Navigating insurance
Marcus pays $4,200 a year to keep his doctor. He doesn't know it.
When loyalty to a provider costs more than switching.
Marcus picked his plan because it was the only one with Dr. Patel in-network.
He’s been seeing Dr. Patel for three years. Loyalty matters. The plan: $5,000 deductible, 40% coinsurance after that. Premium: $380/month.
Plan A is shown on its own, labelled “$380 a month, $5,000 deductible, 40% coinsurance”, with Dr. Patel inside it as the one in-network doctor Marcus was looking for.
The only plan with Dr. Patel in it
Plan A · what Marcus has
$380/mo · $5,000 deductible · 40% coinsurance after
The plan next door has $30 copay visits and a $0 deductible. But Dr. Patel isn’t in it.
Premium: $440/month. Marcus would pay $60 more a month — $720 more a year — but his first doctor visit would cost $30 instead of whatever-it-costs-until-he-hits-$5,000.
Plan A and Plan B now sit side by side. Plan A holds Dr. Patel at $380 a month with a $5,000 deductible; Plan B holds a new doctor at $440 a month with no deductible and $30 copay visits.
Plan A · with Dr. Patel
$380/mo · $5,000 deductible · visits at full price
Plan B · the plan next door
$440/mo · $0 deductible · $30 copay visits
Marcus sees Dr. Patel four times a year. Let’s run the math.
On his current plan: four visits at roughly $250 each = $1,000 out of pocket (all under his $5,000 deductible, so no insurance help). On the other plan: four visits at $30 each = $120. He’d save $880 in visit costs alone — even after paying $720 more in premium. Net: $160 ahead.
Two cost breakdowns run in parallel. Plan A is $4,560 in premium plus $1,000 of visits, totalling $5,560. Plan B is $5,280 in premium plus $120 of visits, totalling $5,400.
Plan A · with Dr. Patel
- Premium (12 × $380)
- $4,560
- Four visits (4 × $250)
- $1,000
- A year on Plan A
- $5,560
Plan B · new doctor
- Premium (12 × $440)
- $5,280
- Four visits (4 × $30)
- $120
- A year on Plan B
- $5,400
Is Dr. Patel worth $160 a year? Maybe. Maybe not.
Only Marcus knows. But most people don’t run this math — they see their doctor’s name in-network and stop looking. The question isn’t whether you love your doctor. It’s whether the plan that includes them is costing you thousands more than one that doesn’t — and whether that gap is worth it to you.
The two yearly totals are weighed against each other. Plan A, the one with Dr. Patel, is the heavier side at $5,560 against Plan B’s $5,400 — a gap of $160 a year.
the heavier side of the scale
$160 lighter, same four visits
$160 the price of keeping Dr. Patel, per year