high deductible health plan doctor visit cost

What’s a high deductible health plan (HDHP)?

high deductible health plan doctor visit cost

A high deductible health plan (HDHP) is a type of health insurance plan that offers lower premiums in exchange for higher out-of-pocket costs. With HDHPs, you’ll pay less each month, but more when you get care compared to other health plans.

Who should enroll in a high deductible health plan?

HDHPs may be a good fit for someone who’s in fairly good health and typically only sees their doctor once a year for preventive care. But there are lots of different factors to consider during the plan year. Things like:

How often you plan to see your doctor
How many tests or screenings you think you’ll need
Whether or not you plan to use a health savings account (HSA)
If your employer contributes to your HSA

What's the difference between an HDHP plan vs. a PPO, HMO, POS or EPO plan?

Think of the term HDHP as a way to describe any health insurance plan with a high deductible. As long as a plan includes a minimum deductible that meets the limit for that year , it's considered an HDHP. This means any plan can be a high deductible health plan — whether it's a preferred provider organization (PPO), health maintenance organization (HMO), point of service (POS) or exclusive provider organization (EPO) plan.

What’s an HSA-eligible health plan?

High deductible health plans are also called HSA-eligible plans. They’re the only type of health insurance you can pair with a health savings account. HDHPs and HSAs go together for a good reason. HSAs can be used to help pay for certain out-of-pocket health care costs and get you closer to reaching your deductible. An HSA comes with its own set of perks, like tax-free saving, employer contributions and freedom to take your HSA with you if you switch jobs.

How does an HDHP work?

High deductible health plans help protect against really high-cost (and even unplanned) services. These can include things like hospital stays, surgeries and complex treatment care that may quickly get you to that deductible. Until you reach your network deductible, you’ll pay for all your health care costs.

Once you reach your network deductible, you’ll split the cost of covered care with your health plan through copays or coinsurance. Then, once you reach your plan’s network out-of-pocket maximum, the plan will pick up the tab for any future covered services. (With plans that offer both network and out-of-network benefits, you’ll have a network deductible as well as an out-of-network deductible and out-of-pocket maximum.)

For example, let’s say you have a high deductible health plan with a network deductible of $1,700. After a surgery and a hospital stay, maybe you reached that network deductible. If that happens, you’d start to split the cost of covered services with your health plan and pay 20% of the bill from now on. You could end up reaching your out-of-pocket maximum after a few more doctor visits and some high-cost tests. Then, your plan would pay for all covered services moving forward until the end of the plan year.

Does an HDHP cover preventive care?

High deductible health plans typically cover preventive care care, like an annual wellness exam. This includes things like vaccines, and tests and screenings for certain health conditions.

What are the advantages of an HDHP?

If you’re planning to rarely see your doctor throughout the plan year, an HDHP may be a good option. Advantages of a high deductible health plan include:

Lower premiums compared to other plans
Option to pair with an HSA

What are the disadvantages of an HDHP?

A high deductible health plan isn’t for everyone or every family. You may not benefit from an HDHP if you frequent your doctor’s office or anticipate unplanned urgent care visits (like for sick kids). That’s especially true if you don’t plan to use an HSA to pay for out-of-pocket costs. Disadvantages of a high deductible health plan can include:

Expensive out-of-pocket costs if you get more care than you had planned
Deductibles can be very high

High deductible health plans can be a great fit if they match your care needs. You may want to decide if you prefer a PPO , HMO , POS or EPO plan first. Then, decide if a high deductible health plan is right for you. Be sure to compare all your options before choosing a plan.

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A simple guide to high-deductible health plans

Wondering if a high-deductible health plan (HDHP) is right for you? We’re here to answer your questions and help make your health care journey a little easier.

What is an HDHP, and how does it work?

An HDHP has a higher deductible than a typical health plan. That simply means you pay out of pocket for your medical expenses until you reach a certain amount. Then, your plan begins to pay.

Savings tip: HDHPs have lower premiums. That means you pay less every month for your plan. Plus, you’re covered for many preventive services and screenings at no cost without having to meet your deductible.

Everyone’s health needs are different

We’ll help you decide if an HDHP is right for you

Top 5 advantages of hdhps.

An HDHP may make sense for you if you’re rarely sick or injured but can afford the higher upfront costs if the unexpected happens. Benefits include:

Lower monthly premiums

You can have peace of mind knowing you’re paying less for monthly coverage.

Lower medical expenses

If you rarely need to see a doctor or use your benefits, you may spend less on your monthly insurance payment.

Quality care for less

Our plans include a broad network of providers. When you choose providers in our network, you get special discounts.

An account to help you save on health expenses

An HDHP is the only plan that can be paired with a health savings account (HSA) . An HSA helps you save pre-tax money for health expenses like deductibles and coinsurance. Even prescriptions, dental care and eyewear.

Savings for the future

When you add money to your HSA, you lower your taxable income. Your earnings are tax free. And your HSA is always yours, even if you leave the plan.

Top things to consider about HDHPs

An HDHP may not make sense for everyone. You’ll want to consider your lifestyle and health needs. For instance, if you have young kids, get ongoing treatment for a condition or take several medications, your upfront costs may be higher. Here are other things to keep in mind:

These plans have higher deductibles.

That means you pay for doctor visits, tests and prescriptions until you meet your deductible, then and your plan begins to pay. If you have an individual plan, the minimum deductible is $1,500. If you have a family plan, the minimum deductible is $3,000.*

Medical emergencies can happen.

Even if you’re fairly healthy, health needs and emergencies can pop up. Are you prepared to pay your full deductible up front?

You may be tempted to put off important care.

Some people might skip a trip to their doctor or the ER because of the upfront cost. The good news is that a health savings account can help you cover these costs.

Other plans may be available to you

Want to explore other coverage options? We’ll explain the differences between HMO, PPO, and POS plans to help you choose.

High deductible health plan FAQs

Think insurance is confusing? We’re here to help.

How can I get coverage or change my plan?

Most people change their plans during Open Enrollment. This is a period that happens once a year when you can sign up for insurance. You can also adjust or cancel your plan.

Have a big life change or one coming up? Certain events, like getting married or losing your coverage, qualify you for a Special Enrollment Period. That means you can enroll in a plan or change your plan outside Open Enrollment.

What does it mean when “it’s covered”?

If a service is covered, that means your health plan will pay for some or all the cost. With an HDHP, you’re covered for medical services after you meet your plan deductible.

Covered services include:

Doctor visits
Emergency care
Hospital stays
Prescription drugs and more

Does an HDHP cover preventive care?

HDHPs typically cover in-network preventive care in full without having to meet your deductible. This benefit can help you save. That’s because it can help prevent or find health issues before they become more costly.

Examples of preventive care include:

Blood pressure, diabetes and cholesterol tests
Routine prenatal and well-child care
Flu shots and other routine vaccines
Cancer screenings, including mammograms and colonoscopies
Screening services for heart disease, infectious disease, mental health conditions, obstetric and gynecological conditions, and more

Note: Preventive care does not include services to treat an existing illness, injury, or condition.

Why is staying in network important?

Choosing network providers can save you money. And here’s why: The providers in our network have agreed to special, contracted rates. That makes it less costly for you.

Some plans include out-of-network coverage. Just keep in mind that providers who are not in our network are not contracted with us. And they may charge higher rates. Another thing to consider is that your out-of-network deductible is separate from your in-network deductible. So even if you’ve met your in-network deductible, you would still be responsible for the cost of any out-of-network care.

*FOR COST-SHARING DETAILS: This is a typical example. Keep in mind that cost-share varies by plan.

*FOR MINIMUM DEDUCTIBLE SOURCE: Internal Revenue Service (IRS). IRS tax forms and instructions . Accessed May 5, 2023.

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Understanding HSA-eligible plans

How hsa-eligible plans work.

Coinsurance Coinsurance A percentage of the cost that you pay for each plan-covered service, like 20%.
Copayments Copayment A fixed amount you pay for a plan-covered service, like $30.
Deductibles Deductible How much you’ll pay for certain covered services and items each year before your plan starts to pay (except free preventive services).
Qualified medical expenses (includes some dental, drug, and vision expenses) – Find an expenses list on IRS.gov.
May have lower monthly premiums
Often have higher deductibles
Are available in many areas and may be offered by your employer
May provide certain preventive care benefits without a deductible or with a a deductible less than the minimum annual deductible
You can deduct the amount you deposit in an HSA from your taxable income.
Unspent HSA funds roll over from year to year. You can hold and add to the tax-free savings to pay for medical care later.
HSAs may earn interest that can’t be taxed.
You generally can’t use HSA funds to pay premiums.
Once you turn 65, you can use the money in your HSA for anything you want. If you don’t use it for qualified medical expenses, it counts as income when you file your taxes.
Six months before you retire or get Medicare benefits, you must stop contributing to your HSA. But, you can use money left in your HSA to help pay for qualified medical expenses that Medicare doesn’t cover.

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Should You Choose a High-Deductible Health Plan?

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High-deductible health plans usually carry lower premiums but require more out-of-pocket spending before insurance starts paying for care. Meanwhile, health insurance plans with lower deductibles offer more predictable costs and often more generous coverage, but they usually come with higher premiums.

What is a high-deductible health plan?

Compared to a traditional low-deductible health plan, a high-deductible health plan, or HDHP, requires you to pay a higher amount for medical care out of pocket before your insurance starts covering eligible costs. The amount you pay out of pocket is called the deductible.

According to the IRS, an HDHP is defined as the following in 2022:

Any health plan carrying a deductible of at least $1,400 for an individual or $2,800 for a family.

Total out-of-pocket expenses for the year can’t exceed $7,050 for an individual or $14,100 for a family, including deductibles, copayments and coinsurance.

HDHPs may cover some preventive care benefits at no or minimal cost. This could include the following:

Annual physicals.

Immunizations.

Routine prenatal care and well-child visits.

Screening services for things like cancer, heart disease, pediatric conditions, and vision and hearing disorders.

Tobacco cessation programs.

Obesity weight-loss programs.

HDHPs were intended to encourage consumers to shop around for health care. The logic is that if you’re responsible for medical costs upfront, you’ll do more work to find lower-cost providers — cutting expenses for you and your insurer.

In practice, this hasn’t panned out for most people. People with HDHPs aren’t shopping around for health care or talking with providers about costs, according to research from the University of Michigan Institute for Healthcare Policy and Innovation. And although consumers with HDHPs tend to reduce costs, they do so by skipping out on care and medication.

High-deductible health plans and HSAs

One of the perks of having an HDHP is that you may be eligible to save funds in a health savings account , or HSA. They are tax-advantaged, meaning you can direct funds from your paycheck pretax into an HSA, or you can add the money post-tax and deduct taxes later.

In 2022, the annual HSA contribution limit for an individual is $3,650. Someone with family coverage can contribute up to $7,300. An employer may also contribute to your HSA.

HSA money can earn interest, can be invested in stocks or mutual funds and can be spent (tax-free) on any qualifying medical expenses, as defined by the IRS . You can contribute to one as long as you have an active qualifying HDHP and no other health coverage. HSA money also rolls over year to year, so you can use it when you need it.

Not all HDHPs qualify you for an HSA, so make sure the one you choose meets IRS requirements.

Pros and cons of a high-deductible health plan

There are several reasons you might decide for or against this kind of health plan.

Typically lower premiums: These types of plans usually cost less per month than more traditional health plans with a lower deductible.

Ability to use an HSA: Having a qualified HDHP means you’re eligible to put thousands of pretax dollars into an HSA, which you can use for medical expenses this year or in the future. Your HSA money can also be invested and grow over time.

Employer contribution: More than half of employers offering HDHPs make contributions toward their workers’ HSAs, according to data from the Kaiser Family Foundation . That’s essentially free money toward your health care costs.

High costs for initial care: If you manage a chronic illness or you seek frequent health care beyond preventive visits, you may find yourself spending more out of pocket, although an employer contribution can help with upfront bills.

High deductible if disaster strikes: Health insurance is meant to protect you in the case of a serious illness, but you must be prepared to pay out of pocket for your full deductible (and any costs beyond that point, up to the out-of-pocket max) if something unexpected happens.

Is a high-deductible health plan right for you?

While an HDHP can be a great option for some health care consumers, it’s not the best choice for everyone.

A high-deductible health plan might be right for you if:

You’re healthy and rarely seek medical care for illness or injury.

You can afford to pay your deductible upfront or within 30 days of receiving a bill for that amount if a surprise medical expense comes up.

You have the means to make significant contributions to an HSA.

You're healthy and are interested in using an HSA as a way to save or invest money.

Your employer HSA contribution is enough to cover much or most of your deductible.

