What Is A High Deductible Health Plan

A high-deductible health plan is health insurance with a high minimum deductible for medical expenses that must be paid before insurance coverage kicks in. 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 expenses for the upcoming year and see how much you’ll be responsible for out of pocket with an HDHP before you sign up.

If you’re enrolled in an HSA eligible plan, what you save in premium costs can help offset out-of-pocket expenses not covered by the plan, especially if you put those savings into an HSA. An HRA is funded by an employer to enable workers to pay themselves back—with tax-free money—for medical expenses they’ve incurred. To participate in an HRA, an employee—and possibly their family members—may be required to be enrolled in a health insurance plan.

The HSA should be viewed mostly as a repository for any free contributions available from your employer because it is such a lousy investment vehicle. It should not weigh heavily in your HDHP-decision otherwise. For those with children, or who have significant predictable medical expenses, you are likely better off with a traditional PPO.

Other health plans – that also have high deductibles – sometimes have lower premiums and also pay for non-preventive care before the deductible is met, which HDHPs cannot do. High Deductible Health Plans usually have lower monthly premiums than plans with lower deductibles. By using the untaxed funds in your Health Savings Account to pay for expenses before you reach your deductible, you reduce your overall health care costs. HDHPs have higher annual deductibles and out-of-pocket maximum limits than other traditional health plan offerings.

How To Choose An Insurance Plan Thats Right For You

If your workforce is primarily young and healthy workers, you and your employees can save a lot of money by opting for a plan that has higher deductibles and maximum out of pocket limits. This demographic rarely uses the more costly services and typically favors a bigger paycheck over coverage they rarely use. Conversely, if your workforce is older, it might be better to choose a plan with higher premiums and lower deductibles and maximum out of pocket limits. In this case, you can also consider supplementing the plan with a group coverage health reimbursement arrangement , health savings account , or flexible spending account . The big drawback to choosing an HDHP is having potentially high out-of-pocket expenses for the year. As of January 1, 2020, the Affordable Care Act rules state that the most any person can pay in out-of-pocket maximums is $8,150 for in-network benefits ($8,550 for 2021). Previously, insurance plans could require that one person in a family plan meet the family maximum.

In addition, the plan’s out-of-pocket maximum must be no higher than $6,900 for an individual plan or $13,800 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.

With an HDHP, the annual deductible must be met before plan benefits are paid for services other than in-network preventive care services . Preventive services are covered 100%, before the deductible is met. In exchange for the increased cost sharing, this plan offers a lower monthly premium cost. The other big advantage of high-deductible insurance is that qualified plans offer a health savings account to help manage health care costs. The planning tools and information calculators are illustrative only, and accuracy is not guaranteed. They are intended to provide a comparative tool for various consumer health care options and potential costs and savings of those options.

Premiums + Maximum Out

It’s no secret that the use of high deductible health plans continues to skyrocket. The number of covered workers on HDHPs has increased from just 4% in 2006 to nearly one-third of all covered workers in 2019 (30%). For 2020, the IRS defines an HDHP as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total yearly out-of-pocket expenses can’t be more than $6,900 for an individual or $13,800 for a family. The other reason an HDHP can be beneficial to a person with significant medical costs is the fact that it allows the person to make contributions to a health savings account . HDHPs typically have lower premiums than traditional health plans because of the high deductible, and they protect you in the event of catastrophic health events. But HDHPs are not always the lowest-priced plans available, as the out-of-pocket maximum can be higher on plans that aren’t HDHPs.

Do you want to save money on your monthly health insurance premiums and have the opportunity to open a health savings account? 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. Using an HRA to reimburse employees for individual insurance plan premiums and out-of-pocket expenses gives you the best of both worlds. You get all the cost savings and tax advantages of a traditional group HDHP while giving employees funds so they can get the care they need. Individual health insurance is more affordable than traditional group health insurance and still gives employees access to preventative treatments to keep them healthy and happy.

Hdhp Versus A Traditional Health Plan

You can subsidize employees tax-free for premiums and out-of-pocket expenses with health reimbursement arrangements or health savings accounts . This is because people with modest health care needs might not end up meeting their out-of-pocket maximum. 1 Per IRS guidelines in 2021, an HDHP is a health insurance plan with a deductible of at least $1,400 if you have an individual plan – or a deductible of at least $2,800 if you have a family plan. The deductible is the amount you’ll pay out of pocket for medical expenses before your insurance pays anything.

• Moreover, high-deductible plans boost companies’ bottom line by shifting more costs to the employee.
• On the negative side, HDHP plans come with a much higher deductible and have much higher out-of-pocket caps on your health care spending.
• To determine which health insurance plan might be better for you, I suggest you compare your expected annual health care costs to the amount you save on your premiums and receive as a company contribution to your HSA.
• The IRS currently defines a high-deductible health plan as one with a deductible of at least $1,350 for an individual or $2,700 for a family, according to healthcare.gov.
• The high-deductible health plan is frequently among the health insurance choices offered by companies these days.

