This is a sample report generated for an example family. Analyze your own plans →

Health Insurance Analysis

Family of 4 (2 adults, 2 kids ages 9 & 6) · Kentucky · 12-month projection

Prepared by Plan Lens · Risk tolerance: 4/10 (balanced, leaning cautious) · Marginal tax rate: 22%

Family profile — what we parsed

Household 2 adults, 2 children (ages 9 and 6)
State Kentucky
Coverage period 12 months
Tax rate 22% marginal (fed + state + SE)
Medications Adult 1: generic sertraline (SSRI) daily · Child 1 (9): albuterol PRN + daily generic inhaled corticosteroid · household OTC allergy meds
Conditions Child 1 mild persistent asthma (~2 pulmonology visits/yr) · Adult 1 anxiety, ~6 therapy sessions/yr
Upcoming/known Orthodontia consult for 9-yr-old · Adult 2 dermatology mole removal · 4 annual physicals · 2 pulmonology follow-ups
Typical year 3–4 colds per kid, ~1 ER trip (asthma flare or fall), 2–3 urgent care visits, steady asthma refills, a couple specialist visits

Note: All three plans cover preventive care 100%, so the 4 annual physicals are $0 across the board. Orthodontia is typically a dental benefit — none of these three medical plans address it; budget separately (see Action Items).

⚠️ Things to watch out for

Notable risks for your specific situation — not dealbreakers, just worth knowing:

Plan A (HDHP) puts your daily meds behind the deductible. Child 1's controller inhaler and Adult 1's sertraline are subject to deductible, then 20% on Plan A — there's no copay shelter. Until you've spent toward the $8,000 family deductible, you pay close to full cash for refills. On Plans B and C those same generics are flat $10–$15 copays.
Therapy & mental-health benefits aren't itemized in any document. Adult 1's ~6 therapy sessions/yr aren't priced in the plan PDFs. We assumed they bill at the specialist rate (copay on B/C, deductible+20% on A). Confirm outpatient mental-health cost-share with each carrier before deciding.
Your one expected ER trip is priced very differently. Plan A: deductible + 20%. Plan B: $400 copay then 20%. Plan C: flat $300 copay. For a household that expects roughly one ER visit a year, this line item matters more than usual.
Orthodontia is not covered by any of these medical plans. The braces likely coming for your 9-year-old will be out-of-pocket or via a separate dental plan — typically $3,000–$6,000. None of the cost projections below include it.
Plan C is an HMO — in-network only, referral required. Pulmonology and dermatology will need a PCP referral, and out-of-network care isn't covered. If you value picking specialists directly, that's friction worth weighing against its strong cost numbers.

Plan-by-plan cost matrix

Totals are after-tax, all-in annual cost (premium + projected out-of-pocket − tax effects), rounded to the nearest $50. Tax effects: HSA contribution shield on Plan A; employer's $1,500 HSA seed credited as real value. Premiums here are not tax-deductible unless you're self-employed and buying this off-employer — see methodology.

Plan	Premium/yr	Family Deductible	OOP Max	ER cost-share	Best case	Mid case	Worst case	Verdict
A — Anthem HDHP/HSA	$5,040	$8,000	$14,000	Ded + 20%	$6,150	$9,250	$17,200	Cheapest premium, worst tail & quiet-year drug exposure
👑 B — Anthem PPO 1500	$9,120	$3,000	$11,000	$400 + 20%	$9,500	$10,750	$14,950	👑 Best balance for your utilization & risk level
★ C — Humana HMO Select	$11,760	$1,500	$8,000	$300 copay	$11,950	$12,500	$14,500	★ Tightest worst-case cap, but priciest in quiet/typical years

Best case ≈ refills + checkups only · Mid case ≈ typical year (your description) · Worst case ≈ 3 ER, 2 MRI, hospitalization possibility, heavy sick-visit load.

Scenario detail

Best case — quiet year

Annual physicals ($0 preventive), steady asthma + SSRI refills, 2 pulmonology follow-ups, a derm visit, minimal sick care. No ER, no imaging.

Plan	Premium	Projected OOP	Tax/HSA adj.	After-tax total
A — HDHP	$5,040	~$1,650	−$540 (HSA shield + seed)	$6,150
👑 B — PPO 1500	$9,120	~$380	$0	$9,500
C — HMO	$11,760	~$190	$0	$11,950

Plan A wins a quiet year on premium alone — but note its ~$1,650 OOP is mostly your two daily generic meds being charged near-cash until the deductible builds.

Mid case — your typical year

Your described year: ~7 sick/urgent-care visits across the family, 1 ER trip (asthma flare or fall), 2 pulmonology + 1 derm + ~6 therapy sessions, all refills. No imaging beyond minor, no hospitalization.

Plan	Premium	Projected OOP	Tax/HSA adj.	After-tax total
A — HDHP	$5,040	~$4,750	−$540	$9,250
👑 B — PPO 1500	$9,120	~$1,630	$0	$10,750
C — HMO	$11,760	~$740	$0	$12,500

This is the scenario that should drive your decision — it's the year you actually expect. Plan B lands ~$1,500 cheaper than A only in pure premium, but A's deductible exposure (especially that ER + meds) closes most of the gap, leaving B just ~$1,500 more for far steadier monthly bills.