A low- or no-deductible health plan might be right for you if:

You're pregnant, planning to become pregnant or have small children.

You see a doctor frequently for a chronic condition.

You take multiple prescription drugs or one drug that’s very expensive.

You or your children play sports, especially those with high risk of injury.

You can’t afford the high deductible.

Doing the math on HDHPs

While it can seem like a straightforward choice based on how often you’re using the health care system, it’s worth doing some side-by-side comparisons. Even with a chronic condition, a high-deductible plan with a low monthly premium and a generous employer HSA contribution might end up being cheaper than a traditional plan with a higher monthly premium and no employer contribution.

Costs to compare from plan to plan include:

Premium: This is the amount of money you’ll pay each month for the plan.

Deductible: This is the amount you’ll pay before your health insurance starts to cover care, with the exception of qualifying preventive care in some cases. Make sure you note if there’s a deductible per person and an overall deductible for the family.

Copays and coinsurance: These are payments you make for medical services after you’ve hit your deductible. Copays are a set amount of money you pay for a particular service, such as $20 each time you see a specialist. Coinsurance is a percentage of the approved service cost, such as 20% of the cost of an office visit.

Out-of-pocket maximum: This is the most you could spend on covered health care in a year. There may be a per-person max and an overall family max.

Employer contribution: If you’re comparing a high-deductible health plan to another plan, make sure you include any contribution your employer makes toward your HSA, which you can use to pay for medical care.

Your decision will be highly individual, a financial choice based on you and your family’s health care needs. Choose the plan that allows you the best options for getting the medical care you need, when you need it.

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High-Deductible Health Plan Pros and Cons

Understanding how a high-deductible health insurance plan works can help you find the coverage that may be right for you.

What is a high-deductible health plan?

An HDHP is any health plan that typically has a lower monthly premium and a higher deductible than traditional plans. Here are some important details that can help you decide if a plan with a high deductible is right for you.

How does a high-deductible health plan work?

In general, your health plan starts paying for eligible medical expenses after you’ve met your deductible, meaning you’ve paid out of pocket up to the amount of the plan’s deductible. This applies to high-deductible health plans, as well as traditional plans.

The amount of your deductible depends on the plan you choose. If you choose a plan with a higher deductible, you may be required to pay more out-of-pocket costs in order to reach your deductible. There are some benefits of high-deductible health plans, as well as some drawbacks.

What are the pros and cons of high-deductible health plans?

Lower monthly premiums: Most high-deductible health plans come with lower monthly premiums. If you anticipate only needing preventive care, which is covered at 100% under most plans when you stay in-network, then the lower premiums that often come with an HDHP may help you save money in the long run. 1
Tax-free spending account: Some qualified high-deductible health plans may be paired with a Health Savings Account (HSA). You can use the funds in an HSA to help pay for eligible medical expenses. The money deposited into an HSA is tax-free, which can also help you save money. 2
Higher deductible: If your deductible is higher, it means you are required to pay for your medical care out of pocket up to that amount before your health plan begins to help pay for covered costs. The exception is for preventive care, which is covered at 100% under most health plans when you stay in-network. 1
Costly out-of-pocket medical expenses: If you choose a high-deductible health plan and need non-preventive medical care, or costly medical care, you will have to pay all of your deductible before your plan begins to help you pay for covered costs. Depending on your medical needs, these costs could be significant out-of-pocket expenses that you may not have planned for.

When choosing between a high-deductible health plan and a more traditional one, consider your anticipated health needs. Are you likely to require medical care above and beyond preventive? If so, an HDHP plan with a lower monthly premium may not necessarily be an advantage. A more traditional plan with a higher premium and lower deductible might offer you improved cost savings.

How much does a high-deductible health plan cost?

On average, if you are a covered employee with a high-deductible health plan in the United States, you may pay $8,217 annually and $22,404 for a family. 3 HDHPs have lower monthly premiums and are a good fit for those who anticipate needing preventive care only.

How do I choose a health insurance plan that’s right for me?

Consider the following when choosing a health plan:

If you’re healthy and usually go to the doctor once a year, a lower monthly premium (like one that comes with HDHPs) may be a good choice for you.
If a chronic health condition means that you go often to your primary care provider (PCP) or specialists during the plan year, you must decide if savings from low premiums are greater than the cost of regular care or medication.

Carefully weighing the pros and cons of high-deductible health insurance may help you find the coverage that’s right for you. In addition to saving you money, finding the right plan for you can help ensure that you’ll receive coverage for the health care you need, when you need it.

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1 Not all preventive care services may be covered. For example, immunizations for travel are generally not covered. See your plan documents for a complete list of covered preventive care services.

2 HSA contributions and earnings are not subject to federal taxes and not subject to state taxes in most states. A few states do not allow pretax treatment of contributions or earnings. Contact a tax professional for details.

3 2023 Employer Health Benefit Survey, KFF, October 18, 2023, www.kff.org/report-section/ehbs-2023-section-8-high-deductible-health-plans-with-savings-option

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How to Survive a High-Deductible Health Plan

Knowing you're on the hook for thousands in medical bills might make you less likely to seek care you need. here's how to save money and stay safe., sharing is nice.

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Brace yourself: Within a few years, your only choice for health insurance through your employer may be a high-deductible health plan.

These plans have smaller monthly premiums, but there's a trade-off: You have to pay a lot more out-of-pocket before your insurance begins to cover a portion of your bills. Those up-front payments, or deductibles, as defined by the IRS (PDF), are a minimum of $1,300 per year for individual insurance coverage and $2,600 for a family. And that's only the minimum.

In reality, individuals are paying an average $2,295 before insurance kicks in and families are ponying up $4,364 on average, according to the Kaiser Family Foundation . That's a heavy financial burden for many of them.

A result: More people are skipping or postponing medical care because they can't afford to pay so much up front.

Faced with steep healthcare costs, many companies are embracing these plans because they push more of the cost onto workers. That's a big deal, because more than half of Americans get health insurance through their employer.

Within three years, almost 40 percent of companies that offer health insurance may make high-deductible plans the only choice, according to a survey by the consulting firm PwC . A quarter of all companies are already doing that. In 2012, it was just 13 percent .

High-deductible plans are also the norm on the Affordable Care Act (ACA) exchanges. Even though there is uncertainty about the ACA long-term, almost 14 million Americans (PDF) are expected to get health insurance on the exchanges in 2017.

In 2016, two-thirds of people on the exchanges were enrolled in Silver Plans, which have relatively low premiums. But the average deductible for a Silver Plan this year is $3,572 for an individual and $7,474 for a family, according to the health insurance data website HealthPocket . Those are eye-popping numbers, but individuals who earn less than $29,700 and families that make less than $60,750 may qualify for cost reductions on those deductibles.

Find out how to get high-quality, low-cost healthcare and where CR stands on high-deductible health plans .

The Downside of High Deductibles

Why are people who are shopping for insurance choosing high-deductible health plans? Sometimes it's because they like the idea of paying lower premiums, and they assume they will stay healthy enough so it will save them money, says Kim Buckey, vice president of client services at DirectPath , a benefits and compliance management firm. For others, there's no choice.

That was the situation two years ago for Monique Dow, a 46-year-old mother of two from Watsonville, Calif., who had a $6,000 deductible with her family's health insurance plan, the only option offered by her husband's employer.

For months she put off surgery to remove what her doctor thought were benign fibroid tumors and a polyp in her uterus. When she eventually scheduled surgery after working out a payment plan with a hospital, the polyp was found to be cancerous, requiring a hysterectomy.

"I waited all that time, not knowing that I had this growing in me," Dow says. "If we had a lower deductible, I probably would have been treated a lot sooner."

Dow is cancer-free but requires frequent monitoring. Now she's weighing another insurance dilemma because her husband started a new job. A high-deductible plan is one choice, but it's an option they want to avoid, she says.

Infographic showing percentage increase of Americans with a high-deductible health plan.

#HighDeductible is a hot topic on Twitter . Join in the discussion with other people feeling the pain of a high-deductible health plan.

Are Consumers Really in Control?

High-deductible plans are part of a move to what's called consumer-directed healthcare. The idea is that if you're more on the hook financially for the medical choices you make, you'll take more control, for example, by shopping around for less costly procedures and providers, and by not running to a doctor every time you come down with a cold.

Sharing the cost of your healthcare, the thinking goes, should drive down your overall medical bills.

Only that's not what's happening. Faced with daunting deductibles, many people like Dow are postponing the care they need and sometimes ending up sicker and with bigger bills down the road, a growing body of research is finding.

A 2015 survey by Families USA found that almost 30 percent of people with deductibles higher than $1,500 for individual coverage avoided medical care—tests, treatment, follow-up care, and prescription drugs—because they couldn't afford the out-of-pocket costs.

That kind of cost-sharing encourages people to use fewer services, according to Gary Claxton, a vice president at the Kaiser Family Foundation. "Some of that is appropriate," he says, "but it can lead to some really bad choices. When someone puts off care, they may end up needing more care and spending more later on."

How to Make the Best of an HDHP Plan

It's not that high-deductible plans are a poor choice for everyone. If you're healthy, you don't need to go to a doctor for more than routine screenings, and you have a savings cushion to cover your deductible, paying lower monthly premiums may be a reasonable option.

Still, Consumer Reports and other consumer advocates say that too many people have plans they can't afford or don't understand. (Read about where CR stands on high-deductible health plans .)

For now, if you have a high-deductible plan or think you will soon, you'll have to be more involved in decisions about your healthcare. But there's a lot you can do to make the plan work better for you.

Consumer Reports consulted health-policy and insurance experts, talked with doctors, and conducted our own research to uncover the most cost-effective ways to use your high-deductible plan while getting the medical services you need.

Know what's free. Many routine health services intended to keep you well or catch problems early (including colonoscopies, mammograms, and vaccinations) are free in all insurance plans now. Yet only one in 10 people in high-deductible plans said they knew such screenings were free, and almost 20 percent said they avoided preventive tests because they thought they would cost them, according to a 2012 study published in the journal Health Affairs. So make sure you go to a doctor for the care you're entitled to get.

Comparison shop. High deductibles are supposed to nudge you to shop around for lower prices for nonemergency care. But few people are doing that. Most health insurance sites provide information on where to find in-network services. And some offer cost-estimator tools that give the price you'll pay different providers for, say, an MRI or knee surgery. But a Consumer Reports Health Ratings Center study of 21 insurance plans found that only 13 percent of people used the tools on their insurer's site, even though 75 percent said they were concerned about cost and the quality of service. One reason is that people simply aren't aware that those tools exist. (If your health insurance company doesn't offer one, call your insurer directly to ask for quotes.)

Spending the time to research costs can be worth it. Prices for medical treatments can vary considerably from provider to provider, even within the same city. In Kansas City, Mo., for example, the average price for bunion surgery is $4,094, but it ranges from $3,136 to $8,150, according to Gooru.com . For medication, one of the biggest out-of-pocket expenses for consumers, check GoodRx , a website where you can compare prices for thousands of prescription drugs at more than 70,000 pharmacies in the U.S.

But don't shop by price alone. Among the insurance websites Consumer Reports evaluated , a majority scored well on price information. But users said that the sites were difficult to navigate and that they lacked information on the quality of services from sources, such as independent ratings of doctors and hospitals, and user reviews. (See our ratings of six national insurer websites. )

"Prices vary a lot, but quality does, too," warns Orly Avitzur, M.D., a neurologist and medical director of Consumer Reports. When one of her patients, Amir Goen, 42, of Tarrytown, N.Y., needed an MRI recently, he found that the prices for the test in his area varied by hundreds of dollars. He consulted with Avitzur, who advised him to ask about the strength of the magnets used in the imaging. Goen discovered that the cheapest MRI didn't use the highest-strength magnet—but neither did the priciest one.

For California residents, check out our cost estimator tool that allows you to find both quality information and cost information for providers and healthcare services in your state.

Interview your doctor. As Goen learned, doctors can be a valuable resource for patients trying to balance cost with quality of care. Researchers at Duke University analyzed recorded conversations from 1,800 doctor visits. Cost came up 30 percent of the time. And in almost half of those conversations, doctors offered ideas about how patients could find less expensive prescriptions, diagnostic tests, or other health services. You can also use online resources such as ConsumerHealthChoices.org , which Consumer Reports created as part of its partnership with the ABIM (American Board of Internal Medicine) Foundation's Choosing Wisely campaign. Those resources provide questions to ask your doctor about medical tests and treatments that are frequently overused. Many of them might waste your money and do more harm than good.

Get care on the calendar. Keep track of your spending against your annual deductible, which resets every year. If you expect you'll need an expensive procedure that will get you close to or over your deductible, schedule it early in the year if you can. That way, if you need more care later in the year, your insurance will kick in. And don't put off making doctor appointments. Make sure your physician has room in his or her schedule before January 1, when your deductible resets.

