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QSEHRA reimbursements cover individual-market premiums AND out-of-pocket medical expenses — so it's worth knowing what employees typically pay for routine care. The figures below show typical patient out-of-pocket (after deductible/coinsurance) versus the cash-pay price for the same visit at a direct-pay or concierge clinic. Every figure carries its source.
High-deductible plans push the full negotiated rate to the patient until the deductible is met. Direct-primary-care memberships publish flat monthly fees that include most office visits outright.
Source: CMS Physician Fee Schedule lookup (CPT 99213); FAIR Health Consumer national median for established-patient office visits; KFF 2024 Employer Health Benefits Survey — small-firm deductible averages.Lab panels drawn in-network usually apply toward the deductible, so HDHP enrollees frequently pay the full negotiated rate. Cash-pay reference labs (Quest, Walk-In Lab, Ulta Lab) publish flat menu pricing on their site.
Source: CMS Clinical Laboratory Fee Schedule (CLFS), national median for CPT 80053; FAIR Health Consumer lab-panel benchmarks; Turquoise Health MRF lab aggregates.Mental-health parity rules cap copays in-network, but out-of-network therapist rates routinely clear $150/session. Many therapists publish a sliding scale ($90–$150) that beats the typical HDHP patient share once deductibles apply.
Source: CMS PFS lookup for CPT 90834; FAIR Health Consumer behavioral-health benchmarks (fairhealthconsumer.org); APA 2024 outpatient mental-health utilization survey.Figures are illustrative national medians and vary by region, network status, plan design, and provider. QSEHRA/ICHRA reimbursements may be applied to all of these as allowable medical expenses — see IRS Notice 2015-87.
Estimates use KFF 2024 small-group avg employer cost ($7,584/employee/yr single). Actual savings vary by state, plan design, and employee mix. Not tax or legal advice.
The calculator gives you the numbers. The full guide explains which program is right for your situation — headcount, wage levels, employee preferences, and state rules all matter.