PPO or HDHP? Plan Chooser | Lexington Clinic

Who is covered

Coverage level

Which plans are you choosing from?

Lexington Clinic tiered plans Anthem Anywhere plans

Anywhere plans are for employees who live 50 miles or more from 1221 South Broadway, Lexington. They use the Anthem national network with one set of costs and no Lexington Clinic preferred pricing.

Where do you usually get care?

Lexington Clinic providers Other Anthem providers

Lexington Clinic providers are Tier 1 on both plans and cost the least. Hospital stays, emergency rooms and mental health visits are always priced at the Anthem network tier because Lexington Clinic does not provide them.

Rates shown are for full-time employees (30 or more hours a week). Employees working 20 to 29 hours pay different rates for every plan; ask the Benefits Department for yours.

Care you expect this year

Count everyone on your coverage. Pick a starting point, then adjust any number.

Primary care visits

Specialist visits

Immediate care visits

Emergency room visits

Physical therapy visits

Mental health visits

Lab work (cost of tests)

Imaging: X-ray, CT, MRI

Outpatient surgery or procedures

Hospital stay

Dollar amounts are the negotiated (allowed) cost of the service before insurance pays, not what you would owe. Rough guides: routine lab panel $150, X-ray $200, MRI $1,200, minor outpatient procedure $3,000 to $8,000, hospital delivery or major surgery $15,000 to $40,000.

Prescriptions

Ongoing medications you fill every month, by drug tier.

Generic

Preferred brand

Non-preferred brand

I fill prescriptions at CVS I use 90-day supplies after the first three fills (required for maintenance medications)

Specialty drugs are $0 on both plans through PrudentRx and are not included here.

Pre-tax accounts

HSA contribution if you choose the HDHP

FSA election if you choose the PPO

Lexington Clinic matches 50% of your HSA contribution, up to $500 for employee-only coverage or $1,000 for other levels. Contribute $1,000 or $2,000 to earn the full match. A healthcare FSA (up to $3,300) works with the PPO; it must be spent within the plan year plus a short grace period.

Your federal tax bracket

I am 55 or older (HSA catch-up)

Payroll contributions to either account avoid federal income tax, Kentucky's 3.5% income tax and 7.65% FICA. Tax savings are shown as a separate line, not in the headline comparison.

Based on the care you entered

Estimate only, based on the care you entered and the plan design in the 2026 benefits guide. Not a guarantee of any benefit. Official plan documents govern.

How the two plans compare as medical bills grow

Net annual cost for care at Lexington Clinic providers, before prescriptions and tax savings. The HDHP line already includes the employer HSA match.

PPOHDHP with HSA

How this is calculated

Typical year shown

The two plans at a glance

Key numbers from the 2026 benefits guide. Tier 1 is care from Lexington Clinic providers; Tier 2 is other providers in the Anthem network.

Questions employees ask

Plain answers about the Lexington Clinic plans. Official plan documents govern; the Benefits Department can confirm anything specific to you.

Tips for choosing

Rules of thumb that hold up for most people.