Leverage tax breaks. You can ease the pain of high out-of-pocket costs by putting money into a health savings account (HSA), which most people in IRS-designated high-deductible health plans are eligible for. That's pretax money—up to $3,400 annually for individuals and $6,750 for families—that you can use to pay for qualified medical expenses, including your deductible. And if you don't use your HSA funds, they roll over and can grow tax-free, year after year.

Employers don't have to set up HSA accounts for their employees in high-deductible plans, but about 63 percent do. (You can also open an HSA on your own.) The account is portable, so the money is yours if you change jobs. To encourage the use of HSAs, about half of employers offer seed money. Some will deposit additional money into your HSA if you take advantage of preventive services like screenings and wellness visits. "Employers don't want workers to skimp on needed care," says Steve Wojcik, vice president of public policy at the National Business Group on Health .

Don't freak out. High-deductible insurance can be hugely expensive, but at least there's a limit to how deep you'll have to dig into your own pocket for health services. The Affordable Care Act mandates that almost all insurance plans cap out-of-pocket costs (not including premiums or out-of-network care). After you've hit the max, the insurer must pay 100 per-cent of in-network costs.

For 2017, all ACA plans have an out-of-pocket maximum of $7,150 for individual coverage and $14,300 for family plans. Employer plans can vary, but only 18 percent of those with out-of-pocket limits make you responsible for more than $6,000 for an individual, according to the Kaiser Family Foundation . Remember that only in-network charges count against your out-of-pocket limits (or your deductible, for that matter). So stay in-network. That's good advice for all of us, whether we're in a high-deductible plan or not.

Where CR Stands On High-Deductible Health Plans

There's no argument that high healthcare costs need to be reined in. But Consumer Reports doesn't think consumers should bear the brunt of that responsibility through insurance plans with enormous out-of-pocket costs. Instead, we believe that employers, the government, and medical-service providers—as well asconsumers—must work together to lowerthe underlying costs of healthcare.

The idea behind high-deductible plans (or HDHPs) is that if consumers face the consequences of their health spending, they will spend their dollars more wisely.

Instead, those cost-sharing plans are causing considerable consumer harm, says Lynn Quincy, director of CR's Healthcare Value Hub. Almost all of the savings that they generate are due to people cutting back on healthcare services. They postpone going to a doctor, don't fill prescriptions, or cut back on preventive care. Most troubling is that the sickest workers may cut back on care. What's more, several studies have found that consumers in HDHPs do no more price shopping for medical services than the average person. They also fail to use free preventive services.

To control spending and bring better value (not just lower costs) to our healthcare system, CR believes we need a different vision of what the consumer's role in healthcare should be. These are some strategies we suggest:

Focus on the root of the problem. Encourage healthcare providers, hospitals, drugmakers, and medical-device makers to address high healthcare costs. We need to cut unnecessary spending and reduce expenses, not just push the cost onto consumers.

Change plan designs. Make costs more predictable by using co-payments (a flat charge you pay each time you go to a healthcare provider) instead of coinsurance (which requires you to pay a percentage of the cost of a covered health service). Make more services not subject to a deductibles. And give consumers timely, accurate, and actionable information to help them make decisions and find high-value care.

Involve state regulators. They need to gather data to understand healthcare spending in their state, see where consumers are experiencing high costs, and determine which markets lack competition, which holds down prices.

Go to ConsumersUnion.org/highhealthcosts for more information.

Editor's Note: This article also appeared in the January 2017 issue of Consumer Reports magazine .

Donna Rosato

I write about the financial challenges of paying for college, managing higher-education debt, and the steep cost of healthcare. I want to help people take control of their finances so that they can enjoy the other parts of their life. What I enjoy: running with friends, kayaking with my husband, and playing Legos with my son. Follow me on Twitter (@RosatoDonna).

The Bottom Line

Health Insurance

How High-Deductible Health Plans Work

Amy Fontinelle has more than 15 years of experience covering personal finance, corporate finance and investing.

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Do you want to save money on your monthly health insurance premiums and have the opportunity to open a health savings account ? If so, you’ll need to have a high-deductible health plan (HDHP) . Let’s discuss what these plans look like, their pros and cons and the times in your life when you might seek out or avoid an HDHP.

Key Takeaways

High-deductible health plans (HDHPs) are affordable health insurance plans with relatively low monthly premiums.
On the downside, these plans have higher deductibles and out-of-pocket maximums. This means more healthcare expenses are paid by the individual and not the insurer.
Because of this, HDHPs are best-suited for younger, healthier individuals who may not need to go to the doctor or hospital often.

What Is a High-Deductible Health Plan?

According to IRS rules, an HDHP is a health insurance plan with a deductible of at least $1,600 for individual coverage, or at least $3,200 for a family plan in 2024. The deductible is the amount you’ll pay out of pocket for medical expenses before your insurance pays anything. In addition, the plan’s out-of-pocket maximum must be no higher than $7,500 for an individual plan or $15,000 for a family plan. The out-of-pocket maximum is the most you’ll have to pay in a year for medical expenses covered by your insurance plan.

Advantages of High-Deductible Health Plans

An HDHP will usually have lower premiums than an equivalent health insurance plan with a lower deductible. For folks who don’t anticipate many medical expenses for the upcoming year, it makes sense to minimize your premiums and choose an HDHP. There’s a good chance you’ll save money—perhaps several hundred dollars or more over the year—this way.

Just be sure you can afford the out-of-pocket maximum in a worst-case scenario. If you can’t, you could end up in medical debt, and the added interest will make it even harder to pay your bills. A health insurance plan with higher premiums but an affordable out-of-pocket maximum might be a safer choice if the HDHP’s out-of-pocket maximum is more than you can cover.

Sample Annual Health Insurance Premiums and Deductibles, HDHP vs. Non-HDHP

The options above show a situation where it clearly makes sense to choose the HDHP. With either plan, you’ll end up spending $4,500 of your own money in premiums and deductibles if your medical expenses for the year are at least as much as your deductible. But with the HDHP, you’re only guaranteed to spend $1,500 in premiums, unless you know for a fact what your upcoming medical expenses will be.

Also, having the HDHP lets you contribute to a health savings account. If you’re in the 24% federal tax bracket and you do incur $3,000 in medical expenses, you could use your HSA to pay for them with pre-tax dollars. If you used post-tax dollars, that same $3,000 in medical expenses could cost you nearly $4,000. If you chose the lower deductible plan (the non-HDHP), you could pay $2,550 of your $3,000 in medical expenses from a flexible spending account (FSA) if your employer offers one. Then you’d have similar tax savings with the non-HDHP.

Even this simplified example isn’t really that simple. Similarly, most real-life situations aren’t clear cut as to whether you should select a high-deductible or low-deductible plan. You’ll need to do the math for your own circumstances, taking into account your likely medical expenses for the year and the premiums, deductibles, and out-of-pocket maximums for the available plans.

High-Deductible Health Plans and Preventive Care

If you do choose the high-deductible plan, you’ll still have 100% coverage for preventive services from in-network providers before you meet your deductible because of the Affordable Care Act requirements. Quite a few services fall into this category, and you aren’t responsible for any copayment or coinsurance for any of them. Here are a few examples taken from Healthcare.gov:

Abdominal aortic aneurysm: one-time screening for men of specified ages who have ever smoked
Aspirin use to prevent cardiovascular disease for adults of certain ages
Blood pressure screening
Cholesterol screening for adults of certain ages or at higher risk
Colorectal cancer screening for adults 45 to 75
Depression screening
Diabetes (Type 2) screening for overweight obese adults 40 to 70
Certain immunizations for adults, such as the flu shot
Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a healthcare provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
Breast cancer mammography screenings every one to two years for women over 40
Cervical cancer screening every three years for women 21 to 65
Osteoporosis screening for women over age 65 as well as under 65 depending on risk factors
Well-woman visits to get recommended services
Autism screening for children at 18 and 24 months
Behavioral assessments
Depression screening for adolescents
Developmental screening for children under age 3
Hearing screening for all newborns
Vaccines for illnesses such as whooping cough, influenza and chickenpox

HSA Eligibility

As noted already, the other major advantage of having an HDHP, besides typically lower premiums, is that it allows you to contribute to a health savings account. Because HSA contributions come from pre-tax dollars, you can save a considerable amount on your medical expenses when you pay for them with your HSA. For example, if you’re in the 24% federal tax bracket , a $100 medical bill will effectively cost you only $76. You must have an HDHP to be eligible to contribute to an HSA and in order to be eligible to receive any employer contributions to your HSA.

In fact, “free” money in the form of optional employer contributions to your HSA is another potential benefit of having an HDHP and an HSA. In addition, you don’t have to keep your HDHP forever to take advantage of an HSA in future years. Contributions carry over from one year to the next, and you can invest your contributions to help them grow, too. In the future, even if you no longer have an HDHP, you can use money previously deposited to your HSA to pay for health expenses.

Disadvantages of High-Deductible Health Plans

The big drawback to choosing an HDHP is having potentially high out-of-pocket expenses for the year. As noted above, that means HDHP plan participants could face out-of-pocket costs of up to $8,050 for individual coverage or $16,100 for a family plan in 2024.

Another potential problem with enrolling in an HDHP is that you may find yourself wanting to skip doctor visits because you’re not used to having such high out-of-pocket costs. Don’t choose an HDHP if it will cause you to avoid doctors, procedures or prescriptions because you want to save money in the short term. Neglecting medical issues could end up costing you more in the long term, plus you’ll be jeopardizing your health.

High-Deductible Health Plans and You

Whether or not it makes sense to have an HDHP depends on your life stage and the associated medical expenses you’re likely to incur. In particular, you should weigh the benefits of lower monthly premiums against the risk of accumulating higher deductibles and out-of-pocket expenses that can add up and overwhelm some consumers.

If you’re young and healthy and rarely go to the doctor or take prescription medication, you’ll probably save a lot of money by choosing an HDHP since the premiums are lower. If you’re planning to have a baby in the near future, an HDHP might not be a good choice since the costs of hospital childbirth are high and your out-of-pocket expenses could easily reach your high out-of-pocket maximum. In that case, it may actually be more cost-effective to opt for a plan with lower deductibles and lower out-of-pocket costs instead, even if the premiums are initially higher.

Similarly, a HDHP also might not make sense if you have young children, since they tend to visit the doctor frequently, which can quickly accumulate deductibles. When your children are older and if they and you are healthy, an HDHP might make more sense. On the other hand, if anyone covered by your plan has a chronic condition that needs ongoing treatment, you might benefit from a plan with a lower deductible. Finally, if you’re older, you’re statistically more likely to have higher medical expenses, so you may not want to take a chance on an HDHP. But if you’re still in good health and have no reason to anticipate expensive healthcare costs, an HDHP might work for your circumstances despite your age.

Whether an HDHP will save you money always depends on the details of the specific plans available to you and your expected medical expenses for the year. An HDHP is not automatically a better or worse deal than an insurance policy with a lower deductible just because your circumstances fall into a certain category. You always have to do the math for your own situation.

How Do I Know If I Have a High-Deductible Health Plan?

If you have access to a health savings account (HSA), then you have a high-deductible health plan. This type of insurance has a lower premium and a higher deductible than a traditional health plan. Having an HDHP is one of the requirements for a health savings account (HSA). If your health insurance plan for 2024 has a minimum deductible of $1,600 for individual coverage or $3,200 for family coverage with maximum out-of-pocket costs of $8,050 ($16,100 per family), then it qualifies as an HDHP.

What Is the Main Drawback of a High-Deductible Health Plan?

You could potentially be on the hook for high out-of-pocket medical costs. You'll have to meet the deductible in your plan before the plan starts to kick in for covered costs. The plan will pay for preventive medical care such as routine visits and well-baby check-ups, but an accident or unexpected illness could mean thousands of dollars in payments to medical providers.

What Is the Main Benefit of a High-Deductible Health Plan?

If you are generally healthy and want to save for future health care expenses, the high-deductible plan gives you access to a tax-advantaged savings vehicle, the health savings account. The HSA can make sense for many people, especially those nearing retirement, because the money can be used for medical care in retirement.

An HDHP can save you money in the form of lower premiums and the tax break you can get on your medical expenses through an HSA. It’s important to estimate your health costs for the coming year to see how much you might pay out of pocket with an HDHP before you sign up. In some cases, a plan with a lower deductible will save you money, even though it will usually have higher premiums and won’t let you have an HSA. In addition, if your employer offers it, you can use an FSA to get tax savings on your medical expenses with a lower-deductible plan.

