What is a High Deductible Health Plan (HDHP)?
I previously mentioned that I had moved to a new high deductible health plan (HDHP) that my employer started offering during open enrollment.
I have had a few questions since around that declaration from people who were curious to know more about HDHP’s and I thought it may be beneficial to dedicate a post towards the topic.
What is an HDHP?
An HDHP is a type of health insurance plan that offers lower monthly premiums than more traditional plans like PPO’s or HMO’s in exchange for a higher deductible – hence the name “high deductible health plan”.
They are usually paired with a health savings account (HSA) that allows you and/or your employer to make tax deductible contributions to. You can later use the HSA to pay for your medical expenses, tax free.
More on HSA’s later.
What is a Health Insurance Deductible?
A health insurance deductible is the amount that you must pay before health insurance kicks in and starts paying. The deductible is an annual amount that usually resets at the beginning of the calendar year.
Once you’ve hit your annual deductible, then your insurance kicks in and starts helping. The HDHP may pay 80%, 90%, 100%, etc. of your health care costs at that point – it will vary based on your individual plan.
The minimum deductible amount for an HDHP as dictated by the IRS is $1,300 per individual and $2,600 per family in 2016. In other words, if you have an HDHP, your insurance will not kick in until you hit at least these minimums. Some HDHP’s may have higher deductibles than this.
What are HDHP Maximums?
A HDHP out-of-pocket maximum, or OOP’s, is the maximum amount you or your family are required to pay in any given year, before the HDHP covers any additional medical costs 100%.
This is important because if you have a high cost event or series of events (i.e. car accident, heart surgery, maternity), your out-of-pocket maximum protects you from serious financial hardship and possible bankruptcy.
The IRS HDHP maximum out-of-pocket limits for deductibles/co-pays for 2016 are:
- Single Plan: $6,550
- Family Plan: $13,100
Remember, HDHP’s are tied to HSA’s, and with that comes the ability to contribute to a tax-deductible account. The IRS HSA maximum contribution limits for 2016 are:
- Individual Plan: $3,350 (same as last year)
- Family Plan: $6,750 (+$100 over last year)
As with 401K’s there is a catch up contribution for those age 55 and over. The 2016 HSA catch-up contribution is $1,000 for both single and family plans.
Your plan’s maximums may be lower, each plan varies.
Is a HDHP Right for me?
It depends. HDHP’s are generally great for those under 50 who have no serious documented health complications because the monthly premiums can be significantly lower than traditional HMO and PPO plans.
And if you’re in good health, your out-of-pocket expenses are likely going to be low. I ultimately made the switch because I am young and haven’t had more than 1 or 2 doctor visits in any given year in the last decade (knock on wood). This means that I probably haven’t spent more than a few hundred $ in any given year on health related costs.
I’m also in the situation where my employer offers an HSA with their HDHP and contributes an amount equal to my annual deductible to it. Anything I don’t spend rolls over every year, and in a few years I would have enough to cover an annual out of pocket maximum. Plus my premiums are lower with the HDHP vs. a PPO. So it makes a lot of sense for me.
These are the things you should be considering when deciding to switch to a high deductible plan:
- What is my present health?
- What will my annual deductible be?
- How do the premiums compare to a standard plan?
- What is the maximum out-of-pocket?
- Where can I find a HDHP?
If you are young and healthy, it is generally financially beneficial to view health insurance as a means to cover you in the event of very high cost events versus a way to cut the costs that may occasionally come up because you may end up paying more for your premiums than you are saving.
Where can I Find HDHP’s?
Check to see if your employer offers a HDHP and what the associated premium, deductible, and maximums are. Some employers offer HDHP’s, others do not.
Even if your employer does offer one, ALWAYS compare it to what is available on the free market. In many cases you will be able to find a cheaper alternative than what your employer offers.
Check the public health insurance exchange at healthcare.gov for public plans. You may be eligible for a subsidy with these plans. If you are not eligible, also check out eHealthInsurance.com. It’s an aggregator that compares the prices of dozens of insurers, which is key because prices can vary wildly based on age, gender, and health history. You need to shop around. I found my term life insurance plan there and have compared HDHP’s there too.
- Do you have an HDHP? How long have you had it? What has your experience been?
- What are your HDHP premiums, deductibles, and maximums?