Worst case — bad year

3 ER visits (simple/moderate/complex), 2 MRIs, a short hospitalization, heavy sick-visit load, all chronic care continuing.

Plan	Premium	Projected OOP (capped)	Tax/HSA adj.	After-tax total
A — HDHP	$5,040	$14,000 (OOP max)	−$1,840 (full HSA shield + seed)	$17,200
👑 B — PPO 1500	$9,120	~$5,830 (toward $11k cap)	$0	$14,950
★ C — HMO	$11,760	~$2,740 (toward $8k cap)	$0	$14,500

In a genuinely bad year the rankings flip: Plan A's $14k OOP max + premium makes it the most expensive at ~$17,200, while C's tight $8k cap nearly catches B despite the high premium. This is the tail risk your 4/10 risk tolerance cares about.

👑 Recommended: Anthem PPO 1500 (Plan B)

Why Plan B fits your 4/10 (balanced, slightly cautious) risk tolerance. You have predictable, recurring care — two daily generic meds, chronic asthma management, regular therapy, and a near-certain ER visit each year. Plan B turns all of that into flat, knowable copays ($15 generic, $30 PCP, $60 specialist, $75 urgent care) instead of deductible-gated coinsurance. In your typical year it runs ~$10,750 — only about $1,500 more than the HDHP — but with dramatically steadier monthly bills and no nasty surprise when a refill or ER trip hits before a deductible is met. Its $11,000 OOP max also caps a bad year ~$3,000 below Plan A's.

If your tolerance were higher (7+): Plan A (HDHP) would deserve the crown — it's $1,500–$3,500 cheaper in quiet-to-typical years and the $1,500 employer HSA seed plus 22% tax shield on $8,550 of contributions is real money. The bet you'd be making is that you don't have a bad year — and given an expected annual ER trip and two daily meds, that's a meaningful bet to lose.

If you were more risk-averse than 4 (1–2), or expect a heavy year: ★ Plan C (HMO) earns the alternative marker. Its $8,000 OOP max is the tightest worst-case ceiling here and its copays are the lowest, but you pay $2,640/yr more in premium than B for that protection, accept HMO referral friction, and lose out-of-network coverage. Only worth it if a high-cost year feels likely or specialist access via referral doesn't bother you.

Methodology & assumptions

All projections rounded to nearest $50. Preventive/annual physicals = $0 (all plans). Generic Rx assumed: 2 daily generics (sertraline, inhaled corticosteroid) ≈ 24 fills/yr combined + albuterol PRN.

Rx cost math by plan

Plan B/C: ~24 generic fills × $10–$15 = ~$240–$360/yr — flat, predictable.

Plan A: Same fills billed at deductible/cash rate. A daily ICS inhaler can run $50–$120 cash; sertraline ~$10–$20. Estimated ~$900–$1,300/yr until the family deductible builds — this is the single biggest reason A loses ground in quiet years for your household specifically.

ER & mid-case build-up (Plan B example)

Typical year OOP ≈ 7 sick/UC visits ($30–$75 each ≈ $350) + 1 ER ($400 copay + ~20% of a small post-deductible balance ≈ $500–$650) + 3 specialist ($60 ea = $180) + 6 therapy (~$60 ea = $360) + Rx (~$300) ≈ ~$1,630. Comfortably under the $11,000 OOP max.

HSA / tax treatment (Plan A)

Employer seeds $1,500 → credited as direct value. If you contribute toward the 2026 family limit ($8,550), 22% marginal shield ≈ up to $1,880 in tax savings, but only on dollars you actually contribute. We credited a conservative −$540 (quiet/mid) reflecting partial contribution, and −$1,840 (worst case, full shield assumed because you'd be funding it to spend it). Premiums shown are not assumed tax-deductible (employer-sponsored, pre-tax already, or non-self-employed); if you're self-employed buying off-marketplace, the SE health-insurance deduction would lower all three plans' net premium by 22% — ask us to recompute.

Uncertain inputs: outpatient mental-health/therapy cost-share isn't specified in any plan document (assumed specialist-equivalent). Orthodontia and the derm mole-removal facility/path fees aren't itemized. MRI/imaging and inpatient rates assumed standard deductible-then-coinsurance. Verify these before signing.

Action items

Confirm outpatient mental-health cost-share on Plan B and C for Adult 1's therapy — get the per-visit copay in writing.
Price the daily inhaled corticosteroid on Plan A's formulary (and check if it's a $0/preventive-tier maintenance drug — some HDHPs exempt chronic generics). If it is, Plan A's quiet-year math improves materially.
Get a separate dental/orthodontia plan quote for the 9-year-old's braces — none of these medical plans help. Budget $3,000–$6,000.
Verify pulmonologist & dermatologist are in-network on Plan C (HMO) and confirm the referral process before choosing it.
If self-employed, tell us — the SE health-insurance deduction shifts the after-tax premium on all three plans and could change the recommendation.
Decide on your HSA contribution if leaning toward Plan A — the tax shield only materializes on dollars you actually fund.