Internal Revenue Service. " Rev. Proc. 2022-24 ," Pages 1-2.

Health Insurance Marketplace. " Out-of-Pocket Maximum/Limit ."

Internal Revenue Service. " Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans ," Page 3.

Health Insurance Marketplace. " Preventive Care Benefits for Adults ."

Health Insurance Marketplace. " Preventive Care Benefits for Women ."

Health Insurance Marketplace. " Preventive Care Benefits for Children ."

Internal Revenue Service. " Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans ," Pages 3-4.

IRS. " Rev. Proc. 2023-23 ."

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What Is a High-Deductible Health Plan (HDHP)?

17 Min Read | Jul 16, 2024

Health care is expensive. And the price never seems to stop rising! That’s why some people avoid it altogether . But skipping health insurance is like white-water rafting without a life jacket. The sun and the spray might feel nice for a while, but when you go overboard, it’ll be tough to stay afloat by yourself.

So, what’s a budget-minded guy or gal to do in these choppy waters? For many, the answer is to accept the possibility of higher out-of-pocket costs while reaping the benefit of lower premiums. It’s called a high-deductible health plan (HDHP).

As you can probably guess from its name, a high-deductible health plan has a higher deductible than other health insurance plans. But there’s a significant payoff—lower monthly premiums. HDHPs are a relatively new approach to health coverage, but they’re becoming more popular every year, both as an employee benefit and for the self-employed.

There are two big reasons you should consider an HDHP:

Health coverage at a lower monthly cost
The opportunity to save more money by using a Health Savings Account (HSA) to help pay your health care costs

How does an HDHP offer these savings? Well, there’s something about a flat fee that tends to encourage people to overuse a benefit . You know, like your Aunt Maxine and your Uncle Mike? Yeah, the ones who are usually in great health, but go to the doctor for blood work and an MRI anytime they sneeze? Those things cost a lot, and if insurance is paying out for those all the time it pushes premiums up.

But when you have to shoulder more of your health care costs (with the bigger deductible up front), you’ll probably look for ways to save. Nobody wants to spend more, obviously.

So, with that in mind, insurance companies created the high-deductible health plan. Lower premiums attract budget-conscious people while the higher deductible makes sure they don’t visit the doctor for every minor thing. Plus, the IRS got in the game and threw in some tax incentives. It’s a win-win for a lot of people.

But is it the right plan for you?

Understanding a High-Deductible Health Plan (HDHP)

So, what is a high-deductible health plan? For a health insurance plan to qualify as a high-deductible health plan (and give you all the premium cuts you’re looking for), it has to meet a minimum deductible dollar amount and a maximum out-of-pocket cost set by the IRS. We’ll get into those specifics a little later.

An HDHP works best for people who are generally healthy and only need health insurance coverage to protect their savings from a catastrophic event like a car accident or appendicitis.

That way, you’ll only be on the hook for low premiums and occasional medical expenses. And you also have health insurance coverage if you need it for big expenses like emergency surgery or treatment for a newly diagnosed medical condition. Plus, your out-of-pocket maximum on your plan puts a limit on how much you’ll have to pay for medical costs in a calendar year.

But our favorite benefit of an HDHP is the ability to have a Health Savings Account (HSA) , where you can save the cash to cover your part of the costs tax-free (and stress-free)!

An HSA is only available to people enrolled in an HDHP, and it gives you a triple tax benefit on the money you set aside to pay your health care costs. You‘re not required to have an HSA, but it makes a ton of sense to have one if you have an HDHP. (But if you’re working the Baby Steps , wait until Baby Step 3 to start contributing.)

Here’s how an HSA works:

The money you put in your HSA goes in pretax. That lowers your taxable income for the year.
You can invest the money in your HSA. And if you go that route, it also grows tax-free. (This is getting exciting.)
You can use the money in your HSA tax-free when you use it to pay for qualified medical expenses .
Any money you save in the account can be used to cover qualified medical expenses. This is a great place to bank the money you’ll save on premiums once you’ve switched to an HDHP.
Employers who offer an HDHP with an HSA as an employee benefit often include an employer match on the money you put in your HSA. That’s free money to use for your health care costs!
Your HSA money rolls over every year so you can use it for any future health care needs.
And last (but not least), after you retire, your HSA acts just like a traditional IRA. So you can spend your HSA funds for anything you’d like. Qualified medical expenses will still be tax-free, and any nonqualified medical expenses will be taxed as income, just like withdrawals from a 401(k).

This is basically like having a turbocharged emergency fund just for your medical expenses. If you can contribute the amount of your annual deductible each year, even better! At minimum, take advantage of any employer match and watch the money grow.

What Does a High-Deductible Health Plan Cover?

A high-deductible health plan (HDHP) will cover all the same health incidents and illnesses a regular health plan would cover—you’ll just have to meet a higher deductible before that coverage kicks in. Like with every plan, your specific policy will have its own particular rules and limitations, but HDHPs don’t exclude anything special as a rule.

One great thing to know is that preventive care like vaccines, annual wellness exams and some screenings are covered in an HDHP even before you reach your deductible. But this plan isn’t designed to help you cover things like doctor visits, prescriptions or trips to the emergency room. You’ll need to cover those out of pocket, up to the amount of your deductible.

Example of a High-Deductible Health Plan

Okay, so we’ve covered a lot of technical info. It’s time for an example of a high-deductible health plan (HDHP).

Let’s look at Kitty. She’s a healthy, 31-year-old, single professional. She’s taking advantage of her employer’s HSA-qualified HDHP.

Every month, Kitty pays a premium of 90 bucks (that’s $1,080 a year). She has a deductible of $5,000, so she doesn’t go to the doctor for things like a sore throat. And when she does go, she uses funds from her HSA to cover her costs. Her annual max out-of-pocket limit is $5,500 and her copay is $20 (more on these two things later).

One day, Kitty’s abdomen starts hurting. It gets really bad, and she ends up having her appendix removed. The bill is $29,000. She pays most of her $5,000 deductible from her HSA and the rest directly out of pocket. After her $20 copay, insurance kicks in and covers the other $23,980 for her surgery.

Now let’s look at a family.

Kitty and Brian tie the knot, pop out a few kids and get an HDHP with family coverage.

They’re now paying $500 a month ($6,000 a year) for a policy that covers all of them. Yes, they have a hefty deductible of $10,000, but nobody has any health issues and they’re financially covered in case something major like a car accident or sudden illness happens.

And they can pay most of that deductible out of their HSA, which they’ve maxed out at the family limit of $7,750. So how did they swing this? They were intense. In the first six months of the year, they loaded up their account with $960 monthly contributions and made sure to nab their matching employer contribution up to $2,000.

How Much Does a High-Deductible Health Plan Cost?

So, what are the actual numbers on one of these things?

On average, single Americans with an HSA-qualified HDHP had an annual premium of $7,170 ($598 a month) in 2022. For families, the average premium was $21,079 per year ($1,757 a month). 1

If you got your HSA-qualified HDHP through your employer, your average numbers looked like $90 per month if you were single and $432 for your family. 2

Now keep in mind, those are averages. When you’re looking at health insurance plans , there are some costs you should compare between each one:

Premiums: Look over your options and add up how much you’ll save on premiums in a year with an HDHP so you can compare it to how much you’d pay out in a deductible.

Deductible: This is where you take on a little more risk to save money. In 2022, the average deductible for a single person with an HDHP was $2,458 and $4,533 for a family. 3 Take a look at what you’ll pay out of pocket and stack it up against how much less you’d pay with a regular health insurance plan. The biggest consideration here is how often you need health care.

Copays and coinsurance: Whenever you do go to the doctor or hospital (even after you've met your deductible), you’ll have to pay a small part of the cost of service. A copay is a flat fee (like $20 for a doctor’s visit) while coinsurance is a percentage of the cost (like 15% of a trip the emergency room). Your copay and coinsurance will vary by plan, so always compare.

Out-of-pocket maximums: Your HDHP limits what you’ll have to pay for covered health care expenses within a calendar year. Once you reach that out-of-pocket maximum, insurance pays 100% of your covered costs for the rest of the year. In 2022, the average out-of-pocket maximum was $4,422 for single coverage. 4

Let’s look at an example: If your HDHP has a $5,500 out-of-pocket maximum and your deductible is $3,000, you’d have to pay your deductible in full (along with your copay). Say you have an additional $2,500 in covered medical costs in the same year. After that, you wouldn’t have to pay your copay or coinsurance for covered costs for the rest of the year (because you’ve reached your out-of-pocket maximum).

Employer contribution: In case you didn’t know, you can save big bucks if you get your health insurance through your employer. In 2022, the average American worker with an HSA-qualified HDHP through their employer paid $1,078 per year in premiums. For a someone with family coverage, their average premium was $5,188. 5

Employers will often contribute toward your HSA as well if you’ve got one. The average employer contribution to HSAs was $1,815 for singles and $3,322 for families in 2022. 6

How Do HDHP Premiums Compare to Other Plans?

On average, single Americans with a high-deductible health plan (HDHP) have an annual premium of $7,170, while those with a more traditional type of health plan (like an HMO or PPO) have an average premium of $8,162. For families, the premium comparison is $21,079 with an HDHP versus $23,003 without. 8

So on average, you’d save over $800 bucks a year on premiums alone if you were single or $1,800 for family coverage (but remember, the HSA is where the real saving begins).

What Qualifies as a High-Deductible Health Plan (HDHP) for a Health Savings Account (HSA)?

One of the best things about using a high-deductible health plan (HDHP) is that you qualify to have a Health Savings Account to double down on savings. But not all HDHPs are HSA qualified.

Minimum Deductibles and Maximum Out-of-Pocket

For you to snag some extra savings with an HSA, your HDHP has to meet the minimum deductible requirement and the maximum out-of-pocket amount set by the IRS (including what you pay for your deductible and copay or coinsurance ). The government updates those requirements every year.

These are the numbers for 2023:

Minimum deductible for an individual: $1,500
Minimum deductible for a family: $3,000
Maximum out-of-pocket expenses for an individual: $7,500
Maximum out-of-pocket expenses for a family: $15,000 10

In 2024, the numbers will go a little higher:

Minimum deductible for an individual: $1,600
Minimum deductible for a family: $3,200
Maximum out-of-pocket expenses for an individual: $8,050
Maximum out-of-pocket expenses for a family: $16,100 11

Remember, these numbers are minimums and maximums set by Uncle Sam. The actual HDHP policy you get could have a higher deductible or a lower out-of-pocket max.

Other Qualifications

On top of meeting those minimums and maximums, your HDHP can’t offer any insurance coverage until you’ve fully paid the deductible (except for some preventative care like screening services). 12

And it’s not just your health plan that has to be up to snuff—you also have to meet some qualifications:

You can’t have any other health insurance coverage, including Medicare.
You can’t be claimed as a dependent on anyone else’s tax return. 13

If you’re not sure if you qualify for an HSA, talk to a health insurance expert . They can help you figure out if your health plan qualifies and help you set up your HSA if it does.

Get the health insurance you need from Health Trust Financial today!

When RamseyTrusted partner Health Trust Financial is in your corner, you’ll have peace of mind knowing you have the right health insurance that won’t break the bank.

HSA Contribution Limits

Now, you can’t just fill up your HSA like a bottomless pit. The government sets a limit each year on how much you can put into your HSA.

Contribution limits for 2023:

Contribution limit for an individual: $3,850
Contribution limit for a family: $7,750 14

Contribution limits for 2024:

Contribution limit for an individual: $4,150
Contribution limit for a family: $8,300 15

How Can HSA Funds Be Used?

This probably won’t come as a surprise, but you can’t spend money from your HSA on just anything tax-free. The government has strict rules around what is a qualified medical expense .

The IRS has a full (and very long) list of all the medical expenses that qualify to be paid for out of an HSA, but here are a few of the common ones:

Acupuncture
Breast pumps and supplies
Chiropractor
Contact lenses
Dental treatment
Fertility enhancement
Hospital services
Laboratory fees
Long-term care
Psychologist

Here are a few you might hope it covers, but it doesn’t:

Cosmetic surgery
Electrolysis or hair removal
Hair transplant
Health club dues
Insurance premiums
Nonprescription drugs and medicines
Nutritional supplements 17

Pros and Cons of a High-Deductible Health Plan (HDHP)

If we haven’t made it crystal clear by now, we’re a fan of the high-deductible health plan and HSA combo. But that doesn’t mean you should drop what you’re doing right now and go get one without another thought. Let’s go over the pros and cons of an HDHP so you can figure out if it really is the best fit .

Pros of an HDHP

If the idea of accepting the risk of higher out-of-pocket costs sounds, well, risky —we get it. But for most people, the advantages are more than worth it!

