Health Savings Account Cost Comparison

CURRENT PLAN QUALITIES		HSA PLAN QUALITIES
Current Deductible	$	Zip Code
Office Visit Copay	$	Primary Gender	M F
Copay for prescriptions	$	Primary Age
ESTIMATED MEDICAL EXPENSES		Spouse Gender	M F N/A
Estimated number of office visits		Spouse Age
Estimated number of prescriptions		# of Children
Estimated Lab/x-ray and other expenses	$	Single or Family Plan? Single Plan Family Plan
Emergency Room Expenses	$	Choose an HSA deductible	$
Expenses not subject to Ded. (Eyecare, Dental etc.)	$	ESTIMATED MEDICAL EXPENSES
Total annual out-of-pocket expenses	$	Estimated total medical expenses*	$
PREMIUM EXPENSES		PREMIUM EXPENSES
Monthly premium for current plan	$	Projected Monthly Premium	$
Annual premium of current plan	$	Projected Annual Premium	$
		HSA CONTRIBUTIONS & TAX SAVINGS
		Total Annual Medical Expenses (w/premium)	$
		HSA Annual Contribution ($2,900 Ind. $5,800 Fam. Max.)	$
		HSA Catch-up Contribution ($900 Max per person, age 55+)	$
		Tax Savings (28% assumed)	$
Total Annual Expenses	$	Total Annual Expenses	$
		Total Net Savings with HSA Plan	$
		Balance in HSA	$