Can you afford a $50 Co-pay?

Can You Afford A $50 Co-pay?
By J. Keith Johnson

With health insurance rates increasing at double digit rates, more and more employers are searching for a way to stem the tide. Employers are forced to ask employees to shoulder more of the cost as premiums increase. If you have health coverage, whether group or individual, ever increasing premiums, deductibles, co-pays, and co-insurance are a fact of life.
To complicate matters, most employees do not understand their health insurance. Ask them about their coverage, they’ll tell you about their co-pay. Few know their individual or family deductible and virtually none of them know their co-insurance amount or maximum out of pocket. If you increase the deductible and co-insurance, hardly anyone will notice. If you increase the co-pay, everyone screams. Therefore, employers take the path of least resistance.
I have a couple of questions. First, do you think most employees could afford a $50 co-pay for doctor’s office visits? Probably. Emergency room co-pays are $50-$100 right now and many use the emergency room rather than a doctor’s office visit for routine illnesses, so it’s possible.
Second question, would most Americans be happy if they could get the insurance company to pay that whole $50? You bet!
So if you would like the insurance company to pay your $50 co-pay, welcome to the HSA plan.
HSA qualified plans use premium savings from the health coverage to help fund medical expenses. Rather than send a large premium for a co-pay plan to an insurance company, you send less premium by purchasing a lower cost, one deductible plan and placing the premium savings up to the amount of the deductible, in a tax-free fund for use as needed.
So how does that equal a $50 co-pay? Easy. An in-network doctor’s office visit is approximately $50. Under a standard co-pay plan, you pay $20 and the insurance company pays $30. Under the one deductible HSA plan, you pay the medical expenses up to the deductible. Voila, $50 co-pay! And, the employee did not have to pay tax on the $50.
But, you may ask, how do I get the insurance company to pay that $50? Once again, it’s easy. Here is an example of a small group with some health issues that recently switched to an HSA qualified plan:

Small group (7 employees)
Last year’s co-pay plan monthly premium: $3,738.00
(This does not include this year’s increase)
This year’s HSA plan monthly premium: $2,604.00
Monthly savings: $1,134.00 (30% savings)

Monthly savings per employee: $ 162.00



Monthly per Employee Contributions:
Contribution to HSA: $ 50.00
Employer paid Dental premium: $ 88.00
(New benefit)
Employer paid voluntary benefit premium: $ 9.00
(new benefit)
Savings to employer’s bottom line: $ 15.00
(per employee)

Total annual employer savings: $1,260.00

As you can see, the employer used part of the monthly savings (insurance company’s money) to help fund the employee’s HSA. This is the money used to pay the doctor’s office visit. Nothing came out of the employee’s pocket. The money literally came out of the insurance company’s pocket.
In addition, the employer was able to improve benefits by adding dental and a medical bridge plan to help pay medical costs in the event of a hospitalization. All this and he reduced his costs. Find that in a co-pay plan!
Oh, and the best part? Whatever the employee doesn’t use each year, he gets to keep!
Congratulations. You just started a de facto retirement plan with no IRS reporting requirements.
I’ve heard all the arguments against HSA’s. They are all baloney. The only reason an HSA qualified plan will not work is if you don’t save enough premium. Period.


J. Keith Johnson is an independent insurance broker, specializing in HSA qualified plans. For more information you may reach him at:
Free State Business, LLC
15954 Mur-Len, #305
Olathe, KS 66062
(913) 787-0152
Email: jkjohnson@freestatebusiness.com