Save money on premiums every month
Save on taxes when you contribute to an adjoining HSA
Save on taxes when you spend money from your HSA on qualified medical expenses
Get untaxed money from your employer when they contribute to your HSA
Use your money for medical services and supplies you actually need with an HSA
Use your HSA to pay your higher deductible (which is usually close to your out-of-pocket max anyway)
Be protected financially from big, unforeseen medical expenses with an out-of-pocket max

We can’t say too often that having an HDHP means you’ll pay lower premiums than in a traditional plan. And that means more flexibility in your monthly budget.

Cons of an HDHP

As much as we like HDHPs, they’re not for everyone. If you or someone in your family suffers from a chronic medical condition, an HDHP might not be your best option. Depending on your situation, you could end up spending a lot of time and money at doctors’ offices, all while getting little or no financial help from your health insurance.

Let’s look at Joe. He has an HDHP with a family deductible of $3,000 and pays $300 monthly premiums. Joe and his wife spend $500 a month to keep a handle on their young son’s asthma.

By June, Joe will end up paying around $3,000 just to cover doctor visits and medicine. By then he’s met the family deductible, but he’ll now be responsible for coinsurance that’s 25% of expenses for the rest of the year. And of course he’ll pay for premiums all year long.

Here’s how the annual breakdown of medical costs looks for Joe’s family:

They’ll pay a total of $3,600 to cover premiums.
They’ll pay in the neighborhood of $3,750 in doctor visits and medicine by the end of the year.
Their grand total will be around $7,350 for the year before they try to put any money in their HSA.

See the problem here? This could end up costing Joe a similar amount, or even more than what he might pay in a traditional plan. At the same time, he won’t have any help from his insurance until midyear.

In cases like Joe’s, it might be worth looking into a plan with higher premiums and a lower deductible. That combo could help you save money by shifting some of the cost to your health plan earlier in the year.

The dollars and the math will vary, both by plan and your family’s changing needs, so run the numbers before you commit to anything. A health insurance expert can be a big help with this.

Is a High-Deductible Health Plan Right for You?

There’s no one-size-fits-all answer to this question. While high-deductible health plans (HDHPs) are being offered by more employers all the time, health care is too complex to solve with one universal plan. Here are a few things to consider as you decide:

Are you young and pretty healthy? If so, this could be a great plan for you. If you don’t visit the doctor’s office much, it’s worth having a high deductible so you can pocket the savings you get with lower premiums.
How big is your family? The smaller the crew in your house, the better you’ll fit with an HDHP. You and your spouse are a lot less likely to blow through a high deductible than a family of six. It’s just simple math. But that’s not to say this approach can’t work for a big family—especially when paired with an HSA and its awesome tax advantages.
Do you have other options? If an HDHP is one of several options you have (like with employee benefits), you’ll need to do the math. Try to see what a typical month or year will look like financially in each option. Sometimes the savings on one side or the other are small. In that case, strongly consider an HDHP so you can take advantage of an HSA.
Do you, or does a family member, have chronic health conditions? It could be worth your while to accept higher monthly premiums if you already know you’ll have higher-than-average medical costs in a given year.

Who Offers High-Deductible Health Plans?

If you’re thinking an HDHP with an HSA is for you, you may be wondering who offers them. It’s not hard to find one—most insurance companies offer them. But what’s hard is finding the right one for you.

Whether you’re 100% sure you want an HDHP or you’re still feeling it out, our friends at Health Trust Financial can walk you through all the details, take a look at your situation, and help you figure out what’ll serve you best. They’re a bunch of independent insurance agents, so they can answer all your questions and make sure you get the right fit for the best price.

Learn more about HDHPs vs. PPOs.
Read up on how an HSA could be the perfect money-saving strategy for you.
Run some numbers with a health insurance agent and talk about whether an HDHP is a good fit for you.
Connect with Health Trust Financial to get in touch with a health insurance agent today.
Next open enrollment, sign up for an HSA-qualified HDHP.
Open an HSA and start funding it up to your limit as an individual or family!

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About the author

Ramsey Solutions has been committed to helping people regain control of their money, build wealth, grow their leadership skills, and enhance their lives through personal development since 1992. Millions of people have used our financial advice through 22 books (including 12 national bestsellers) published by Ramsey Press, as well as two syndicated radio shows and 10 podcasts, which have over 17 million weekly listeners. Learn More.

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Understanding Healthcare Terms and Costs

Updated September 11, 2023. Becoming a smart healthcare consumer starts with asking the right questions. We’ve summed up a few of them here along with some helpful definitions of key terms you’ll run across when trying to understand your insurance.

With the ABCs of healthcare under your belt, you’ll be well on your way to feeling more confident about managing your costs.

FAQs about healthcare costs

What doctors can I see with my plan?

Search your insurance directory if there’s a specific doctor you’re looking to see. Or give your insurance provider a call to learn what groups and doctors near you are considered “in-network.” If your plan includes “out-of-network benefits,” you can see a doctor that’s not in your network, but that’s typically going to cost you more.

Do I need to choose a specific doctor to see?

Before getting care, some plans–such as HMOs–require that you designate a primary care physician (PCP) within your network. If you’re a One Medical member, simply call your insurance provider before your next visit and request one of our physicians be designated as your PCP. Once that change is effective, you’re welcome to book an appointment with any of our providers in and outside the office.

What services are covered under my plan?

Navigate to your insurance provider’s website or give them a call — look for the Member Services number on your insurance card — to get a list of covered services.

What will I owe for doctor visits?

For primary care visits, you’ll typically need to pay a copay (a flat dollar amount) or coinsurance (a percent). Specialist visits may have a higher copay or coinsurance, and you should see these listed on your insurance card. On top of your copay or coinsurance, you may owe more if your visit is applied to your deductible. More on that below.

What about my deductible?

Your deductible is the dollar amount you must pay out-of-pocket for certain covered services before your health insurance begins paying for your care. This may include services like in-office visits and lab tests, so it’s a good idea to check with your insurance to learn how much your deductible is and what services apply to it. Check out our guide to deductibles to learn more.

What about physical exams or well visits?

Good news! Most insurance plans fully cover one “well visit” or “physical exam” every 365 days. They’re pretty strict about that time constraint, though, so make sure it’s been at least 365 days since your last physical before you book your next one.

How about lab services?

Labwork will likely be billed separately from your office visits. At One Medical, we charge a nominal amount for in-office phlebotomy services (i.e. the blood draw itself). The bill for your lab tests will come from the company that processes them — at One Medical, we work with LabCorp and Quest.

How do I know what my labs will cost?

If you’d like an estimate of what you may owe for your labs, One Medical is happy to provide you with the names of your specific tests. You can then call your insurance provider to find out what you might be expected to pay.

Frequently used terms and phrases

Benefit: Health insurance is often referred to as an “employee benefit,” meaning that your employee covers all or a portion of its cost.

COBRA: The Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, touches on many different topics, including health insurance coverage. Notably, it allows employees to continue their health insurance coverage even after leaving employment.

Coinsurance: Some health plans are structured so that you pay a percent of your health care bill even after hitting your deductible, often ranging from 10 to 50 percent. This amount is pre-specified by your individual health plan.

Copayment: This is the amount that you pay us when you come in for a visit. If you are an HMO patient, it’s the only amount we receive for your visit. If you are a PPO patient, it’s a form of pre-payment.

Deductible: This is the amount that you are required to pay out of pocket before your insurance covers the remaining costs. For example, if you have a $500 deductible, and you have $1,200 in medical expenses for the year, you’ll have to pay the first $500, and your insurance will cover the remaining $700.

EOB: An explanation of benefits, or EOB, is a statement sent from your health insurance company detailing what health services were covered at a recent visit.

EPO: An exclusive provider organization, or EPO, is a type of health insurance plan that, like a PPO, has monthly premiums and deductibles. However, much like their name implies, EPOs have a smaller set of in-network providers and they generally do not offer any coverage if you decide to go out of network.

FSA: A flexible spending account (FSA) allows you to use pre-tax dollars to pay for many medical expenses (everything from office visits to medications). When you set up an FSA, you decide how much money you want to contribute from your paycheck each month and the funds are automatically deducted as pre-tax dollars. $500 in FSA funds can roll over to the next year.

HDHP: A high deductible health plan (HDHP) is an insurance plan that has a low monthly cost and a high deductible. These plans typically cover some preventive wellness visits without having to pay a deductible. If you have an HDHP, you also generally quality for an HSA.

HMO: Health maintenance organizations, or HMOs, offer comprehensive coverage among a more limited selection of providers than PPOs. Visits to specialists often require referrals, and diagnostic tests, procedures, and specific medications may require approval in advance. Out-of-pocket costs are generally lower than other forms of insurance, but monthly premiums are higher than HDHPs.

HRA: Funds in health reimbursement accounts (HRAs) are contributed by your employer. The funds in HRAs also do not count as income, and therefore aren’t taxed.

HSA: Much like FSAs, health savings accounts (HSAs) give you the opportunity to set aside money (pre-tax) to use for health care expenses. In order to have an HSA, your deductible must be at least $1,500, so it’s most common to have an HSA with a HDHP. HSA funds roll over from year to year, making them a great way to save for future health care expenses. There are limits on how much you can contribute to an HSA.

Labs / labwork: Common medical tests are often referred to as “labs” or “labwork” and may only be covered in network — or not at all — by some health insurance plans. Make sure to double check with your specific plan before the time comes to get tests performed.

Open enrollment: Once a year, employees have the opportunity to enroll in a health insurance plan or change his or her coverage. If an employee wishes to change coverage outside of the open enrollment period, he or she must experience a qualifying life event.

Out-of-pocket expenses: These are healthcare services that are not billed to insurance and require payment at the time of service. At One Medical, these include acupuncture and nutrition counseling.

Out-of-pocket maximum: This is the maximum amount you will have to pay for services covered by your health insurance in a plan year. Once you’ve reached this amount, you won’t pay any additional copayments, coinsurance, or other fees on covered benefits.

POS: A point of service (POS) insurance plan is a combination of PPO and HMO. You have the flexibility of both HMO and PPO coverage but are charged depending on who you see. These plans are functionally quite similar to PPOs but can sometimes be a little less expensive per month.

PPO: This type of insurance gives you more flexibility in whom you can see, but it often costs more than HMOs and HDHPs. Most preferred provider organizations (PPOs) charge you based on your level of consumption. Deductibles, co-insurance and other charges are common. In addition, we’re finding that PPOs have an increasing number of restrictions on which medications we can prescribe you.

PCP: Your primary care physician — the quarterback of healthcare! Your PCP serves as the first point of contact for an array of medical concerns, helping to identify new concerns and monitoring your overall health. Your PCP can refer you to specialists if needed. Many insurance plans require that you designate a specific PCP. At One Medical, the PCP you designate through insurance can be different from who you actually see in the office.

Qualifying life event: This is when a change in your life makes you eligible for updates to your healthcare coverage. Qualifying life events can include getting married or divorced, having a baby, moving to a new city, or a change in income.

Well visit / physical exam: Most insurance plans fully cover one preventive visit (aka “physical” or “well visit”) every 365 days.

Still looking for answers? Here are the rest of the posts from our “Becoming a Smarter Healthcare Consumer” series.

What is open enrollment?
Making sense of your insurance deductible
How billing works at One Medical
What do I need to know about FSAs and HSAs?
Pregnant? 4 important questions to ask your insurance

Riley Steinmetz is a communications professional and experienced writer based in the San Francisco Bay Area. She's passionate about all things health and wellness. An avid runner, you can regularly find her participating in races around the Bay Area. She has a Masters degree from Ball State University.

The One Medical blog is published by One Medical , a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. 1Life Healthcare, Inc. and the One Medical entities make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.

Take a Mid-Year Review of Your Health Insurance Coverage

Whether it's monitoring your deductible or using a health savings account, here are the best ways to maximize use of your health insurance coverage

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Many Americans spend thousands of dollars each year on health care, even if they have good insurance. But there are ways to reduce the amount you spend on everything from elective procedures to prescription drugs.

Start by reviewing how much you have left to meet your deductible. The average amount that employees have to pay before most health insurance coverage kicks in has increased by 10% over the past five years and 53% over the past 10 years, according to KFF (formerly the Kaiser Family Foundation).

The average deductible for workers with single coverage was $1,735 in 2023, and 31% had a general annual deductible of $2,000 or more. If you’ve reached your deductible or are close to it, schedule appointments and elective procedures by the end of the year, before a new deductible kicks in for 2025.

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Even if your insurance company offers some level of coverage if you go out of the plan’s network, you’ll have lower co-payments on a lower negotiated rate if you choose in-network providers. You can save even more by comparing how much in-network providers charge for specific procedures.

