Navigating the world of health insurance can be overwhelming — there are many options and each has its pros and cons. And, most of these options are simplified down to acronyms like PPOs, HMOs, and others, which can be hard to understand. At the core of all of these options, there are two main insurance types: High Deductible Health Plans (HDHPs) and regular health insurance plans.
In this article, we'll break down the distinctions between HDHPs and regular health insurance plans, some real-life applications of each type of plan, and how each affects what patients pay — allowing you to make an informed choice that aligns with your healthcare needs and financial goals. Let’s dive into the differences between HDHPs and regular insurance plans!
What’s a High-Deductible Health Plan (HDHP)?
With rising costs of healthcare and other essential costs, these lower up-front plans, known as HDHPs or High Deductible Health Plans have become more popular, especially among younger patients or those with less frequent healthcare needs.
An HDHP is a type of health insurance that offers lower monthly premiums
(payments) but requires higher out-of-pocket expenses before the insurance coverage kicks in. These plans are designed to be more cost-effective for individuals who are generally healthy and do not require frequent medical care or prescription drugs. But, in the case of needing medical care patients will have to pay more (meaning your deductible is higher) before insurance contributes to the cost of medications, procedures, etc.
What’s a Deductible?
So, what’s a deductible? It’s the amount of money you’ll have to pay before the insurance plan starts covering your care. The key to HDHPs is their relatively high deductible. For 2024, HDHPs can have a maximum out-of-pocket of $8,050 for an individual and $16,100 for a family.
So, while this may save patients money on their monthly payments, it can mean that in the event of major healthcare expenses, patients are responsible for a larger chunk of the overall cost.
HDHPs and HSAs
Luckily, these plans can often be paired with a Health Savings Account or HSA. HSAs allow you to contribute pre-tax money to a savings account, which can be used to cover some medical expenses. Remember that because there are tax implications with HSAs, they follow stringent guidelines. The 2024 HSA contribution limit is $4,150 for single filers and $8,300 for families.
Additionally, if you’re 55 and older, you can contribute an extra $1,000 to your HSA each year. These are considered “catch-up” contributions.
There are a few more stipulations to how patients can contribute to HSAs:
- Your HDHP must be an HSA-eligible plan
- You cannot be enrolled in Medicare
- You cannot be claimed as a dependent on another filer’s tax returns
If you meet these requirements and are interested in the benefits a lower monthly premium can bring, then an HDHP might be a good fit for you — but what if you anticipate more frequent medical costs? Let’s explore the alternative: a regular insurance plan.
What’s a Regular Insurance Plan?
The alternatives to an HDHP are what are collectively known as regular insurance plans. These can fall under a few different names such as traditional plans or comprehensive plans. They typically have lower deductibles and higher monthly premiums compared to HDHPs.
The lower deductibles mean you’ll pay less out of pocket before the insurance kicks in but in return, the amount you pay into the insurance plan each month will be higher. These plans are good for people who know they will have a lot of healthcare expenses throughout the year, such as older patients or patients who receive ongoing comprehensive care.
Comparing HDHPs to Comprehensive Coverage: Real-World Examples
Let’s examine a few different examples of common healthcare scenarios and the pros and cons of each insurance type for different situations.
Plans for a Young, Health-Conscious Family
Let’s imagine you’re selecting a plan for your family of four. You and your spouse are fitness trainers with no pre-existing conditions and lead very health-conscious lifestyles. You have two children but don’t plan on expanding your family further — and so don’t expect to need pregnancy healthcare.
None of the members of your family receive or anticipate receiving more than typical, preventative medical care this year and maybe the occasional urgent care visit for colds, cases of flu, and minor sprains.
Choosing an HDHP
If you choose an HDHP, your family will have the flexibility of lower monthly payments — and possibly even a pre-tax HSA to put away funds to pay for unexpected medical expenses like urgent care visits when one of your little ones takes a spill or the family comes down with the yearly flu.
But, in the case of unexpected major medical services, like ICU admittance or prolonged treatment for serious illnesses, the family would be left paying for more of the bill and the amount that you’ve contributed to your HSA may not fully cover costs.
Choosing a Regular Insurance Plan
On the other hand, if your family selects a more traditional insurance plan, you would lose out on extra cash in hand every month and an HSA may not be available to you as an option. It’s the more financially conservative route that ups your monthly expenses, but in the case of the unimaginable happening — and one of your family members needs intensive care — you’ll have peace of mind knowing that the lump sum you owe to your insurance provider is much lower because your deductible may be a few hundred dollars vs. much higher amounts associated with HDHPs.
Plans for Senior Patients
Comparatively, the choice between these two types of plans is a bit simpler for seniors. One of the biggest pros for HDHPs, the HSA, is not available for those who are enrolled in Medicare — which includes many Americans 65+.
Additionally, routine healthcare for seniors is much more frequent and broad, so folks 65+ know to expect higher care costs. This makes a comprehensive, or regular insurance plans, very attractive: you pay slightly more monthly but the bills you do get for major procedures are much more manageable due to lower deductibles.
It's essential to weigh the pros and cons of each health insurance plan, look at your healthcare requirements, and even consult with an insurance professional to make an informed decision.
The choice between these two types of plans is also ultimately a fiscal decision, so be sure to consult with a tax professional or financial advisor when weighing your options. With either decision, you’ll have peace of mind knowing your healthcare is covered — it’s really all about maximizing options based on your unique needs!