Namely, you're responsible for paying a larger portion of your healthcare expenses out of pocket. This can be a significant financial burden for those with a lot of medical expenses and could lead to financial strain. HDHPs may not be the best choice for those with chronic or frequent medical needs.
HDHPs can be a good form of insurance for the young and healthy — especially if your employer offers you HSA contributions. But for anyone with significant medical expenses, an upcoming surgery, or a serious health condition, a PPO could be a better fit because of the lower deductible.
One study found that the enrollment in HDHPs among private-sector workers increased from 11.4% in 2006 to 46.5% in 2016%. Moreover, according to the Bureau of Labor Statistics, the proportion of people enrolled in HDHPs increased from 24% in 2010 to 45% in 2018.
For insured adults who are ill, having higher deductibles would mean they would be more likely to have difficulties paying medical bills or accumulate medical debt: 59 percent of sick adults with deductibles of $500 or more would experience medical bill or debt problems, compared with just 24 percent of comparatively ...
Large medical expenses: Since HDHPs generally only cover preventive care, an accident or emergency could result in very high out-of-pocket costs. Future health risks: Because of the costs, you may refrain from visiting a physician, getting treatments, or purchasing prescriptions when they're not covered by your HDHP.
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.
An HDHP is best for younger, healthier people who don't expect to need health care coverage except in the face of a serious health emergency. Wealthy individuals and families who can afford to pay the high deductible out of pocket and want the benefits of an HSA may benefit from HDHPs.
4. A High Deductible Health Plan is Cheaper for Employers. An HDHP is typically cheaper for employers than other, more traditional health plans such as PPOs.
PREMIUMS AND WORKER CONTRIBUTIONS
In 2023, average annual premiums for covered workers in HDHP/HRAs are $8,217 for single coverage and $22,404 for family coverage. The premium for family coverage is significantly less than the average family premium for covered workers in plans that are not HDHP/SOs [Figure 8.6].
If you're generally healthy and don't have medical expenses beyond annual physicals and preventive screenings, an HDHP could save you several hundred dollars or more a year.
HMO plans might involve more bureaucracy and can limit doctors' ability to practice medicine as they see fit due to stricter guidelines on treatment protocols. So just as with patients, providers who prefer a greater degree of flexibility tend to prefer PPO plans.
Copays do not count toward your deductible. This means that once you reach your deductible, you will still have copays. Your copays end only when you have reached your out-of-pocket maximum.
The primary disadvantages of a high-deductible health plan include the high out-of-pocket costs and the potential reluctance to seek medical care due to upfront expenses.
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.
For families, the deductible has to be at least $2,700, with a $13,500 max out-of-pocket. Many high deductible plans actually have a much higher deductible ($5,000-$7,000).
If you are generally healthy and don't have pre-existing conditions, a plan with a higher deductible might be a better choice for you. Your monthly premium is lower since you're only visiting the doctor for annual checkups, and you're not in need of frequent health care services.
A plan that has a deductible of at least $1,400 (for individuals) or $2,800 (for a family) is considered a high-deductible plan. If your insurance plan has a low deductible, this means you may reach the threshold earlier and get cost-sharing benefits sooner.
With a high-deductible health plan, your out-of-pocket costs may be higher. If something unexpected happens you must be financially prepared to cover the high deductible. Avoiding Care. Those high payments for medical care might keep you away from checkups and other preventative measures.
Bureau of Labor Statistics, U.S. Department of Labor, The Economics Daily, 51 percent of private industry workers participated in high deductible health plans in 2023 at https://www.bls.gov/opub/ted/2024/51-percent-of-private-industry-workers-participated-in-high-deductible-health-plans-in-2023.htm (visited January 11, ...
Generally, if you're younger and/or healthier, an HSA could definitely be worth it. What's in it for you is major healthcare coverage, potentially lower insurance premiums, and a tax-deferred account that can grow over time.
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.
A HDHP requires you or your family to pay the full cost of your health care, including your medications, until you meet your plan's annual deductible. Sign in or register for an account to view your plan summary for details.