Employers and insurers are offering better tools to help you decide where to get care when you need it, says Regina Ihrke, managing director of health and benefits at WTW, a benefits consulting firm. Some employer health plans also offer one-on-one concierge services to help employees navigate their care options; by phone, a representative will walk you through your choices from providers covered by your insurance.

“Transparency tools have been around since about 2010, and now every carrier has them to at least show you what the range of the costs would be for certain procedures,” Ihrke says. The new generation of tools include quality measures in addition to cost data, she says. “The cheapest options may actually cost you more in the end because you may get misdiagnosed or have more readmissions.”

For example, Healthcare Bluebook , which is offered through some plans, lets you search by procedure to see the fair price in your area and look up cost and quality information for nearby doctors who perform the procedure. You’ll also see whether the provider falls in the top third, middle third or bottom third of quality ratings.

Other ways to make the most of employer and insurance benefits:

Take advantage of preventive care services. Even if you have a high-deductible health insurance plan, you likely qualify for many preventive care services, such as mammograms and colorectal cancer screenings, without having to pay the deductible or co-payments.

Depending on your age, you may also be eligible to get vaccines for the flu, shingles and other diseases without having to pay the deductible or co-payments. Also, some services and medications for chronic conditions may not be subject to the deductible. Take advantage of these tests, screenings and programs without any cost to you.

Cash in on wellness benefits. Many employers offer additional benefits to keep their employees healthy. You may, for example, get a discounted gym membership, a reduced insurance premium or extra contributions to your health savings account if you take a health risk assessment and complete certain activities, Ihrke says.

About 10% of employers offer lifestyle savings accounts, in which employees are given up to $1,000 to use for a variety of physical, mental or financial wellness expenses, such as a gym membership, a mindfulness resiliency app, nutrition counseling, financial wellness courses or student loan assistance. If you have access to these programs, make sure to use them by the end of the year.

Clear out your flexible spending account. An FSA allows you to set aside tax-free money from your paycheck to cover deductibles, co-payments and other out-of-pocket costs. And to use an FSA , you don’t need to enroll in a high-deductible health plan, as you do with a health savings account.

But unlike HSAs, FSAs generally require you to use the money by December 31 of the plan year (or March 15 of the following year, if the plan offers a grace period); otherwise, you forfeit the unused balance. A study by the Employee Benefit Research Institute found that half of FSA contributors forfeited funds to their employers in 2022, with an average forfeiture of $441.

The Coronavirus Aid, Relief and Economic Security (CARES) Act of 2020 made it possible for FSA (and HSA) users to buy over-the-counter medications such as aspirin or acetaminophen without a prescription, says Rachel Rouleau, chief compliance officer at Health-E Commerce, parent brand to FSA Store and HSA Store, which sell products that qualify for FSA and HSA reimbursement. You can also use FSA money for ibuprofen, cough syrups, and allergy pills and sprays.

Other items that you can buy with FSA money include glasses, contact lenses, prescription sunglasses, broad-spectrum sunscreens, certain lip balms and sun protection moisturizers with an SPF of 15 or higher, first aid kits, acne medications, menstrual care products, hearing aids, acupuncture devices, health monitors, and deep-tissue pain relief devices.

“The list of eligible FSA expenses has expanded in recent years to include a wide variety of clinical services, an extensive list of everyday essentials and several surprisingly eligible products,” Rouleau says. See a list of eligible expenses at https://fsastore.com/fsa-eligibility-list .

Pay less for prescription drugs

The Inflation Reduction Act also eliminated deductibles and co-payments for all recommended adult vaccines. And starting in 2025, Medicare Part D will have a $2,000 spending cap on out-of-pocket drug costs.

Websites such as GoodRx.com , SingleCare.com and Amazon Pharmacy can help you save money on prescription drugs, and more employers are incorporating cost-saving tools — such as Rx Savings Solutions and Scripta — into their pharmacy benefits. “It further directs members to additional cost savings,” says Chantell Sell, senior director in the pharmacy practice at WTW. Using these resources can help you find the lowest-cost pharmacy to buy the drug, coupons to reduce the cost or similar drugs that may cost less under your insurance.

“This can help people save quite a bit of money because prescription drug prices can vary by up to $100 between pharmacies — even between pharmacies in the same neighborhood,” says Charlene Rhinehart , a certified public accountant and personal finance editor at GoodRx. Using a coupon can help if you’re paying cash, and sometimes it can reduce the cost to less than you’d pay by going through your insurance plan instead, says Rhinehart. Other ways to lower your prescription drug costs:

Explore generic and alternative drugs. If you’re prescribed a drug that isn’t covered by your health insurance or that has high co-payments, ask your doctor whether there’s another drug that can serve a similar purpose but costs less under your plan. You may save a lot of money by switching to a generic drug. And even if no generic medication is available, there may be a “therapeutic alternative” — another name-brand drug that has similar effects — with better coverage from your insurance and lower co-payments for you.

“If your medication isn’t on the formulary, then in some cases there are generic versions or drugs within the same class that work the same, and they might be covered by insurance,” says Rhinehart. For example, several types of statins are prescribed to lower cholesterol and treat heart disease.

“There are many different options within the drug class, so you may have a better shot at finding an affordable alternative,” she says. When you look up a drug on GoodRx, you’ll see a list of alternatives you can ask your doctor about.

Use a preferred pharmacy. Many drug plans have preferred pharmacies with lower co-payments than other in-network pharmacies. If you have a Medicare Part D prescription drug plan, you can use the Medicare Plan Finder to compare costs for your medications at several pharmacies in your area. If you and your spouse have different health plans, make sure you know the preferred pharmacies for each one because you may need to go to different pharmacies to get the best deals. Using your prescription plan’s mail order pharmacy may save you even more money.

Buy in bulk. If you take maintenance medications every month, it can cost less to buy them in larger quantities. For example, ordering a 90-day supply of your medications instead of a 30-day supply could save you money, Rhinehart says. Ask your pharmacist for other ideas to trim costs.

Find out about pharmaceutical assistance programs. Several types of programs can help you spend less on prescription drugs. People with low incomes who have Medicare Part D drug coverage may be able to save money on premiums and co-payments through the government’s Extra Help program , which was recently expanded to include those with higher income levels. You may also be able to save through a state pharmaceutical assistance program or state discount program. Many pharmaceutical companies have programs to help with the cost of drugs that aren’t covered by insurance or co-pay assistance programs. Check with the drug manufacturer or go to this Medicare page .

Manufacturers also sometimes offer co-pay cards for certain name-brand drugs that don’t have generic alternatives, Rhinehart says. These cards cover part or all of the costs that aren’t covered by your health insurance. They don’t have income requirements, but most are available only to people who have private health insurance. You can find these co-pay cards either on the manufacturer’s website or through GoodRx.

Check out new benefits for Medicare Part D. The Inflation Reduction Act of 2022 included several changes to make prescription drugs more affordable under Medicare Part D. It capped the cost of a monthly supply of insulin at $35, but not all Part D plans cover all types of insulin. Use the Medicare Plan Finder to find out what the plans available in your area cover.

Use a health savings account

You can stretch your health care dollars by taking advantage of a health savings account, and it’s not too late to sign up for an HSA and make contributions for 2024. You can c ontribute to an HSA in 2024 if you have an eligible health insurance policy with a deductible of at least $1,600 for single coverage or $3,200 for family coverage — whether you get your health insurance through an employer or on your own. Maximum contributions for 2024 are $4,150 for self-only coverage and $8,300 for family coverage, plus $1,000 if you are 55 or older.

Many employers offer incentives to participate in an HSA, such as by matching contributions or contributing a fixed amount for all employees who have a high-deductible health insurance plan. Some employers provide HSA contributions for employees who participate in a wellness program or take a health risk assessment, Ihrke says.

Contributions to an HSA are pretax if you have a plan through your employer (or tax-deductible if you don’t have an employer plan), the money grows tax-deferred through the years, and you can withdraw it tax-free for eligible medical expenses at any time in the future; there are no use-it-or-lose-it rules. You can withdraw money from the HSA tax-free for out-of-pocket medical expenses, such as your deductible and co-payments, as well as your costs for vision, dental and hearing care, prescription drugs, and over-the-counter medications.

Once you reach age 65, you can even use HSA money to pay premiums for Medicare Part B (and Part A, if you have to pay premiums for it), Part D prescription drug coverage, or a Medicare Advantage plan. You can also pay a portion of long-term-care insurance premiums with HSA money (the amount you can cover with HSA funds is based on your age).

You’ll get an even bigger tax benefit if you keep the money growing tax-deferred in the HSA for future health care costs. You have an unlimited amount of time to with-draw money for eligible expenses you incurred since you opened the account — you can even claim re-imbursement for expenses years after you paid them out of pocket. Just keep your receipts for the health care costs you paid with cash, and then you can withdraw the money tax-free at any time.

If you plan to keep the HSA money growing in the account for future expenses, make sure your investments match your time frame. Many people keep HSA money in the plan’s savings account and don’t realize that they may have a menu of mutual funds to choose from.

If you plan to use money in the account for medical expenses soon, check out the HSA’s interest rates on savings, which can also vary significantly by administrator. “It’s shocking to me how low the interest rates being offered by some major providers are,” says Greg Carlson , senior manager and research analyst at Morningstar and coauthor of the firm’s annual HSA landscape study.

In addition to comparing investment options and interest rates, pay attention to fees, which can vary significantly among HSAs. A study by the Consumer Financial Protection Bureau found that some HSAs charged monthly maintenance fees , paper statement fees, outbound transfer fees and account closure fees. “This complex fee structure may obscure the true cost of the product, and the financial impact of these fees directly reduces the funds consumers can spend on health care expenses,” the report said.

If your employer offers an HSA, look for ways to minimize the fees, such as by receiving online account statements and keeping a minimum balance to avoid or reduce fees. For example, Carlson says, some plans don’t charge a maintenance fee if you have a certain account balance.

Note: This item first appeared in Kiplinger Personal Finance Magazine, a monthly, trustworthy source of advice and guidance. Subscribe to help you make more money and keep more of the money you make here .

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As the "Ask Kim" columnist for Kiplinger's Personal Finance, Lankford receives hundreds of personal finance questions from readers every month. She is the author of Rescue Your Financial Life (McGraw-Hill, 2003), The Insurance Maze: How You Can Save Money on Insurance -- and Still Get the Coverage You Need (Kaplan, 2006), Kiplinger's Ask Kim for Money Smart Solutions (Kaplan, 2007) and The Kiplinger/BBB Personal Finance Guide for Military Families. She is frequently featured as a financial expert on television and radio, including NBC's Today Show, CNN, CNBC and National Public Radio.

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What Part B covers

Medicare Part B (Medical Insurance) helps cover 2 types of services:

Medically necessary services: Services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition.
Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage when treatment is likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment .

If you're in a Medicare Advantage Plan or other Medicare plan, your plan may have different rules. But your plan must give you at least the same coverage as Original Medicare.

Part B covers things like:

Ambulance services
Clinical research
Durable medical equipment (DME)
Limited outpatient prescription drugs
Mental health & substance use disorders
Oxygen equipment & accessories

IMPORTANT INSULIN BENEFIT! If you use an insulin pump that's covered under Part B's durable medical equipment benefit, or you get your covered insulin through a Medicare Advantage Plan, your cost for a month's supply of Part B-covered insulin for your pump can't be more than $35. The Part B deductible won't apply.

If you get a 3-month supply of Part B-covered insulin, your costs can't be more than $35 for each month's supply. This means you'll generally pay no more than $105 for a 3-month supply of covered insulin.

If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, your Medigap plan should cover the $35 (or less) cost for insulin.

Next step: Understand what Part A covers Take action: Find out if Medicare covers a test, item, or service you need Learn more: Learn what Original Medicare doesn’t cover

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They Hit Their Health Care Deductible. It Was Time to Party.

Some of those grappling with high health care costs are finding ways to celebrate small wins and build a sense of community.

A seated audience watching a performance by dancers, one of whom holds a sign that reads "Universal Healthcare."

By Connie Chang

Last year, when CVS called Ian Goldstein and told him that he owed $23,000 for medicine he takes for Crohn’s disease, he spiraled in despair. After a fruitless call with the pharmacy, Mr. Goldstein, a comedian and writer who lives in Brooklyn, N.Y., went for a walk to clear his head and had to sit down.

“I went into a complete panic state,” Mr. Goldstein, 32, said. He had become used to wrangling with health care companies over billing mistakes and coverage ever since he was diagnosed with the condition as a teenager.

