Plan A Cost

Plan A

Enter the details for the first plan that you want to compare. You’ll need to know the plan’s monthly premium, annual deductible, and out-of-pocket maximum. You’ll also enter the plan’s copay or coinsurance amounts for the most commonly incurred medical expenses.

Plan Name

Plan Type

Employer Annual HSA Contributions

Total HSA contributions exceed 2021 limit. Adjust to $X,XXX or less.

Individual Annual HSA Contributions

Monthly Health Plan Premium

Annual Deductible

Annual Out-of-Pocket Maximum

Anticipated Medical Expense this Year Choose the option that most closely represents the level of medical costs that you expect.

  • Negligible

    You don’t expect to seek any medical services this year

  • Low

    You only visit the doctor for check ups.

  • Average

    You visit the doctor a few times a year and have a few prescriptions.

  • High

    You have an ongoing condition or anticipate a major surgery this year.

  • Custom

    You can input your own healthcare costs and how many times you expect to incur.

Office Visit Coverage
Select All
Select All
Counts towards deductible
Routine Preventative Care
%
Specialist Office Visit
%
Diagnostic Coverage
Diagnostic Costs
%
Lab & Radiology
Imaging tests
%
Hospital Coverage
Inpatient Visits
%
Outpatient Visits
%
Emergency Room Care
%
Prescription Drug Coverage
Generic
%
Brand
%
Other Costs
Other
%