The Pro’s and Con’s of High Deductible Health Insurance Plans

Are you familiar with the term “high deductible health insurance plan” (HDHP)? This type of coverage saves you money on monthly health insurance premiums in exchange for higher deductibles—the annual upfront amount of covered health expenses you must self-pay (out-of-pocket) before your plan pays for medical expenses. Read today’s post to better understand if these plans are right for you.

Autumn brings a change in the weather, the onset of fall colors, and for many, it signals the annual rite of choosing a health insurance plan for 2015. Employers are increasingly offering HDHPs to their employees. In fact, according to a National Business Group on Health survey, of the 136 large companies studied, almost 33% offer HDHPs to their employees. These plans are also available from the health insurance marketplace for individuals and families who do not receive their health insurance through employers.

Before deciding on whether or not this plan is right for you and your family, it is wise to evaluate your own and your family member’s mental health care needs.

Compare your options

The Good: High deductible health insurance plans tend to have lower monthly premiums, making health coverage more affordable for many, especially workers earning lower wages. Basic preventive services, such as an annual physical, preventive vaccines for flu and pneumonia provided by in-network health care providers, and generic drugs are often covered at low or no cost to the patient.

The Bad: Consumers with HDHPs must pay for health expenses, including co-pays before the deductible kicks-in. Charges for out-of-network providers or services or drugs not covered by the health plan don’t apply toward meeting the annual deductible. The hope is that users will become more responsible for their health care and will comparison shop. While in principle this is a good idea, in reality, when one chooses an in-network provider for their care, it may turn out that the recommended subsequent lab work is out-of-network, or that the necessary prescription is not a generic brand.

The Ugly: Beyond paying monthly premiums, in 2014, the out-of-pocket limits are $6,350 for covered individuals and $12,700 for families.

The Challenge: Patients must be prepared to seek covered treatment by in-network providers, and have the financial resources to cover a greater share of the cost of unanticipated medical costs. When reviewing mental health care needs, it is important to find out how many clinicians are available in the carrier’s network. A common complaint is that there are not enough in-network clinicians to handle the capacity. Call the doctors listed in your plan before you enroll. Make sure they are not only taking new patients, but learn how long it will take to actually see the clinician.

Learn more
It seems astounding that one could have health insurance and yet feel completely vulnerable to health care costs due to high out-of-pocket deductibles, for mental health care, medications, costly labs, and other diagnostic tests. To learn more about how to evaluate health insurance coverage register to attend a webinar offered by the Depression and Bipolar Support Alliance on November 13, 2014.

The Questions

  • What changes have you made in managing your health care to meet the cost of high deductibles?
  • How have you evaluated the benefits of low premiums versus the high cost of upfront out-of-pocket expenses?

Facebook Comments

9 comments
James Lisbon
James Lisbon

I suppose something like this would probably come down to the needs of the family or the individual.   The last thing someone would probably want is to not be able to find a service that would work for them.   However, there seem to be options out there, so that is probably a good thing. http://www.adkinsoninsuranceservices.com 

EmilySmith3
EmilySmith3

Wow, I had no idea that a higher deductible could mean lower monthly premiums. I am trying to find a good health insurance plan that will work for me. I will have to keep these pros and cons in mind as I look around. http://www.danaiello.com/services/ 

LaurenAdams
LaurenAdams

It is so important to compare the pro's against the cons when it comes to different insurance companies. After all, if you can't tell the difference between the two, you may make the wrong decision. Everyone is different, so it is important to remember to get what works for you and not just what someone suggested. http://fultonins.ca/ 

CaseyJones1
CaseyJones1

I rarely ever get sick and there are no genetic health problems in my family.  Perhaps high deductible health insurance would be good for me.  Considering that I am a student with very little money, I think that would be my best option.

http://www.baileymt.com/services 

KentClark1
KentClark1

Most people prefer having a lower premium. However, that may not be what is best for everyone. I think that you should just consider where your health is, and then make a decision based upon that. Obviously, do your research when making such a choice. http://www.quesenberryagency.com/health-insurance/ 

BonobosMarcos
BonobosMarcos

I like the idea of a lower monthly premium as a result of a higher deductible. I feel that this is always the better option if you have the money. Whether it be gym memberships, or a car loan, paying the higher fee up front usually is the better financial decision. I am in the process of switching health insurance companies and need every tip I can get.


http://www.gbtaylorins.com/

sfreddson2156
sfreddson2156

So basically when you choose a high deductible plan, you're assume that you won't have many regular medical expenses. Is this a reasonable option for younger people? I know you're never 100% guaranteed to be medically safe (even if you're perfectly healthy), but it seems like a decent option to consider. Thanks for sharing these tips with us! http://yourfiscalfitness.com/new-york-health-insurance-exchange/about

Kerstin Day Lochrie
Kerstin Day Lochrie

High deductible insurance plans have made us question the very thing that we fought so hard for - to go to a doctor. We were the first state to introduce mandatory health care, which was ensure that everyone had access to medical care. Now, with high deductible plans, we think hard about whether we really need to go to a doctor or to fill a prescription

kimgallen
kimgallen

Though admittedly I do shop carefully based upon my high deductible health plan, changes I have made are things like leaving the therapist with whom I have had a long and successful history. This, based upon the fact that she is out-of-network. That alone is to some extent de-stabilizing, but it is a fact of what I must do in order to afford care. What is worse is that my psychiatrist is also out of network. I thought of leaving him, but am virtually afraid to do so. So the bottom line answer is, due to money, I have either changed providers or thought of changing providers. The risk is that I would not attend care due to money. That, I do not do. So the point is, I am assuming a lion's share of the cost with my med management needs, and seeing a therapist who is far less trained and who does not know me, as she is in network with my health plan. Changing plans will change the entire dynamic, yet again.