THIS IS INTENDED AS AN ESTIMATE — NOT A QUOTE OR GUARANTEE OF COVERAGE. BUILT ON STANDARD FULL TIME EMPLOYEE RATES AND BENEFIT DESIGNS. YOUR ACTUAL COST AND AVAILABILITY OF DISPLAYED OPTIONS MAY DIFFER BASED ON JOB CLASSIFICATION, NUMBER OF HOURS WORKED, AND ACTUAL UTILIZATION.
Answer a few quick questions about how you expect to use care, and we'll estimate your total cost under the 2026 Madison plans available to you — premium, out-of-pocket, the district's annual HSA contribution where applicable, and tax savings.
Runs entirely in your browser — nothing is saved or sent.
First, tell us about you
Which employee group are you in?
Your answer determines the plans, monthly contributions, and district annual HSA amounts used in your estimate.
First, the basics
Who are you covering?
What matters more?
What matters more to you?
There's no wrong answer — it just helps us frame the trade-offs when we show you the math.
No crystal ball required — just a rough guess. An active lifestyle can mean the odd weekend urgent-care visit or occasional ER trip, and estimating it helps us get your numbers right.
Urgent-care visits
Walk-in clinic for minor, urgent issues
Emergency-room visits
Hospital ER for serious emergencies
Prescriptions
How about medications?
We just need the meds you take regularly, in two buckets. Not sure whether something's generic or brand? Your pharmacy label says.
Short-term — a few times a year
Short-term prescriptions
One-off fills like an antibiotic (Z-Pack) or an infection. How many courses in a typical year? Most are generic, so we count each as a single copay.
Ongoing — taken every month
Ongoing generic medications
Maintenance meds you refill monthly — we'll do the 12-fills-a-year math. Just count how many different generics.
Ongoing brand-name medications
Same idea, higher-cost name-brand drugs. Count how many different brand meds.
Specialty medications $0
Covered via Specialty Advocacy — $0 to you, handled outside the plan
The year ahead
Any significant upcoming healthcare events that you're aware of?
Almost there
Roughly, what's your annual household income?
We use this only to estimate your potential tax savings from paying for care with pre-tax dollars. Nothing is saved.
Last one
What kind of plan are you on today?
Totally optional. Many people prefer to keep the type they already have — if you're on an HSA, we'll put those options first.
Your personalized estimate
Your best match is —
Plans ranked by your estimated total cost — lowest first — based on the information you provided. This is an estimate, not a guarantee of coverage, provided to support your enrollment review. Consult plan details for a complete review of coverage.
Preventive care & specialty medications are $0. For an HSA plan, total = premium + your expected out-of-pocket − the district's annual HSA contribution, capped at the plan's out-of-pocket maximum. PPO and MedFlex estimates do not include an employer account contribution. Premiums are the monthly amounts straight from payroll; your per-paycheck deduction depends on how many pay periods you have. Estimate only — not a quote.
Assumptions & data behind the estimate
Plan cost-sharing & annual HSA contributions — 2026 SBCs and plan documents
Plan
Deductible S/F
OOP max S/F
Office visits
District Annual HSA S/+1/Fam
CDHP with HSA
$3,400 / $6,000
$4,000 / $8,000
10% after deductible
HSA · $1,000 / $2,000 / $2,000
PPO
$500 / $1,000
$6,600 / $13,200
20% after deductible
—
Monthly employee premium — straight from payroll
Plan
Single
+ Partner
+ Child(ren)
Family
Care unit costs — standard claims & Rx averages
Service
Cost
Service
Cost
Preventive visit
$0
ER visit
$2,600
Primary-care (sick)
$125
Having a baby (blended)
$20,000
Specialist
$150
Planned surgery
$13,500
Urgent care
$200
Chronic condition / yr
$5,000
Generic Rx / fill
$22
Brand Rx / fill
$311
Specialty Rx (member)
$0
Each Rx = ~12 fills/yr
assumption
For HSA plans, total = premium + expected out-of-pocket − the district's annual HSA contribution. PPO and MedFlex estimates do not include an employer account contribution. The one-time LCSC contribution that may be available to first-time HSA enrollees is not included in the estimate. Premiums are the monthly employee contributions, shown per month. The model uses each Madison plan's premium, deductible, coinsurance, emergency-room cost sharing, prescription costs, and district annual HSA contribution. Household income maps to an approximate marginal tax bracket, used only for the separate "smart move" pre-tax savings note — it is not baked into the ranking. Your stated preference and current plan type frame the recommendation but don't change the dollar math. Estimate only — not a quote.