Since her daughter is on a specialty medicine that qualifies for the PrudentRx program, she will receive the specialty medication at no cost.
- Jessica is comfortable paying more per paycheck and paying copays for her family’s other prescriptions.
Vince is soaking up the sun
Vince lives in Phoenix, Arizona, and has family coverage under the Aetna ACO plan. He, his spouse, and their child use a moderate amount of health care, and Vince is not interested in investing in the Health Savings Account (HSA).
Which plan does Vince pick?
Vince selects the Aetna ACO plan.
- Vince prefers a lower monthly contribution.
- He likes that he can reach out to Teladoc for telemedicine or primary care at no cost.
- His spouse has type 2 diabetes and would like to take advantage of Aetna’s Virta Health program focused on diabetes support.
- Vince and his spouse are able to work with a care coordinator at Included Health to find providers that understand their needs.
Steve is nearing retirement
Steve has family coverage under the BCBSIL QHDHP (with HRA) plan, and his son will remain on the plan for two more years, until he reaches age 26. His family is generally healthy, and his wife’s prescription drug is on the preventive drug list and 100% covered at $0. Steve has $2,000 in HRA funds and maxes out his HCFSA each year, but he struggles to use it all. He is five years away from retiring at age 62 and is worried about paying for health care after he retires, before he becomes Medicare eligible at age 65. Steve would also like to reduce his taxable income.
Which plan does Steve pick?
Steve selects the BCBSIL QHDHP (with HSA).
- Steve prefers lower monthly premiums and is ok paying for services from savings/HSA.
- He likes the idea of contributing tax-free to his HSA and receiving State Farm contributions.
- He prefers the HSA rather than the HCFSA. It reimburses for the same expenses as HCFSA, rolls over annually, and he can use the funds into retirement.
- Steve likes that he can invest contributions in the HSA and that both interest and contributions can grow tax-free.
- Finally, he wants to grow a balance in his HSA to pay for medical premiums when he is Medicare eligible (65+).