What is Blue Shield HDHP PPO?
Asked by: Cleo Daugherty | Last update: December 25, 2025Score: 4.5/5 (71 votes)
What is the difference between Blue Cross Blue Shield HDHP and PPO?
High-deductible health plans (HDHPs) offer lower monthly premiums but higher deductibles, while preferred provider organizations (PPOs) typically have higher monthly premiums but lower deductibles. When choosing between an HDHP and a PPO, consider your health status, expected medical needs, and financial situation.
What is a downside of a 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.
What's the point of health insurance with a high deductible?
HDHPs are popular because they have low monthly premiums. Because the premiums are lower than other health insurance plans, the deductible is higher. However, many HDHPs provide 100% in-network coverage for preventive services before you meet your deductible. This includes services such as physicals and vaccinations.
How much does a HDHP cost?
On average, single Americans with a high-deductible health plan (HDHP) have an annual premium of $7,170, while those with a more traditional type of health plan (like an HMO or PPO) have an average premium of $8,162.
Health Insurance 101: How Insurance Works In 90 Seconds | BCBSND
What is the main disadvantage of choosing a high deductible on an insurance policy?
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. While HDHPs have lower premiums, individuals may face financial strain if they need medical services before meeting the deductible.
Is a $3,000 deductible high?
The IRS defines high-deductible health plans for 2023 as: Individual plans with deductibles of at least $1,500. Family plans with deductibles of at least $3,000.
Who should avoid a high deductible health plan?
While these types of plans can be beneficial to those who are relatively healthy, they can be very expensive for those who have chronic conditions or who experience a medical crisis. It's important to carefully consider your expected medical expenses before choosing to participate in a high deductible health care plan.
Does HDHP cover prescriptions?
How your HDHP works. 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.
Why is it not a great idea to have a high deductible?
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.
How much does a doctor visit cost with a high deductible health plan?
A rough guide is: New Patient Office Visit: $200 - $450 depending on how much time is spent on evaluation and/or how many medical conditions are addressed. Subsequent Office Visits: $75 - $300 depending on how much time is spent on evaluation and/or the number of medical conditions being addressed.
Who is HDHP best for?
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.
Do copays count towards deductible?
No. Copays and coinsurance don't count toward your deductible. Only the amount you pay for health care services (like the medical bill you receive) count toward your plan's deductible.
Can I be covered by HDHP and PPO at the same time?
The truth is that you can get a PPO plan that's also an HDHP and, therefore, eligible for an HSA.
Is Copay or HDHP better?
A high deductible plan may seem cheaper at first, but it can expose you to higher financial risk if you have a major health issue or an unexpected emergency. A low copay plan may seem more expensive at first, but it can protect you from high medical bills and help you manage your cash flow better.
Is it better to have HDHP or PPO?
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.
What does blue shield HDHP mean?
A plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share (also called your deductible).
How do I know if I am covered by an HDHP?
Per IRS guidelines in 2025, an HDHP is a health insurance plan with a deductible of at least $1,650 if you have an individual plan or a deductible of at least $3,300 if you have a family plan. The deductible is the amount you'll pay out of pocket for medical expenses before your insurance pays anything.
What is one disadvantage to a high deductible health plan?
While High Deductible Health Plans (HDHPs) offer low monthly premiums, they come with several cons that individuals need to consider before enrolling. One major disadvantage is the high out-of-pocket expenses that a person may face before their coverage kicks in.
What is the 12 month rule for HSA?
It means you must remain eligible for the HSA until December 31 of the following year. The only exceptions are death or disability. If you violate the testing period requirement, your ineligible contributions become taxable income.
What are the pros and cons of a PPO?
PPO insurance plans allow plan participants to choose from a larger network of doctors and hospitals without needing a referral to see a specialist. While PPO plans allow for out-of-network care, they tend to have higher monthly premium costs and annual deductibles than other types of health insurance plans.
How much is a doctor visit with a high deductible health plan?
In an HDHP, the deductible is $1,400 or more for individuals and $2,800 or more for families. For example: If you have an HDHP with a $2,000 deductible, you must pay the first $2,000 of your medical bills in a year. You could be responsible for expenses such as: A $200 bill for a doctor's appointment.
Is PPO or HSA better?
The choice between an HSA and a PPO can depend heavily on the type of business you run and the needs of your employees. In California, where the tech industry thrives and many employees are younger, healthier, and more likely to value long-term savings, an HSA may be the better option.
Do you get a tax break for having a high deductible health plan?
High-Deductible Health Plan Tax Benefits
To help offset the costs of meeting a higher deductible, many people with HDHPs also open a health savings account (HSA), a tax-advantaged savings account. With an HSA: You don't pay federal taxes on the money you put into it. Your total annual contribution is tax deductible.