My High Deductible Health Plan (HDHP) is seriously a love of mine. Everyone in my life knows if you ask about my HDHP or about HDHP plans, I’m going to get excited! Let me preface the rest of this post with the fact that I am NOT a healthcare expert, I do NOT know about your plan details, and I have NO idea how healthcare or health coverage will change with this presidency. I can tell you about my experience with having an HDHP over the last 6 years, and why I love it.
Let’s start with a few basic definitions:
Premium – cost you pay for your plan
Deductible – amount you must pay before your plan starts to pay for your care
Out of pocket max – the most amount of money you’ll have to pay in a year
Okay, back to HDHP’s…here’s the obvious first awesome feature. They’re usually way less expensive! That’s right, LESS expensive than PPO plans (when comparing similar HDHP vs. PPO plans – obviously a low-end PPO could potentially cost less than a very high end HDHP).
In general, with an HDHP, you’re going to pay a lower premium, but your deductible will be higher than those with a PPO plan. With a PPO, your premiums are higher, but your deductible will be significantly lower. In most cases, the coverage itself is the same, so the difference is really whether you want to pay for your healthcare costs up front (HDHP), or want to pay them over time (PPO).
It might sound better to pay them over time, but let’s talk about some other things that can make HDHP plans awesome.
With most HDHP and PPO plans, preventive care is typically free. In most cases, you can go to an in-network doctor to receive services and care recommended by the government at no cost, even before you meet your deductible. So, flu shots, well-woman visits, mammograms for those 40+ years old, etc. will all be included. Check out this link to the see the preventive care services recommended for women. You know how the HDHP and PPO plans are different on this one? With an HDHP, there’s no copay at the doctor! With a PPO, you typically have a co-pay, and you have to pay the co-pay even after meeting your deductible.
While plans vary, on quite a number of HDHP plans, the deductible and the out of pocket max run concurrently. If your plan is structured that way, that means that when you hit your deductible, you simultaneously hit your out of pocket max. At that point, your costs may be covered at 100% for the rest of the year! How amazing is that?!?!
With an HDHP, you’re eligible for an HSA account. There are other tax-advantaged saving accounts for healthcare, but the HSA is my favorite. The money from an HSA rolls over year to year, so you can continue to save and use that money when you want/need to, rather than lose the money at the end of the year. Plus, you can use your HSA account for vision and dental care, in addition to medical expenses.
If you are a single person who doesn’t need to go to the doctor often, an HDHP may be for you because you’ll pay lower premiums, preventive care will likely be included for free, you may never get close to reaching your deductible, and you have the ability to contribute to an HSA.
If you are part of a family or you are a person who has a lot of healthcare needs, an HDHP may be for you too. Since preventive care is likely going to be covered, all of your well-child and other routine care will be included. If you do have a lot of expenses, you may hit your deductible pretty quickly, and if you’re on a plan where the deductible and out of pocket max run concurrently, then all of your care will likely be free for the rest of the year! You can get a lot of bang for your buck if you have surgery or other high-cost procedures! Plus, as mentioned, you’ll have the option to contribute to a tax-advantaged HSA.
I’ve had an HDHP plan individually, then been on an HDHP with my husband, and now have family coverage with an HDHP, and it’s been tremendously beneficial in all scenarios.
Again, I’m not an expert about your plan, but do your research to determine if an HDHP may be right for you. It could be a great option!
You can learn more about HDHPs and HSAs on the IRS website.