By - January 8, 2018

One New Prescription and I Was in the Wrong Health Plan

One New Prescription and in Wrong Health Plan Blog Image

For employees of Tango Health, we offer two high-deductible health plans (HDHP). My spouse and I have been on Tango’s highest deductible plan, which has an individual deductible of $4,000 and an out of pocket maximum of $5,000 per person. After contributing to our HSA for several years, we have a high enough balance in our HSA to cover both the deductible and the out-of-pocket maximum for both of us.

Most years, we don’t even come close to the $4,000 deductible. When I use Tango’s Decision Assist software and look at “other people like me” who have typical medical expenses, my peer group doesn’t seem to hit the deductible either and in total have around $700 in annual expenses. When I look at peer groups that have “higher than normal” expenses, they did not hit the deductible even with their expenses over $3,000. The highest deductible plan, which has the lowest premium, still made the most financial sense for us.

However, I was recently prescribed a very expensive brand-name drug that while “covered” is incredibly expensive. Until there is a generic, I will pay several hundred dollars each month. I consulted the Tango decision support software and found that I will save several hundred dollars in both annual out-of-pocket and annual net cost (which figures in tax savings from HSA contributions) if I switch plans. Why? Even with paying higher premiums each month, by hitting my deductible sooner, each prescription after that is drastically cheaper because of the co-insurance factor.

My financial and health risk profile has not changed.  Decision support software that only consider a person’s risk profile and not specific medical spending scenarios would not recommend the most economical plan for me in this circumstance.  I am fortunate to have access to the Decision Assist software to quickly run scenarios with different medical cost estimates.  Otherwise I would be spending more money for the same care. I’m ready to make the switch with open enrollment approaching.

If your employees are choosing the same plan year-after-year and aren’t able to make a data-driven decision, see how we can help. Request a Demo.


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