What is the downside of having a high-deductible?

Asked by: Garry Hodkiewicz IV  |  Last update: February 5, 2023
Score: 4.3/5 (27 votes)

The cons of high-deductible health plans
Yes, HDHPs keep your monthly payments low. But they can also put you at risk of facing large medical bills that you may not be able to afford. Since HDHPs generally only cover preventive care, an accident or emergency could result in very high out-of-pocket costs.

What is a disadvantage of having a high deductible?

HDHP Cons: People managing chronic illnesses find that their out-of-pocket expenses are high. Prescriptions, office visits, and diagnostic tests are completely out-of-pocket until you reach your deductible. If you need surgery, you will need to hit your deductible before the insurance company will pay anything.

What is the main disadvantage of choosing a high deductible on insurance?

The cons of high-deductible health plans include: Higher Deductibles: It's no surprise that an HDHP has high deductibles. This means that you will have a lot more you'll have to pay for yourself to get care before your insurance begins to cover things.

Is a high deductible a good thing?

High-deductible health plans usually carry lower premiums but require more out-of-pocket spending before insurance starts paying for care. Meanwhile, health insurance plans with lower deductibles offer more predictable costs and often more generous coverage, but they usually come with higher premiums.

Is it better to have a high deductible or worse?

Key takeaways. Low deductibles are best when an illness or injury requires extensive medical care. High-deductible plans offer more manageable premiums and access to HSAs. HSAs offer a trio of tax benefits and can be a source of retirement income.

High-Deductible Health Plans, Explained

18 related questions found

Is a $6000 deductible high?

Any plan with a deductible of at least $1,400 for an individual or $2,800 for a family is considered a high-deductible health plan (HDHP), according to the IRS.

Why would I want a high deductible health plan?

An HDHP can save you money in the form of lower premiums and the tax break you can get on your medical expenses through an HSA. It's important to estimate your health expenses for the upcoming year and see how much you'll be responsible for out of pocket with an HDHP before you sign up.

Should I switch to a high deductible health plan?

When you're healthy. If you're in good health, rarely need prescription drugs, and don't expect to incur significant medical expenses in the coming year, you might consider an HDHP. In trade for lower premiums, HDHPs require you meet your deductible before you get any coverage for treatment other than preventive care.

Is it better to pay higher premium or higher deductible?

In most cases, the higher a plan's deductible, the lower the premium. When you're willing to pay more up front when you need care, you save on what you pay each month. The lower a plan's deductible, the higher the premium.

What is a good annual deductible for health insurance?

The IRS has guidelines about high deductibles and out-of-pocket maximums. An HDHP should have a deductible of at least $1,400 for an individual and $2,800 for a family plan.

Is a $500 deductible Good for health insurance?

Choosing a $500 deductible is good for people who are getting by and have at least some money in the bank – either sitting in an emergency fund or saved up for something else. The benefit of choosing a higher deductible is that your insurance policy costs less.

Is a PPO or HDHP better?

HDHPs are typically better suited for people who make infrequent trips to the doctor, while PPOs are ideal for those who make regular visits to the doctor.

Is it better to have a lower deductible or lower out-of-pocket maximum?

Low deductibles usually mean higher monthly bills, but you'll get the cost-sharing benefits sooner. High deductibles can be a good choice for healthy people who don't expect significant medical bills. A low out-of-pocket maximum gives you the most protection from major medical expenses.

Why would consumers ever choose insurance plans with large deductibles?

For the insurer, a higher deductible means you are responsible for a greater amount of your initial health care costs, saving them money. For you, the benefit comes in lower monthly premiums. If you have a high-deductible plan, you are eligible for a Health Savings Account (HSA).

What is considered a high deductible health plan 2021?

An HDHP's total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can't be more than $7,050 for an individual or $14,100 for a family. (This limit doesn't apply to out-of-network services.)

Is it better to have a $500 deductible or $1000?

A $1,000 deductible is better than a $500 deductible if you can afford the increased out-of-pocket cost in the event of an accident, because a higher deductible means you'll pay lower premiums. Choosing an insurance deductible depends on the size of your emergency fund and how much you can afford for monthly premiums.

Is it good to have a $0 deductible?

Is a zero-deductible plan good? A plan without a deductible usually provides good coverage and is a smart choice for those who expect to need expensive medical care or ongoing medical treatment. Choosing health insurance with no deductible usually means paying higher monthly costs.

Is it better to have a deductible or copay?

Copays are a fixed fee you pay when you receive covered care like an office visit or pick up prescription drugs. A deductible is the amount of money you must pay out-of-pocket toward covered benefits before your health insurance company starts paying. In most cases your copay will not go toward your deductible.

Do copays count toward the deductible?

In most cases, copays do not count toward the deductible. When you have low to medium healthcare expenses, you'll want to consider this because you could spend thousands of dollars on doctor visits and prescriptions and not be any closer to meeting your deductible. Better benefits for copay plans mean higher costs.

What is PPO good for?

PPO stands for preferred provider organization. Just like an HMO, or health maintenance organization, a PPO plan offers a network of healthcare providers you can use for your medical care. These providers have agreed to provide care to the plan members at a certain rate.

Does insurance cover anything before deductible?

Screenings, immunizations, and other preventive services are covered without requiring you to pay your deductible. Many health insurance plans also cover other benefits like doctor visits and prescription drugs even if you haven't met your deductible. Your expenses for medical care that aren't reimbursed by insurance.

Can one person meet the family deductible?

All individual deductibles funnel into the family deductible. The family deductible can be reached without any members on a family plan meeting their individual deductible.

Is a PPO worth it?

A PPO gives you increased flexibility and allows you to bypass seeing a primary care physician, every time you need specialty care. So, if you are a heavy healthcare user or have a large family, the flexibility of a PPO plan may be worth it.

Can you switch from HDHP to PPO?

What if I decide to switch from a HDHP to a traditional PPO plan? If you are no longer on a qualified HDHP, you can still use your funds to pay for medical expenses, but you cannot contribute to the account. Keep in mind that an HSA can also pay for things like Medicare premiums in the future.

Which is better HMO or HDHP?

Plus, an HDHP will give you the ability to contribute to an HSA, which can be a great tool for paying for planned medical expenses. An HMO could be a good option if you know that the doctors and specialists you see are part of an HMO network, or if you are comfortable seeking a lot of care from an HMO network.