Home

Comparison Charts

Now that you know the difference between how the CHOICE and NAVIGATE plans work, in terms of network and PCP requirements, let's take a look at your out-of-pocket costs between the plans.

There are three variations of each, simply named Choice 1, Choice 2 and Choice 3 vs. Navigate 1, Navigate 2 and Navigate 3.

The benefit structure for Choice 1 is the same as Navigate 1. This means that once you've enrolled in Navigate 1, for example, going to see the doctor for a regular checkup requires the same $20 co-pay that you would pay on the Choice 1 plan. While you are paying a lower premium on Navigate, this HMO plan requires you to select a primary care physician (PCP) from within the smaller Navigate network, and seeing any other doctors requires a referral from your PCP.

Terms To Know

We understand that Health Insurance terminology can be very confusing. To understand the differences between the 1, 2 and 3 Plan options, it is important to begin with the basics and understand the meaning and definitions of a few key words to help you maneuver more effectively through the Healthcare landscape.

Co-payment: Each time you see a provider or fill a prescription, you’ll pay a co-pay (a fixed amount each time, so there is no deductible or co-insurance).

Deductible: You pay your share of care, which is 100% of the costs until you reach your deductible. For the Choice and Navigate plans, the deductible only applies certain health benefit claims.

Co-insurance: After you’ve reached your deductible, you only pay a percentage, called co-insurance. For the Choice and Navigate plans, the co-insurance only applies certain health benefit claims.

Out-of-pocket limit: You’ll never pay more than your out-of-pocket limit during the plan year. The out-of-pocket limit includes all of your network co-payment, deductible and co-insurance payments.

See our full glossary of insurance terms here:

Glossary of Terms

Please note: Monthly premiums listed on the chart do not consider your Premium Benefit eligibility to offset premium costs. Read more about Premium Benefit here.

For more details, review the complete guide to Non-Medicare Plans in 2017!

Non-Medicare Retiree 2017 Group Insurance Guide

Updated October 21, 2016

The bottom line

Which plan is right for you? Neither UHC nor the ASRS can make that decision for you. This is your decsion to make and yours alone. However, we want to help as much as we can. We have devised four likely profiles of utilization and compared the out-of-pocket costs for you to see where each plans has its pros and cons.

Things to know about these examples below:

  • First, you should review your claim history on your secure myuhc.com account. Once you know your personal claim history, the examples below might help you decide the best plan for you in 2017.
  • The estimated 'Total Annual Cost' on all of these examples includes the monthly premium * 12 months.
  • The 'Total Annual Cost' amounts listed below may sound inflated to you because they are depicted BEFORE applying your ASRS premium benefit. Still, the bottom line is accurate in terms of potential savings.
  • If you are currently receiving premium benefit, you can find the annual amount if you log in to your myASRS account and click 'payment history'. The default selection shows your year-to-date in 2016. You would need to add any remaining months worth of premium benefit through December to the total to estimate the full 2016 amount, or look at the '2015' total if there have been no changes.
  • If you are NOT current receiving premium benefit, read more about Premium Benefit here, including a chart you can use to estimate your benefit.

Okay let's review some typical examples of utilization of medical benefits.

Example 1 - Minimal Utilization

If you are generally healthy and experience a year with few medical expenses and no hospital stays, this chart shows your expected out-of-pocket costs for 2017 under each of the non-Medicare plans for those who live in state.

The 'Choice 1' Plan is the same plan that was available in 2016. Total out-of-pocket costs for you, BEFORE APPLYING any premium benefit reductions, would have been $9,776 in 2016 in this scenario.

If you look at the two 'Difference from 2016' rows, you can see that the Choice plan, now called Choice 1, has a 4% premium increase from 2016. But any of the new plans would result in a savings to you of $282-$1,826 dollars over the course of 2017 in the scenario provided.

You can see that while the new Non-Medicare plans have slightly higher co-pays and introduce the concept of a deductible, the deductible does not apply to regular medical costs like doctor visits and prescriptions. Doctor visits have varying copays, while prescriptions all have the same copays across all plans.

Example 2 - Low medical / high prescription utilization

In another example of a generally healthy year with few medical expenses and no hospital stays, this chart shows your expected out-of-pocket costs for 2017 under each of the non-Medicare plans for those who live in state. The difference in this chart from the previous chart is a dramatically increased prescription drug experience.

The 'Choice 1' Plan is the same plan that was available in 2016. Total out-of-pocket costs for you, BEFORE APPLYING any premium benefit reductions, would have been $11,526 in 2016 in this scenario.

If you look at the two 'Difference from 2016' rows, you can see that the Choice plan, now called Choice 1, has a 4% premium increase from 2016 and so will cost more in 2017. But any of the new plans would result in a savings to you of $282-$1,826 dollars over the course of 2017 in the scenario provided.

You can see that while the new Non-Medicare plans have slightly higher co-pays and introduce the concept of a deductible, the deductible does not apply to regular medical costs like doctor visits and prescriptions. Doctor visits have varying copays, while prescriptions all have the same copays across all plans.

Example 3 - Moderate utilization

Some years you experience an ER visit and some physical therapy as well as increased doctor visits and prescriptions. This chart shows your expected out-of-pocket costs for 2017 under each of the non-Medicare plans for those who live in state.

The 'Choice 1' Plan is the same plan that was available in 2016. Total out-of-pocket costs for you, BEFORE APPLYING any premium benefit reductions, would have been $12,776 in 2016 in this scenario.

If you look at the two 'Difference from 2016' rows, you can see that the Choice plan, now called Choice 1, has a 4% premium increase from 2016 and so will cost more in 2017. But any of the new plans would result in a savings to you of $272-$1,536 dollars over the course of 2017 in the scenario provided.

You can see that while the new Non-Medicare plans have slightly higher co-pays and introduce the concept of a deductible, the deductible does not apply to regular medical costs like doctor visits and prescriptions, and does not even apply to ER, urgent care (UC) or physical therapy. Doctor, ER and UC visits have varying copays, while prescriptions all have the same copays across all plans.

Example 4 - High utilization

Some years are just painful and expensive. This chart shows your expected out-of-pocket costs for 2017 under each of the non-Medicare plans for those who live in state, for a year where you experience a high cost procedure and hospital stay.

The 'Choice 1' Plan is the same plan that was available in 2016. Total out-of-pocket costs for you, BEFORE APPLYING any premium benefit reductions, would have been $13,016 in 2016 in this scenario.

If you look at the two 'Difference from 2016' rows, you can see that the Choice plan, now called Choice 1, has a 4% premium increase from 2016 and so will cost more in 2017. Two of the new plans, Navigate 1 and Navigate 2, would cost less money to you in 2017 in a catastrophic year like this scenario depicts. However, Choice 2, Choice 3 and Navigate 3 would end up costing you more money.

In a bad medical year, the new plans have higher out-of-pocket maximums and so could conceivably cost more than the current 2016 Choice plan in total member expenses. Refer the chart at the top of this page. For unexpected expenses like outpatient surgery and inpatient hospital stays, the deductible applies before co-insurance kicks in until the out-of-pocket maximum is reached. In the scenario described here, the inpatient hospital stay pushes you right to the out-of-pocket maximum. After that, all expenses are covered 100% by the plan.

We hope these examples help give you context when deciding which plan is best for you.

Was this page helpful?: 
Average: 4.1 (15 votes)