HRA funds may in some cases be used to pay for health insurance premiums. Deductibles are only one consideration among many when shopping for health insurance.

If you choose a plan with a higher deductible, you may be required to pay more out-of-pocket in order to reach your deductible. There are some pros and cons to a high deductible health plan. In the early 2000’s, as health insurance prices increased, businesses providing healthcare for employees began looking for ways to save money. At that point, high deductible health plans were few and far between, but some companies picked them up, believing that it was their best option.

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 exceed the plan’s annual out-of-pocket maximum. On average, though it varies state to state, commercial insurers paid $18,329 for vaginal delivery and $27,866 for a cesarean in 2010, according to a 2013 study from Truven Health Analytics. 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 only cost you $76.

Even employers not jumping to high deductible health plans are still increasing deductibles in order to lower premiums. Kaiser reports that in 2009, covered workers with deductibles over $1,000 for individual coverage, was 22 percent. This trend is more prevalent in small firms because health insurance for small businesses is typically more expensive than in large companies, as there are less people upon which to amortize expenses. As the costs for premiums continue to surge, so do the number of employers opting for high deductible plans. With an HRA, employers can get the cost savings of an HDHP, get out of the insurance business, and give their employees tax-free money to buy coverage that more closely meets their personal needs. The money in your HSA rolls over from one year to the next — there’s no “use it or lose it” provision with an HSA.

The IRS currently defines a high-deductible health plan as one with a deductible of at least $1,350 for an individual or $2,700 for a family, according to healthcare.gov. Field notes that many deductibles are in the range of $5,000 to $6,000.

Network size, out-of-pocket maximums, plan structure and covered expenses also are important to think about. Once you compare your anticipated medical costs for 2015 with your coverage options, look more closely at the plans you’re considering to ensure they provide the right type of coverage for the money you expect to spend. A Health Savings Account is an account for individuals with high-deductible health plans to save for medical expenses that those plans do not cover.

Hence, workers pay more medical costs out of their own pocket, as compared to traditional health plans, before the insurance company starts picking up the coverage. On the positive side, people’s monthly premiums are typically lower. While a “high deductible” plan begins at $1,400 for an individual and $2,800 family, there are plenty of offerings with much higher deductibles that may work depending on your workforce’s demographics.

The Pros And Cons Of High Deductible Health Plans (hdhps)

You can use the money in your HSA to pay your deductible and other out-of-pocket expenses, as well as any qualified medical expenses that aren’t covered by your health plan. Because your HDHP doesn’t provide any non-preventive coverage until your deductible is met, you’ll need to have some way of paying the deductible in case you need medical treatment other than preventive care. An HSA is a good solution for making sure you have the funds available to cover your deductible if necessary. As the name suggests, a high-deductible health plan carries a higher deductible, which must be met before your plan benefits kick in for anything beyond in-network preventive care services. A high-deductible plan is any plan that has a deductible of $1,400 or moreOpens in new window for individual coverage and $2,700 or more for family coverage. An HSA can be paired with a qualified high-deductible health plan and offers the opportunity to save for health care expenses.

According to IRS rules, an HDHP is a health insurance plan with a deductible of at least $1,400 if you have an individual plan—or a deductible of at least $2,800 if you have a family plan. The deductible is the amount you’ll pay out of pocket for medical expenses before your insurance pays anything.

This new rule limits your risk if you have a family health insurance plan. Once any family member has $8,150 in medical expenses, their costs will be 100% covered for the rest of 2020. HDHPs can be a good form of insurance for the young and healthy, but the attractive tax treatment applied to an HSA should in no way influence your decision. And if your employer happens to offer you a choice between an HDHP and another plan with no out-of-pocket maximum, you might be better served with the HDHP.

The high-deductible health plan is frequently among the health insurance choices offered by companies these days. On the negative side, HDHP plans come with a much higher deductible and have much higher out-of-pocket caps on your health care spending. To determine which health insurance plan might be better for you, I suggest you compare your expected annual health care costs to the amount you save on your premiums and receive as a company contribution to your HSA. Moreover, high-deductible plans boost companies’ bottom line by shifting more costs to the employee.

In addition, the plan’s out-of-pocket limit must be no higher than $7,000 for an individual plan or $14,000 for a family plan. The out-of-pocket limit is the most you’ll have to pay in a year for medical expenses covered by your insurance plan. Though high-deductible health plans involve greater out-of-pocket costs, they still save some consumers money. 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.

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. 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.

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. 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 $4,000. If you chose the lower deductible plan (the non-HDHP), you could pay for $2,550 of your $3,000 in medical expenses with a flexible spending account if your employer offers one.