Still, the need for constant vigilance exhausts him. “There’s always some clerical error that blocks the whole thing up,” he said. Mr. Goldstein managed to resolve the matter with CVS only after months of calling the pharmacy three times a week.

This year, after he hit his insurance deductible, he decided to celebrate by throwing a party. On a sweltering Sunday in June, Mr. Goldstein and approximately 60 guests gathered at the Brooklyn Art Haus, a performance space in Williamsburg co-owned by a friend, for an evening of camaraderie and storytelling.

“Health care is such a problem, I just felt like celebrating that I’ll get to pay less money now,” he said.

For some people dealing with high health care costs, small wins, like meeting a deductible or paying off a medical bill, are sufficient reasons to party. Many Americans have inadequate health insurance coverage that has “led to delayed or forgone care, significant medical debt and worsening health problems,” according to a recent survey from the Commonwealth Fund, a nonprofit research group that focuses on health care issues.

“Celebrations, even if they’re done in jest, can provide relief and a sense of community around something that can feel really heavy,” said Megan Ford, a financial therapist at the University of Georgia.

At his party, Mr. Goldstein sang a duet with a friend, Louie Aronowitz, 36, lampooning health care costs. Others talked about having to declare bankruptcy because of medical costs or arguing with insurers for more than a year over bills that should have been covered.

Wendy Maskin, 35, attended the party with her husband, Michael Maskin, 31. The couple have been friends with Mr. Goldstein for years and thought the celebration made “perfect sense.”

“I think everyone knows someone who has been affected by medical debt,” Ms. Maskin said. “We all want it to change. It’s nice to be here and laugh a little, but also to acknowledge that we’re in it together.”

Partygoers enjoyed cupcakes decorated with a screenshot of Mr. Goldstein’s patient portal rendered in edible ink and held on to raffle tickets for customized baseball caps.

At one point, people lined up to whack a cerulean piñata shaped like an Advil pill. Cheers erupted when it cracked open, spilling candy and medical supplies like cotton swabs and bandages.

Despite meeting his deductible, Mr. Goldstein continues to spend about $400 a month on payment plans for past treatments and worries about the next bowel obstruction that could upend his finances.

Insurance can feel like a jungle. “You could be an expert on health insurance and still have to read the fine print in incredible detail to understand exactly what’s covered, so it does become mind-boggling and difficult for the average person,” said Michael Sparer, a health policy professor at Columbia University. Opaque billing practices and schemes designed to maximize profits further muddy the waters.

“Years ago, if you had health insurance paid by your employer, you might have to pay a small copay when you went to the doctor, but you wouldn’t have a significant deductible,” said Dr. Sparer. But soaring medical costs over the past 15 years have pushed employers (and insurers) to shift the burden onto individuals by increasing deductibles across the board and promoting high-deductible plans.

A Reason to Rage

Sarah Baker, who lives in Brooklyn, had been on her parents’ health care plan until last November and described dealing with health insurance for the first time on her own as a “second coming of age” and “comically bad.”

Things like setting up a payment account on the New York State of Health website and figuring out which medications her plan would cover required jumping through bureaucratic hoops. Over several hourslong calls to sort out the mess, “I never talked to the same person more than once, and I had to fight for myself constantly,” Ms. Baker, 26, said.

By the time she met her $2,100 deductible in March, which reduced her average monthly medical costs to $700 from $1,200, Ms. Baker was ready to let off some steam.

“It was the beginning of spring, no one was up to anything, and I needed a light at the end of the tunnel,” she said.

“It was a fun assortment of people coming and going,” said Mitzi Zitler, 26, who went to college with Ms. Baker and attended her party in April. Tinsel strewed on houseplants and a banner from a local dollar store reading “My First Communion” added to the irreverent mood. Ms. Baker mixed Shirley Temples and put out a big pot of beans alongside chips and salsa.

But the conversations were the real draw. Health care is “a big, scary topic, and people don’t talk about it that much,” Ms. Zitler said. “Or at least not as openly and with a dark humor like Sarah does.” Case in point: Ms. Baker sent out her party invite using Partiful, an event-invitation service popular among Gen Z , with an expletive about her deductible and saying it was time to “rage.”

Nathan Astle, a financial therapist in Kansas City, Mo., sees celebrations like deductible parties as a healthy response to this uncertainty. “Humans are meaning-making creatures, so these parties could help us cope with something that feels largely out of our control,” he said.

Smaller Celebrations

The day Jessamyn Stanley paid off a $10,000 medical debt, she posted on Instagram in search of connection. She said she felt compelled to share her experience, citing the stigma often associated with debt.

In a celebratory 90-second video , Ms. Stanley described how an emergency room visit for a scooter accident created a financial obligation that took her five years to settle. Looking intently at the camera, she concluded with a direct message to anyone who might be similarly struggling: “I see you, and I feel you, and it will one day be over.”

The “spiritually frustrating” travail conjured up unpleasant memories for Ms. Stanley, 36, a founder of The Underbelly , a virtual yoga studio. Her mother, who has congestive heart failure, was in and out of the hospital throughout Ms. Stanley’s childhood. “I grew up in a family where we were constantly hounded by debt collectors,” she said.

Ms. Stanley also treated herself to a cheeseburger — a rare indulgence — and rerouted the monthly $178 payments she had been making to a high-yield savings account. “The debt limited my life and prevented me from doing other things,” she said. “Now I can really work towards my goals.”

For Marta Olmos, medical costs exceed other expenses like car insurance and student loans, and curtail financial goals such as saving for a house. She felt immense relief when she met her $3,000 out-of-pocket maximum early in 2023 with an emergency appendectomy.

“It was like a burden being lifted because I knew I wouldn’t have to pay anything out of pocket for the rest of the year,” Ms. Olmos, 28, said.

Ms. Olmos remembered treating herself to a nice dinner out with her boyfriend and high-end personal care items purchased with funds from her flexible spending account. But the true celebration was taking care of long-neglected issues.

“I was like, now I feel totally chill just going and getting an M.R.I.,” Ms. Olmos said. She ended up having shoulder surgery as well and then physical therapy sessions to rehabilitate.

Dr. Benjamin Schmidt, a gastroenterologist in St. Louis, often sees a deductible-driven stampede in November and December. “We always have people begging us to get them in after they’ve waited to meet their deductible, which is unfortunate because a lot of times these procedures aren’t truly elective,” he said.

Dr. Schmidt, 33, opts for a high-deductible plan because it’s tied to a health savings account , a tax-free account akin to a 401(k) for future health expenses. “But it’s sort of gambling on yourself” that you won’t have significant health needs right now, he said. And for many, the choice is less about tax savings and more about affordability. High-deductible plans typically have lower premiums than other options — just keep your fingers crossed that you don’t get sick.

These nuances require the average person to act as an insurance expert, a financial whiz and a prognosticator, making a complex system even more confusing. In response, Dr. Schmidt has begun making videos that run the gamut from a tongue-in-cheek skit on deductibles to a debunking of scam colon cleanses , and that he posts on Instagram and TikTok.

The week after Mr. Goldstein’s deductible bash in Brooklyn, he was still riding the high that had gripped him that day. He has been receiving appreciative texts from friends who attended, thanking him for sparking much-needed discussions.

“I’d really love to go around and just get people to do parties like this and talk about this stuff,” Mr. Goldstein said. “Because the things that have helped me in the worst moments — and it sounds really cliché — is knowing, hey, someone else has gone through this, or someone else is dealing with these issues with insurance.”

Mike Dang contributed reporting.

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Dental access is an American 'crisis': Here's how vulnerable people are shut out.

Jackie Duda spent nearly a year recovering after a life-threatening case of sepsis. Duda, of New Market, Maryland, was never denied medical care, even when bills from her extended hospital stay and doctors’ visits surpassed $250,000.

But the 61-year-old hasn’t had the same luck with dental bills. As a freelance health journalist, she learned there's no easy solution.

Her Medicaid insurance won't cover dental implants, which she needs to replace three teeth that decayed beyond repair because of sepsis and another chronic illness. Even with a discounted rate offered through the University of Maryland’s dental school, Duda doesn't have $6,000 for the required dental work – charges she hopes to put on a high-interest rate Care Credit account that will only add to her existing credit card debt. Her grown children have offered to help her and her husband, who is on disability and works part-time at Sam's Club, with these dental costs.

“Who has that kind of money just lying around?” said Duda. “At least hospitals will work with you on costs and even waive some of the payments, but all the dental providers I've ever encountered never do.”

There’s a great divide for Americans who need dental care, with some forced to live with pain and shame while others flash five-figure veneers. The government offers no backup plan for the tens of millions without dental insurance, and insured people often struggle to cover out-of-pocket costs if they have extensive dental needs. Since 2014, the Affordable Care Act has provided coverage to millions of Americans through subsidized medical insurance and expanded Medicaid, the federal and state health insurance program for low-income families. The federal law doesn't mandate adult dental insurance, which means millions of people are routinely denied necessary dental care.

But the problem runs deeper. Having dental insurance often does not amount to financial security if you have extensive needs. Many dental plans, including Duda's, require patients to shoulder pricy out-of-pocket care beyond routine cleanings and X-rays.

More: Why Bernie Sanders is targeting oral health: 'Dental care in America is in crisis.'

Duda discovered that with Care Credit, and other medical credit cards, she faces the risk of high interest rates if she can't pay the balance within six months. In a report released July 2 , the Consumer Financial Protection Bureau warned that medical credit cards generate a "significant number of consumer complaints regarding how dentists and other healthcare providers promoted, offered, and sold medical credit cards."

Duda will apply for the medical credit card before her scheduled procedure next month since there's no other way to pay for the dental care she needs.

"I'm trying to work and look like a professional," Duda said. "I can't be smiling and have holes in my mouth."

The ethics of serving everyone in need

The problem for patients begins at a philosophical level, namely, the degree to which providers consider patient care their professional duty.

In health care, the bar has always been lower for accessing care if you don't have insurance or funds.

Hospitals are legally required to assess and stabilize patients regardless of whether they can pay, but there are no such mandates for dental practices. Most dental clinics operate as independent businesses and they can – and often do – reject patients who can’t afford care.

Dentists say they need to recover operating costs, including the cost of hygienists, office workers and expensive equipment. Many providers also have hefty debt. Dental school graduates in 2023 owed an average student loan balance of $296,500, surpassing what doctors owed in student loans for medical school.

Dentists do offer discounted or free care to some patients. In 2018, the American Dental Association Health Policy Institute estimated dentists gave $800 million in discounts and $1.6 billion in free care. Another 6.1 million patients in 2022 received dental care from federally funded community health centers, which provide medical and dental care to underserved populations.

But dentists say their charity has limits, given the nation's overwhelming, unmet oral health needs.

"We all went into business to help the communities we're serving, but there's a limit to that," said Brett H. Kessler, president-elect of the American Dental Association. "We can't give away everything for free."

There are routes to improving access, but the legislative proposals face an uphill battle with the election pending. The Biden administration has adopted a rule to let states opt into adult dental insurance coverage as part of their Affordable Care Act plans. Sen. Bernie Sanders, I-Vt., wants a more comprehensive plan : His bill would expand dental coverage through Medicare, Medicaid and the Veterans Administration and increase the number of dentists, dental hygienists and dental therapists nationwide.

Sanders told USA TODAY that U.S. dental care is "in crisis" with far too many Americans shut out of the system. Nearly 69 million U.S. adults did not have dental insurance or access to routine oral health care last year, according to the nonprofit CareQuest Institute for Oral Health.

"Most people know that our health care system is broken. It's outrageously expensive. Millions of people can't afford insurance," Sanders said. "But I think there is not that same consciousness with regard to dental care. The reality is that dental care in America is extremely expensive. Many dentists do not accept Medicaid reimbursement because it is too low or for other reasons."

Another problem in Sanders' view: "We don't have enough dentists in America, and we especially don't have dentists in many underserved areas."

While there is no estimate yet on the cost of Sanders' bill, any plan that significantly expands health and dental benefits would be pricey at a time of ballooning federal budget deficits and will likely face opposition from fiscal conservatives.

Kessler, the incoming leader of the American Dental Association, acknowledges far too many Americans are shut out of dental care, but the reasons people can't access needed dental care are complex.

A major barrier, he said, is that dental insurance tends to limit coverage as costs rise. With medical insurance, once people reach their deductible, all necessary care at hospitals and with in-network doctors is largely covered. With dental insurance, the coverage tends to run out quickly. After a certain range or a few thousand dollars of service, the plans stop covering patients.

"That's the ridiculousness of the dental insurance model," Kessler said. "Why can't dentists offer the finest dentistry has to offer for our patients, yet medicine can? It makes no sense to me."

Carlos S. Smith, a professor and associate dean of inclusive excellence, ethics and community engagement at Virginia Commonwealth University School of Dentistry, challenged the profession to examine whether independent dentists can do more to improve access to care, in a 2022 column posted by the Academy of General Dentistry. Smith asks in the piece whether organized dentistry should be rooted in an "ethical decision-making model" or a model that supports "office profits?"

Smith recently told USA TODAY this foundational question remains essential. Too many patients are shut out of the system because of a lack of dental insurance. And patients with limited benefits through Medicaid, won't necessarily get the care they need, since many dentists don't accept those plans.

"One of the hallmarks of our profession is autonomy," Smith said. However, he thinks self-evaluation and self-analysis are essential for practitioners: "I believe it is incumbent upon the profession to ask of ourselves, how can we be better?"

'Pray to get something deadly' to get dental care

Harold Krieg is among the millions experiencing the fallout of the country's crisis in dental care. The Las Vegas resident no longer smiles. He can't remember a day when he wasn't in pain.

On good days, the discomfort from his untreated dental disease is tolerable. On bad days, he said, it “feels like somebody jabbing knives into my mouth.”

The 62-year-old former television crew worker feels “shame and ugliness” because years without care have left him with receding gums and a dozen remaining teeth. His dental disease is exacerbated by other medical conditions – esophagitis, severe acid reflux and Type 2 diabetes.

He can visit the doctor because he has Medicare and Medicaid insurance. But he does not have $35,000 to pay for the dental care he needs. That's the total he was quoted for extracting his remaining teeth and installing “All on 4” dental implants that would be screwed into his jaw.

Krieg’s doctor wrote a letter asking insurers to cover his dental care. The doctor explained stomach acid from his medical condition causes him to vomit frequently – and that has eroded his gums.

That effort went nowhere.

He also tried unsuccessfully to get the procedure at dental schools, hospital emergency rooms and through dental lotteries. A former production worker on a New York cable talk show, Krieg volunteered to tell his story on television talk shows, including on Dr. Phil and The Doctors, hoping he'd catch the attention of someone who could help. Those pitches went unanswered.

He reached out to dental companies and volunteered to be filmed for dental implant training videos. That also failed.

When he went to a periodontist in Las Vegas who advertised free consultations, he quickly learned that there was no charity care. Instead, he said, staff at the clinic chastised him “for being poor.” He left with “tears in my eyes and the sense that I don’t matter as a person.”

For more than six years, Krieg has lived with pain and discomfort. He can no longer eat foods he loves such as corn on the cob or crisp apples. Instead, his diet consists of soft foods like mashed potatoes and eggs.

He said he's landed on one final way he could get insurance coverage for necessary dental care. Medicare covers some dental procedures for cancer patients before they start chemotherapy.

He's contemplated that as a way out of the pain in the event he's ever diagnosed with cancer.

“You literally have to pray to get something deadly in order to get your teeth done,” Krieg said. “Unfortunately, I don’t have cancer and I am not on chemotherapy.”

Stuck with half a mouth of broken, infected teeth

Another firsthand witness to the dental crisis is Betty Lowe, of Jellico, Tennessee, who never had consistent access to oral health care. Her husband's employer does not offer dental insurance, and Lowe relies on that since she is raising the couple's children.

She was ecstatic last year when Tennessee expanded dental benefits to adults who qualify for TennCare, the state’s Medicaid program. She could finally address her long-neglected dental needs.

The mother of three waited months to land an appointment with a dentist who would take her new dental coverage. The dentist, Timothy Gansore, works in Jacksboro, about 30 miles south of Jellico, a small town near the Kentucky border. He told USA TODAY he is one of two dentists who accept Medicaid in the region.

During that appointment, Lowe learned the price of years without dental care: All her teeth were infected. Gansore drew up a care plan. The dentist would extract all her teeth and replace them with dentures to “get the beautiful smile I've always longed for,” Lowe recalled.

But after the dentist pulled her molars and other back teeth, she lost her Medicaid coverage when Tennessee resumed Medicaid eligibility checks halted during the COVID-19 emergency. She couldn't afford to pay Gansore to extract her remaining teeth or to finish the dentures. She now has a dozen teeth in the front of her mouth and all of them “are all broken and infected.”

At her dentist's suggestion, she applied for Care Credit but only qualified for $300 of care, far short of the $2,700 she needs to cover the remaining work. Dental office workers told her another option would be to apply for a bank loan, but that was impossible. Her husband earns $10 an hour, so there's no way they can qualify, let alone make loan payments. She can't get a job herself because of a recurring leg ulcer, for which she has unsuccessfully sought Social Security disability status.

"Not only do I feel terrible because I don't have the pretty smile, but I don't have any hopes of getting it either, because I don't have money," Lowe said.

Gansore told USA TODAY he is one of two dentists who accept Medicaid in a 25-mile region north of Knoxville including two rural counties near the Kentucky border.

He said he offers patients a discount of up to 10%, but he can't afford to lop off much more of their costs. He has to pay for staff, equipment, insurance and other expenses. Since Tennessee expanded adult dental benefits last year, his dental practice has been inundated with calls from low-income patients desperate for care. The problem, he said, is Medicaid pays far less than private insurance and customers who pay in cash. To keep his business afloat, he's had to maintain a healthy mix of insurers and payments and has limited the number of bookings for Medicaid patients.

"I cannot see all of them," Gansore said. "I take whatever I can – and the rest of them, I say, 'I cannot take any more new patients.'"

"It's unfortunate because the other providers probably would (accept Medicaid) if the reimbursements were attractive," he said. "It doesn't matter if the government offers programs like that if no doctor wants to take it."

Have you had trouble accessing dental care due to cost or lack of health insurance? Please share your story with consumer health reporter Ken Alltucker, [email protected] .

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High Deductible Health Plans: Your Complete Guide To HDHPs
The IRS defines an HDHP as any plan with a deductible minimum of: $1,400 for an individual. $2,800 for a family. An HDHP's total annual in-network out-of-pocket expenses (including deductibles ...
High-deductible health plans and how they work
High deductible health plans help protect against really high-cost (and even unplanned) services. These can include things like hospital stays, surgeries and complex treatment care that may quickly get you to that deductible. Until you reach your network deductible, you'll pay for all your health care costs.
Is a high-deductible health plan right for you?
Though HDHPs usually have higher deductibles than most PPOs or HMOs, they do come with an out-of-pocket maximum. This is the most you'll pay in a year for covered services from in-network providers. For 2021, the maximum is $7,000 for a single person and $14,000 for a family — rising to $7,050 and $14,100 in 2022.
What is a High-Deductible Health Plan (HDHP) & How Does it Work?
These plans have higher deductibles. That means you pay for doctor visits, tests and prescriptions until you meet your deductible, then and your plan begins to pay. If you have an individual plan, the minimum deductible is $1,500. If you have a family plan, the minimum deductible is $3,000.*
5 Things to Know About High Deductible Health Plans
Labs can be extremely costly, and even if your provider deems a test medically necessary, a high deductible plan usually means that the responsibility of payment falls on you. 2. You Can Pay Out of Pocket Expenses with Pre-Tax Dollars. When you have an HDHP, you have the option of opening a Health Savings Account (HSA).
Who should consider a high-deductible health plan?
The lower deductible means that their insurance plan will start to pay sooner, and the plan might cover a variety of services - like office visits, urgent care visits, and prescriptions - with copays instead of having the patient pay for them with the costs counting towards the deductible.
What are HSA-eligible plans?
Health Savings Account (HSA) -eligible plan (also called a High Deductible Health Plan (HDHP)) and open an HSA, a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses (like some dental, drug, and vision expenses). How HSA-eligible plans can lower your costs.
How HSA-eligible plans work
More info. How HSA-eligible plans work. A Health Savings Account (HSA) lets you set aside money on a pre-tax basis to pay for: Coinsurance. Coinsurance. A percentage of the cost that you pay for each plan-covered service, like 20%. Copayments. Copayment. A fixed amount you pay for a plan-covered service, like $30.
Should You Choose a High-Deductible Health Plan?
According to the IRS, an HDHP is defined as the following in 2022: Any health plan carrying a deductible of at least $1,400 for an individual or $2,800 for a family. Total out-of-pocket expenses ...
High-Deductible Health Plan Pros and Cons
Higher deductible: If your deductible is higher, it means you are required to pay for your medical care out of pocket up to that amount before your health plan begins to help pay for covered costs. The exception is for preventive care, which is covered at 100% under most health plans when you stay in-network. 1.
HDHP Calculator
Step 7: Compare Your Results. Your Total Estimated Costs (includes the premium you expect to pay and costs relating to health care services) Category. Annually. Per Pay Period. Total Estimated Costs for High Deductible Health Plan: $ 0.00. $ 0.00.
Understand Your Deductible Plan Costs
How a deductible works. With a deductible plan, you pay the full cost for many services until you reach a set amount for the year — your deductible. After you reach your deductible, you'll usually start paying just a copay or coinsurance: A copay is a set amount you pay for a service. A coinsurance is a percentage of the full cost of a service.
Guide to Deductible Plan Bills and Costs
You pay the full cost for certain services until you reach a set amount for the year — your deductible. After you reach your deductible, you typically just pay a copay or coinsurance. With some plans, you may pay a copay or coinsurance for certain services even before you reach your deductible.*.
How to Survive a High-Deductible Health Plan
But the average deductible for a Silver Plan this year is $3,572 for an individual and $7,474 for a family, according to the health insurance data website HealthPocket. Those are eye-popping ...
What Is a High Deductible Health Plan (HDHP)?
A high deductible health plan (HDHP) is a health insurance plan with lower premiums but higher deductibles, and HDHPs enable HSA contributions. ... who bills $200 for the visit. Lynn's insurance plan has a negotiated rate of $140 for the office visit, so the doctor reduces the bill down to that amount. ... She still has to pay $1,260 in ...
How High-Deductible Health Plans Work
If your health insurance plan for 2024 has a minimum deductible of $1,600 for individual coverage or $3,200 for family coverage with maximum out-of-pocket costs of $8,050 ($16,100 per family ...
What to Know About High-Deductible Health Plans
The bottom line. High-deductible health plans (HDHPs) are health insurance plans where you pay lower premiums in exchange for higher deductibles. You can pair them with health savings accounts (HSAs) to make it easier to pay for your medical expenses. HDHPs are good choices for some people. You need to look closely at your health expenses and ...
What Is a High-Deductible Health Plan (HDHP)?
On average, single Americans with a high-deductible health plan (HDHP) have an annual premium of $7,170, while those with a more traditional type of health plan (like an HMO or PPO) have an average premium of $8,162. For families, the premium comparison is $21,079 with an HDHP versus $23,003 without. 8. So on average, you'd save over $800 ...
High Deductible Health Plans
High Deductible Health Plans. An HDHP offers a lower premium with a higher annual deductible. You pay for most of your care until you've met your deductible, and preventive care like screenings and immunizations are still covered at no cost. Learn more with helpful FAQs.
Understanding Healthcare Terms and Costs
HDHP: A high deductible health plan (HDHP) is an insurance plan that has a low monthly cost and a high deductible. These plans typically cover some preventive wellness visits without having to pay a deductible. If you have an HDHP, you also generally quality for an HSA. HMO: Health maintenance organizations, or HMOs, offer comprehensive ...
Deductible and cost of dr appointment : r/personalfinance
Deductible and cost of dr appointment. My company-sponsored heathcare has a deductible of $1850, and i pay about $32 a month for premium. I have some health issues that require me to visit the doctor several times a year, and each appointment (less than 15 mins) costs about $200. That means after only 9 appointments, I have already reached my ...
Take a Mid-Year Review of Your Health Insurance Coverage
Even if your insurance company offers some level of coverage if you go out of the plan's network, you'll have lower co-payments on a lower negotiated rate if you choose in-network providers.
Telemental health visits decline when cost-sharing returns, new study
The charge per visit was enough to cause patients to attend 1.5 fewer telemental health visits per month and for 11.7% of patients to stop visits altogether. Ami Parekh, chief health officer at ...
What Part B covers
The Part B deductible won't apply. If you get a 3-month supply of Part B-covered insulin, your costs can't be more than $35 for each month's supply. This means you'll generally pay no more than $105 for a 3-month supply of covered insulin.
They Hit Their Health Care Deductible. It Was Time to Party
Dr. Schmidt, 33, opts for a high-deductible plan because it's tied to a health savings account, a tax-free account akin to a 401(k) for future health expenses. "But it's sort of gambling on ...
Dental access is an American crisis. How vulnerable are shut out
Duda, of New Market, Maryland, was never denied medical care, even when bills from her extended hospital stay and doctors' visits surpassed $250,000. But the 61-year-old hasn't had the same ...

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